Journal CME May 2026: Intercostal nerve injury after rib fractures: A case series correlating electrodiagnostic testing with imaging, ultrasound, and surgical findings-PM R - 2026 - Sherrier - Intercostal nerve injury after rib fractures A case series correlating electrodiagnostic testing

PM R - 2026 - Sherrier - Intercostal nerve injury after rib fractures A case series correlating electrodiagnostic testing

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Pdf Summary

This case series examined 8 patients with abdominal pseudohernia and intercostal nerve injury after rib fractures, using nerve conduction studies/electromyography (NCS/EMG), CT imaging, ultrasound, and intraoperative nerve stimulation. The goal was to identify rib fracture patterns associated with nerve injury and assess how well preoperative testing guided surgery.<br /><br />A total of 17 injured intercostal nerve levels were identified. Fractures at the affected levels were equally likely to be displaced or nondisplaced, with an average separation of 1.45 cm. Most were posterior, posterolateral, or lateral; two cases showed intercostal hernias (one with lung herniation and one retroperitoneal hernia). Seven patients underwent surgery, including neurolysis and/or nerve reconstruction with allograft.<br /><br />Preoperative NCS/EMG correlated well with intraoperative findings, matching nerve stimulation results in 12 of 15 explored nerves (80%), with only one level discrepancy. Ultrasound showed significant rectus abdominis atrophy on the affected side: average thickness 0.66 cm vs 1.04 cm on the unaffected side. There was also a trend toward greater atrophy with increasing time from fracture.<br /><br />The authors conclude that intercostal nerve injury after rib fractures may be underrecognized and can lead to abdominal wall denervation, atrophy, pain, and pseudohernia. Electrodiagnostic testing appears useful for diagnosis, localization, and surgical planning, while ultrasound can quantify muscle atrophy. Early recognition of high-risk fracture patterns may improve treatment decisions and outcomes.

Keywords

abdominal pseudohernia

intercostal nerve injury

rib fractures

nerve conduction studies

electromyography

CT imaging

ultrasound

nerve reconstruction

rectus abdominis atrophy

surgical planning