Operative procedures designed to effect functional sympathetic denervation of the upper extremities have occupied the attention of surgeons and experimental investigators. Clinical reports of cases in which operations for sympathetic denervation of the upper extremity have been carried out in the treatment of peripheral vascular disease indicate a relatively high percentage of failure to obtain complete functional elimination of the vasomotor and sudomotor nerves. This is due in part to anatomic variations. On the other hand, some of the operative procedures which have been outlined are not based on complete knowledge of the anatomic relations of the nerves in question and are not sufficiently extensive to interrupt all the sympathetic pathways leading into the upper extremity.
The gray communicating rami through which sympathetic fibers join the brachial plexus are derived mainly from the cervicothoracic and the middle cervical sympathetic ganglions. These ganglions receive preganglionic fibers via the white communicating rami
KUNTZ A, DILLON JB. PREGANGLIONIC COMPONENTS OF THE FIRST THORACIC NERVETHEIR ROLE IN THE SYMPATHETIC INNERVATION OF THE UPPER EXTREMITY. Arch Surg. 1942;44(4):772-778. doi:10.1001/archsurg.1942.01210220175012