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T-4 Syndrome

T-4 Syndrome. Wilharnus van den Berg. What is T-4 Syndrome?. T4 Syndrome is a clinical pattern that involves upper extremity paraesthesia and pain with or without symptoms in the neck and/or back Symptoms may not be solely derived from the 4th vertebra

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T-4 Syndrome

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  1. T-4 Syndrome Wilharnus van den Berg

  2. What is T-4 Syndrome? • T4 Syndrome is a clinical pattern that involves upper extremity paraesthesia and pain with or without symptoms in the neck and/or back • Symptoms may not be solely derived from the 4th vertebra • Can also be referred to as "upper thoracic syndrome"

  3. Pathophysiology • The exact cause of T4 syndrome is still widely debated • Two major thoughts exist on the cause of the pain • First theory is that hypomobile thoracic segments give rise to the pain and other symptoms then follow

  4. Pathophysiology cont... • Secondly and more favored is that symptoms are of sympathetic origin • The sympathetic nervous system provides pathways for referral of symptoms from the thoracic region to the upper extremities, head and neck • Thus a proximal problem/dysfunction can give rise to distal symptoms

  5. Causes and risk factors • Sympathetic chain is in very close proximation to the thoracic spine • Thoracic joint dysfunction can lead to mechanical pressure on the ganglia and give rise to the referred symptoms • Sustained extreme postures may lead to relative ischemia in various tissues which in turn contributes to symptoms of sympathetic origin

  6. Predisposing factors • New job or hobby that requires prolonged bending and or stooping • Bad postures and prolonged sustained position in front of a computer • In a 2005 case report by Conroy et al. A patients' symptoms started after swimming for the first time in 2 years and studying for a prolonged period of time. • According to DeFranca et al.1995 the prevalence of T4 syndrome is four times higher in females than in males

  7. Signs and symptoms • Symptoms may present unilaterally or bilaterally • Symptoms may develop suddenly or gradually • Symptoms may refer to ribs,chest and back • Symptoms generally worsen with activities that involve twisting, lifting, arching backwards, bending, sitting for prolonged periods of time and coughing or sneezing.

  8. Signs and symptoms cont... • Symptoms may include • Diffuse pain in the arms and may be felt in the upper back and neck • Pins and needles • Numbness • Muscle spasm and stiffness • Restricted mobility around affected thoracic joint

  9. Management and Rx • Conroy et al.2005 reported that hot showers and upper back massage occasionally relieved pain • Grade 3 central PA mobilisations of T4 increased T4/5 mobility and relieved the patients pain • Over 4 treatments, pain localized over T4 with distal symptoms disappearing

  10. Management and Rx cont... • Joint mobilization stimulates descending inhibitory pain pathway. Therefore the sensation of pain is decreased. • Spinal mobilization is a good treatment option for T4 syndrome.

  11. References • NMS dictate • Conroy,JL., Schneiders,AG. Case Report - T4 Syndrome. Manual herapy 2005;10; 292-296 • Evans, P. The T4 Syndrome Some Basic Science Aspects. Physiotherapy 1997; 83(4) 186-189 • DeFranca, CG., Levine, LJ. The T4 Syndrome. J Manipulative Physiol Ther 1995; 18910: 34-7 • T4 Syndrome (internet). Available from:http://www.physioadvisor.com.au/10290050/t4-syndrome-physioadvisor.htm. Retrieved on 20-06-2012.

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