Nerve
Stellate (cervicothoracic) ganglion
A sympathetic ganglion at the neck–thorax junction
High-yield
The lung apex, lower brachial plexus and cervical sympathetic pathway are close together. A lesion in this region can combine arm or hand symptoms with Horner syndrome; the ocular sympathetic fibers are passing toward a higher ganglionic relay.
Overview
The inferior cervical and first thoracic sympathetic ganglia commonly unite as a cervicothoracic ganglion, but fusion and shape vary. It is usually near the neck of the first rib, behind the vertebral vessels and close to the pleural dome. Its postganglionic branches reach upper-limb nerves, vessels and the cardiac plexus.
Learning this group? Read How to learn the brachial plexus.
Reference facts
- Origin
- Commonly a fusion of inferior cervical and first thoracic sympathetic ganglia; separate ganglia and more extensive fusion also occur.
- Root value
- Preganglionic inputs arise from upper thoracic spinal segments, commonly described across T1–T4 rather than one fixed T1–T2 root pair.
- Course
- Usually anterior to the first rib's neck near C7–T1, behind the vertebral vessels and close to the cervical pleura; exact relations vary.
- Motor
- Postganglionic sympathetic branches reach the upper limb through lower cervical/upper thoracic spinal nerves and periarterial routes, and reach the cardiac plexus through cervical cardiac branches.
- Sensory
- Visceral afferent axons can traverse the sympathetic chain on their way toward thoracic spinal sensory ganglia; they do not relay in the stellate ganglion.
Clinical correlation
An apical lung tumor may affect sympathetic fibers and the lower brachial plexus together. Possible findings include ipsilateral Horner syndrome, shoulder–arm pain and weakness or wasting of intrinsic hand muscles. The combination reflects local spread, not every apical tumor.
Frequently asked questions
What are the roots of the stellate (cervicothoracic) ganglion?
Preganglionic inputs arise from upper thoracic spinal segments, commonly described across T1–T4 rather than one fixed T1–T2 root pair.
What muscles does the stellate (cervicothoracic) ganglion supply?
Postganglionic sympathetic branches reach the upper limb through lower cervical/upper thoracic spinal nerves and periarterial routes, and reach the cardiac plexus through cervical cardiac branches.
What is the sensory distribution of the stellate (cervicothoracic) ganglion?
Visceral afferent axons can traverse the sympathetic chain on their way toward thoracic spinal sensory ganglia; they do not relay in the stellate ganglion.
What is the course of the stellate (cervicothoracic) ganglion?
Usually anterior to the first rib's neck near C7–T1, behind the vertebral vessels and close to the cervical pleura; exact relations vary.