The thoracic sympathetic trunk is the part of the paired sympathetic chain that runs down the posterior thoracic wall on the heads of the ribs, continuous above with the cervical trunk and below with the lumbar trunk. Each of its ganglia receives a white ramus from the corresponding spinal nerve and returns a grey ramus to it. Its branches include cardiac and pulmonary nerves from the upper ganglia and the greater, lesser and least splanchnic nerves from the lower ganglia.
| Origin | Preganglionic neurons in the lateral horn of the spinal cord (T1-L2), reaching the trunk through the white rami communicantes |
|---|---|
| Course | Descends on the heads of the ribs and the costovertebral joints behind the costal pleura, bearing 11 or 12 ganglia, then moves onto the sides of the lower thoracic vertebral bodies and passes behind the medial arcuate ligament to become the lumbar sympathetic trunk |
| Sensory |
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The upper thoracic sympathetic trunk is divided or ablated in thoracoscopic sympathectomy, most often at the T2-T3 level, to treat severe palmar and axillary hyperhidrosis. The commonest troublesome side effect is compensatory sweating of the trunk and legs. Damage to the uppermost part near the stellate ganglion, from surgery or an apical lung (Pancoast) tumour, can produce Horner syndrome. Because cardiac pain afferents travel with the upper thoracic sympathetic fibres, cardiac ischaemia is referred to the T1-T4 dermatomes of the chest and medial arm.
After thoracoscopic division of the upper trunk for hand sweating, many patients develop increased sweating of the back, abdomen and legs, which can be more troublesome than the original problem.
Injury to the upper thoracic trunk or stellate ganglion during surgery, or invasion by an apical lung tumour, causes ipsilateral ptosis, miosis and facial anhidrosis.
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