T4 Syndrome

Written by Dr. Jason Ngan, DC

What is T4 Syndrome?

T4 syndrome is a musculoskeletal condition of the T4 segment of the spine. The spine is separated into 3 sections, cervical (neck), thoracic (upper/mid back), and lumbar (low back). The T4 segment is the fourth bone of the thoracic spine. Functionally, the neck ends at the T4 vertebra and many extensor muscles of the cervical spine starts at T4-T6. Thus irritation to T4 can affect the neck, the back, and the upper extremities.

What Causes T4 Syndrome?

T4 syndrome is caused by irritation to the T4 nerve fibers. These can include:

  • Prolonged slouching

  • Sudden movements

  • Immobility

  • Arthritis

  • Abnormal movements such as bending and twisting

  • Carrying heavy objects

What are the Signs and Symptoms?

  • Paresthesia (pins and needle sensation) at the upper extremities (shoulder to hands)

    • Especially in all five fingers (glove-like distribution)

  • Neck or head ache

  • Hands feel hot or cold

  • Heavy sensation in upper extremities

  • Neck, head, or arm pain

    • Pain feels like being crushed

  • Symptoms are worse when bending or slouching

How is T4 Syndrome Diagnosed?

T4 syndrome is diagnosed with a thorough medical history, physical examination, orthopedic testing, x-ray diagnostic imaging, CT scan, EMG/NCV, and MRI. T4 syndrome is a diagnosis of exclusion. When all other conditions do not fit the clinical presentation, then it may indicate T4 syndrome.

What are the Treatment Options?

  • Chiropractic manipulation and mobilization

  • Flexion-distraction

  • Spinal traction

  • Soft tissue therapies

  • Gua-sha

  • Cupping

  • E-stim

  • Ultrasound

  • Ergonomic/postural counseling

  • Rehabilitative exercises

Other treatments that patients may seek (not provided at Ngan Chiropractic) include acupuncture, pain medications, and surgery if severe.

References

  1. Karas S, Pannone A. T4 Syndrome: A Scoping Review of the Literature. J Manipulative Physiol Ther. 2017 Feb;40(2):118-125. doi: 10.1016/j.jmpt.2016.11.002. Epub 2016 Dec 23. PMID: 28024663.