T4 syndrome - A distinct theoretical concept or elusive clinical entity? A case report.
T4 syndrome has existed as a clinical concept for more than three decades and it has been identified as a source of upper extremity (UE) symptoms. This case report explores the clinical reasoning in the diagnoses and management of a patient with symptoms consistent with T4-type syndrome and critically discusses the concept of T4 syndrome using recent research to help explain the clinical presentation. Manual therapy treatment focused on stimulation of the sympathetic ganglia, decreasing local upper thoracic pain and UE referral pattern noted during passive examination. The successful outcomes included immediate and lasting symptom relief after upper thoracic spinal manipulation. Although treatment has been based on the theory that mechanical thoracic dysfunction can produce sympathetic nervous system (SNS) referred pain, the role the sympathetic reflexes potentially plays on the referral symptoms to the UE presently remains unclear.
Research Centre, British School of Osteopathy, 275 Borough High Street, London, SE1 1JE, UK.
Patricia Miyuki
PM
Hirai
Research Centre, British School of Osteopathy, 275 Borough High Street, London, SE1 1JE, UK. Electronic address: o.thomson@bso.ac.uk.
Oliver P
OP
Thomson
D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D013564:Sympathetic Nervous System / Q000503:physiopathology; D013577:Syndrome; D013904:Thoracic Vertebrae; D034941:Upper Extremity / Q000503:physiopathology*
Osteopathic medicine; Osteopathy; Sympathetic nervous system; T4 syndrome; Thoracic spine