According to the Sports Injury Bulletin website, T4 syndrome--a syndrome that affects the nerve roots at the fourth thoracic vertebral segment--is likely linked to a thoracic hyper-kyphoses, or excessive forward angulation of the upper and middle thoracic spine. T4 syndrome is a relatively rare condition, and is associated with injury to the facet joints at the T4 segment.
Upper Back Stiffness and Facet Joint Tenderness
According to the TodayInPT.com, T4 syndrome is characterized by upper back stiffness and tenderness over the T4 vertebra's facet joints. Although little evidence exists to explain the definitive cause or causes of T4 syndrome and its associated upper back stiffness and tenderness, it's believed that faulty postural alignment, joint hypomobility and thoracic vertebral segmental rotation dysfunction may be contributory factors. It's also possible the T4 syndrome symptoms such as upper back stiffness and facet joint tenderness could arise due to excessive strain on the thoracic spine, especially with bending or twisting motions or heavy lifting. Sudden, unguarded spinal movements can cause significant back pain or discomfort. A health care practitioner assessing a patient with T4 syndrome will be able to elicit discomfort by compressing the tissues overlying the T4 vertebral segment's facet joints. Palpation of the upper back may also reveal muscle spasms.
Arm & Hand Pain or Numbness
Arm and hand pain and numbness is one of the most common symptoms associated with T4 syndrome, and its presence helps a health care practitioner properly diagnose and treat the condition. According to Medic8.com, patients with T4 syndrome will experience diffuse pain--often in a glove-like distribution--throughout one or both arms, although pain in the upper arm is most common. And although both arms and hands may be affected, T4 syndrome-related arm and hand pain typically manifests on just one side of the body. The arm pain often is accompanied by numbness or tingling. TodayInPT.com notes that some researchers believe the pathway provided by the autonomic nervous system helps explain why thoracic spine dysfunction can cause headaches, neck and extremity pain, and paresthesias, or tingling sensations.
Headaches
Headaches are another common symptom associated with T4 syndrome. According to a study published in the "Journal of Manipulative and Physiological Therapeutics," upper extremity paresthesias in a glove-like distribution, along with a stiff upper thoracic spine without neurological indication of disease and headaches, may be indicative of T4 syndrome. The study's authors suggest that joint manipulation of the involved dysfunctional upper thoracic segments may alleviate these symptoms. The Central City Physio website states that T4 syndrome-related headaches manifest in the mid to upper back, and typically are felt on both sides of the head. Patients often describe a T4 syndrome-related headaches as a fuzzy or fluffy feeling, similar to cotton wool in the ears, or as a band around their head, which is similar to a tension headache.
