THE T4 SYNDROME

Objective: To discuss two cases of the T4 syndrome in order to raise a wareness and aid its clinical recognition. Clinical Features: Paresthe sias, numbness, or upper extremity pains associated with or without he adaches and upper back stiffness characterize the T4 syndrome. In addi tion, no hard neurological signs are present. Upper thoracic joint dys function, especially in the region of the T4 segment, appeared to be t he major cause of the upper extremity symptoms and headaches. A nontra umatic onset is common and the peculiar glove-like distribution of han d or forearm pain can often lead to a mistaken diagnosis, including ps ychogenesis. Intervention and Outcome: Joint manipulation, stretching, and strengthening exercises directed at the upper thoracic dysfunctio nal segments were used with good results. Conclusion: Upper extremity symptoms of nocturnal or early morning paresthesias, especially in a g love-like distribution, coupled with headaches and a stiff upper thora cic spine without neurological signs of disease may indicate a T4 synd rome. Manipulation of the dysfunctional upper thoracic segments may re lieve these symptoms.