T4 Syndrome
- Description / Cause
- Clinical pattern that involves upper extremity paresthesia and pain with or without symptoms into the neck and/or hand
- Mobilization of an upper thoracic vertebrae (commonly T4) reproduces or eliminates symptoms
- Prevalence / Risk factors
- Occupations involving:
- Forward stooping and bending
- Sedentary seated positions
- Research is inconsistent with developing prevalence if T4 syndrome
- Signs / Symptoms
- Musculoskeletal
- Mid-thoracic hypomobility
- Upper extremity paresthesia
- Unilateral or bilateral
- Common in digits
- Forward head posture
- Flat thoracic spine
- Upper extremity referred pain
- Thoracic spine aching pain and stiffness
- Limited cervical ROM
- TMJ pain
- Biopsychosocial
- Loss of sleep
- Anxiety
- Neurophysiological
- Temperature changes in hands
- Swelling in hands
- Neurovascular compression
- Upper extremity weakness and coldness
- Allodynia
- Hypoalgesia
- Somatovisceral
- Headache
- Cardiac pain or pain pattern
- Autonomic nervous system affected
- Objective / Special Test
- Central postero-anterior accessory movement of thoracic spine
- Reproduce or eliminate symptoms
- Postural assessment
- AROM
- Decreased in thoracic spine
- Decreased sensation along affected nerve root at elbow
- Treatment / Interventions
- Treatment based on interpretation of movement
- Grade III - central postero-anterior (PA) mobilization of thoracic spine in prone
- With improved movement, transition thoracic spine into slight flexion and perform central PAs
- Education on posture and working ergonomics
- Possible Pilates exercise program for discharge with emphasis on upper back mobility and general trunk stabilization
- Epidural block at T4 level
- Differential diagnosis
- Thoracic outlet syndrome
- Cervical spine dysfunction
- Cardiac or neurological disease
References
- Conroy J, Schneiders A. Case Report: The T4 syndrome. Manual Therapy [serial online]. January 1, 2005;10:292-296. Available from: ScienceDirect, Ipswich, MA. Accessed June 22, 2015.
- Karas S. T4 syndrome: A clinical example of the regional interdependence theory – a clinical commentary. Sportex Medicine [serial online]. October 2014;(62):9-11. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed June 30, 2015.
Acknowledgements:
David Funk, Student Physical Therapist at A.T. Still University
Ethan Hunke, Student Physical Therapist at A.T. Still University
Morgan Johnson, Student Physical Therapist at A.T. Still University
Ed Nheiu, Student Physical Therapist at A.T. Still University
Lindsay Walczak, Student Physical Therapist at A.T. Still University
Last edited: July 13, 2015