Thursday, November 4, 2010

Identifying T4 Syndrome

While working in another facility appx. a year ago, a colleague of mine introduced me to the diagnosis of T4 syndrome. I was fascinated by this disorder and went to research databases (pubmed and google scholar) to check it out…and was extremely disappointed. While finding the earliest documentation about T4 syndrome to have occured in 1986, there has been very limited research in its differential diagnosis and management since. Below is a list of criteria which appears to be consistent in the documentation of this disorder:

1) Symptoms of stiffness in the upper thoracic spine (T2-6)
2) Paresthesias/numbness in a glove-like pattern in bilateral hands and forearms
3) Associated weakness/clumbsiness/pain of bilateral hands and forearms which follow non-segmental/non- dermatomal patterns
4) Associated sympathetic nervous system symptoms such as temperature changes (coldness) in the pattern of symptoms
5) May or may not have headaches which fluctuate with UE symptoms

I believe we must continue to investigate this disorder. The thoracic spine may be the source of pain in some of our radicular patients (vs. the cervical spine) and while many of us may be treating the thoracic spine anyway, we need to find out the most effective interventions for these patients to manage their symptoms effectively. If anyone has any literature on this diagnosis, please share. . .

Joseph Brence

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