Thoracic- T4 Syndrome
The term "T4 syndrome" represents a clinical pattern of signs and symptoms that are described below, namely hypomobility of the T4 segment. Mobilization of upper thoracic vertebrae often reproduces or eliminates the patient's symptoms.
Demographics:
Incidence/epidemiology: More common in women (3:1 women:men)
Clinical Presentation:
Must rule out:
- Carpal Tunnel syndrome
- Special tests to rule out:
Tinels
Phalens
- Thoracic outlet syndrome
Special tests to rule in/out:
- See TOS
- Cervical disk disease
Special tests to rule in/out:
-Spurling’s
-Cervical distraction
- Vascular disease
Special tests to rule in/out:
:Blood Pressure
:Pulses
- Neurologic disease
Special tests to rule in/out:
-Dermatomes
-Myotomes
-Deep tendon reflexes
Bottom Line: The cluster of signs and symptoms referred to as “T4” syndrome has been documented as responsive to manual therapy/manipulation. A patient who has been cleared for other systemic pathologies should receive treatment in the form of thoracic mobilization/manipulation followed by range of motion exercises and strengthening/stability to maintain the increased range of motion.
Conroy, J. L. and A. G. Schneiders (2005). "The T4 syndrome." Man Ther 10(4): 292-296.
References: Please refer to the "T4 Syndrome" section of the reference list.
Demographics:
Incidence/epidemiology: More common in women (3:1 women:men)
Clinical Presentation:
- Local tenderness of spinous processes possibly ranging from T2-7 (always including T4)
- Positive slump test
- Positive upper limb tension test
- Local hypomobility of a vertebral segment (although gross thoracic ROM appears normal.
- Upper extremity parasthesias (glove-like distribution)
Must rule out:
- Carpal Tunnel syndrome
- Special tests to rule out:
Tinels
Phalens
- Thoracic outlet syndrome
Special tests to rule in/out:
- See TOS
- Cervical disk disease
Special tests to rule in/out:
-Spurling’s
-Cervical distraction
- Vascular disease
Special tests to rule in/out:
:Blood Pressure
:Pulses
- Neurologic disease
Special tests to rule in/out:
-Dermatomes
-Myotomes
-Deep tendon reflexes
Bottom Line: The cluster of signs and symptoms referred to as “T4” syndrome has been documented as responsive to manual therapy/manipulation. A patient who has been cleared for other systemic pathologies should receive treatment in the form of thoracic mobilization/manipulation followed by range of motion exercises and strengthening/stability to maintain the increased range of motion.
Conroy, J. L. and A. G. Schneiders (2005). "The T4 syndrome." Man Ther 10(4): 292-296.
References: Please refer to the "T4 Syndrome" section of the reference list.