Complete Sympathetic Denervation of the Upper Extremity

The preganglionic fibers which effect synaptic connections in the inferior cervical sympathetic ganglion include components of the first and lower thoracic nerves. Preganglionic components of the first and lower thoracic nerves also extend upward in the cervical portion of the sympathetic trunk. These findings are in agreement with current teaching. The axons of inferior cervical ganglion cells with which preganglionic components of the first thoracic nerve effect synaptic connections are relatively widely distributed in the upper extremity, particularly its distal portions, both to the vascular musculature and the sweat glands. If the inferior cervical sympathetic ganglion and the gray communicating rami connecting it with the brachial plexus are left intact, complete functional sympathetic denervation of the upper extremity cannot be effected without interruption of the white communicating ramus of the first thoracic nerve.