title: Clinical presentation, quantitative sensory testing, and therapy of 2 patients with fourth thoracic syndrome.
abstract: OBJECTIVE
  The aim of the study was to describe 2 representative cases of patients presenting to an osteopathic pain practice with signs and symptoms consistent with the fourth thoracic (T4) syndrome. In addition, this article reports the application of quantitative thermosensory testing and dynamometer strength testing to confirm associated sensory and motor strength changes. Nonmanipulative therapeutic interventions are reported for the first time.
  
  
  METHODS
  Two patients experienced paresthesias in all digits of the hands, glove-like numbness of the hands and forearm, weakness (unable to open jars), hand clumsiness, upper extremity coldness, fullness or tightness, deep aching pain, and other signs and symptoms consistent with T4 syndrome. The patients were evaluated using quantitative thermosensory testing and handgrip dynamometry before and after treatment.
  
  
  RESULTS
  Relief of bilateral arm pain, numbness, and paresthesias occurred after intramuscular injections of 1 to 2 mL of 0.5% bupivacaine at the fourth thoracic paraspinal level. Additional therapy for associated signs and symptoms was provided using an anticonvulsant (gabapentin).
  
  
  CONCLUSIONS
  The clinical presentation of the patients reported in this article provides a description and additional information regarding T4 syndrome.
authors.affiliation: American Pain Specialists, Grafton, Ohio 44044, USA. mellickg@msn.com
authors.forename: Gary A
authors.initials: GA
authors.lastname: Mellick
authors.forename: Larry B
authors.initials: LB
authors.lastname: Mellick
mesh_terms: D000328:Adult; D000588:Amines / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D005260:Female; D000077206:Gabapentin; D006801:Humans; D008349:Manipulation, Orthopedic / Q000379:methods*; D008875:Middle Aged; D010292:Paresthesia / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D013901:Thoracic Outlet Syndrome / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000588:Amines; D000700:Analgesics; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin