July 14, 2020

T4 Syndrome: Know the Symptoms, Causes, Diagnosis and Treatment

The thoracic spine is a complex structure made from a series of twelve small bones called vertebrae named as T1 to T12. These lie in the upper back region forming the mid-structure of the spine. The thoracic spine is strongly attached to the rib cage thus provides support and stability to the body along with spinal movement, thereby minimizing the risk of injuries in the thoracic region. The vertebrae in this region are small discs associated to each other by the facet joints which play a major role in the movement of spine. When these joints get strained due to excessive stretching or compression, it may lead to joint dysfunction and irritation in the muscles in the back and shoulder region. When this injury is localized to the T4 level of the thoracic spine, then this condition is known as the T4 syndrome.

What is T4 Syndrome?

T4 syndrome or the upper thoracic syndrome is the spinal injury that occurs at the T4 level of the upper back region or the thoracic spine which causes damage to the nerves adjacent to T4 vertebrae, along with numbness and diffusing pain on the upper region of the arm. The condition is relatively uncommon but when occurs it deserves serious attention.

Symptoms of T4 Syndrome

The symptoms for T4 syndrome can be categorized under two categories namely generic and less common. The symptoms for each include:

Generic Symptoms:

  • Diffused pain in the upper region of arms.
  • Tingling and pricking sensation in the whole arm or in the fore-arm.
  • Temperature variations in hand, extreme hot or cold sensation.
  • Heaviness in the upper region.
  • Entire arm or fore arm ailing with non-dermatome pains or aches.
  • Pain with a crushing or tight sensation.
  • Persistence of alternating pain in thoracic region.

Less Common Symptoms:

  • Occurrence of neck pain.
  • Pain that radiates towards the chest area.
  • Stiffness in the shoulder region.
  • Pain severity at night.
  • Stiffness in muscles during the morning hours.
  • Muscle spasms
  • Both sides of the body or both arms are painful.
  • Unpleasant feeling in the affected area.

Causes of T4 Syndrome

The major causes to T4 syndrome is contributed to the routine activities done with negligence. It usually occurs due to repeated actions like twisting, bowing, lifting, arching which injures the T4 vertebrae. Other causes are the slouchy postures which involve leaning the head forward while standing and sitting that leads to the stiffening and tightening of the muscles and joints of the upper back region. People suffering from cervical lordosis or Cervico-thoracic kyphosis are more likely to suffer from T4 syndrome. In case of women, the heaviness of the breasts makes them to have a leaning posture thereby increasing the chances for developing the T4 syndrome.

Risk Factors of T4 Syndrome

The risk factors that are involved include:

  • Development of Poor posture
  • Stiffness and firmness in the thoracic spine
  • Sedentary and inactive lifestyle
  • Inappropriate techniques utilized for lifting objects.
  • Poor stability and strength of the core muscles.
  • Weak, tight and inflexible muscles
  • Activities demanding sitting for long duration with no proper support to the back or posture.

Diagnosis of T4 Syndrome

Identifying the T4 syndrome is a tedious process because there are no specific diagnostic techniques dedicated to its identification. Thus, the process of diagnosis is focused on analyzing the symptoms following certain physical tests to verify the presence of the syndrome.

The first step is to check the intensity of the pain on touching. Then for a definite diagnosis, the doctors rule out any chances of presence of other medical conditions like TOS syndrome, vertebral fracture, neurological disease, Carpal Tunnel Syndrome, Intercostal Neuralgia and Ankylosing Spondylitis. Furthermore, MRI and CAT scan are done to deeply analyze the pain.

Treatment of T4 Syndrome

The treatment measures can be broadly categorized into:

  • Chiropractic Treatments for T4 Syndrome: The treatment techniques for T4 Syndrome are primarily based on physiotherapy. It follows an impairment based approach in which sessions involve manual therapy followed by gradual and progressive home based exercises. The chiropractic sessions usually involve below therapies or a combination of them:

– Joint mobilization and manipulation: It is the most sought after technique focusing on the thoracic and cervical spine region aiming to restore the pain free motion of the spine.
– Soft tissue massage: This uses techniques to release trigger points and soothe soft tissues thereby decreasing the muscle tension.
– Taping/Bracing: It helps in releasing muscle tension and maintaining correct posture through sensory feedback mechanism.
– Electrotherapy: It utilizes electrical energy to stimulate the irritated and damaged nerve adjoining the T4 region.
– Dry needling: Uses needles to release muscle tension.
– Pilates: Helps in improving posture.
– Hydrotherapy: Involves exercises for muscular relaxation under a warm pool.
– Exercising: Performing stretching and strengthening exercises of the upper back to improve the flexibility and stability of the back muscles.

  • Invasive Medical Treatments to Treat T4 Syndrome: When physiotherapy fails in providing adequate relief then doctors take up certain pain relieving measures which involves injecting of the Corticosteroids or NSAIDs into the T4 joint. This treatment is given in combination with physiotherapy.

Coping and Self-help of T4 Syndrome

Apart from the pain medications, there are certain other approaches that help in rapid healing of T4 syndrome. These include:

  • Seating posture for long time: There are many things to check when sitting for a long period of time for patients suffering from T4 syndrome.

– The patients should refrain from sitting for long periods. Rather taking small breaks in every 2 hours and doing a small walk or some simple stretch is advised.
– Stooping posture worsens the condition, hence placing a pillow or a rolled towel to support the back while sitting, reduces the tension and pressure on the back.

  • Ample amount of rest: It is advised that the people suffering from the condition take loads of rest because excess of physical strain especially on the upper back region can lead to worsening of the injury and increase the pain. Consequently, the process of recovery would slow down or delay.
  • Application of Cold and Heat Compression: Using Ice packs for cold compression thereafter application of heat in an alternating manner helps in relieving the pain for a considerable period of time. Additional application of Diclofenac ointments and muscle relaxants gives better results.
  • Regular Exercise: Following a regular exercise regime with exercises focusing on the medical condition can work wonders but they should be done under medical supervision.


T4 syndrome is a condition affecting the T4 level vertebral disc in the thoracic spine. Though a rare medical condition, it may occur in individuals usually following a slouching posture while sitting when the upper and middle region of the back leaning too much forward for a long time, thereby affecting the T4 disc. It can also occur due to vigorous physical activity straining the upper back region. The patients can take up chiropractic sessions along with pain medications, and lifestyle modification by following regular exercising, application of hot and cold compression, taking rest and maintaining proper postures help in speedy recovery. The optimal time for recovery is about two to three weeks and the patients can go back to their normal routines. Hence, the T4 syndrome can be treated successfully if the patient abides by the medical suggestions and physiotherapy routine. However, if neglected the pain can be debilitation causing hindrance in daily life activities to a great extent.

Note: This information is only for reference and is not a substitute of a medical care in any form. Kindly consult with a Healthcare Professional for detailed diagnosis, treatment and follow up.

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