T4 Syndrome (Upper Thoracic Syndrome)

What is T4 Syndrome (Upper Thoracic Syndrome)?

T4 syndrome is also known as the “upper thoracic syndrome”, however, T4 syndrome is the more commonly used/recognised term. In the mid-back there are 12 thoracic vertebrae that provide movement and support as well as attachments for the ribs. T4 syndrome is the name given to irritation that occurs most commonly at the level of the T4 vertebra, however the name given to this syndrome can be misleading since T4 syndrome can be described as a dysfunction of the thoracic spine at levels T2-T7, which are mainly felt in the upper back, upper limbs, and hands.

The exact cause of T4 syndrome is difficult to pinpoint, however it is suggested that some risk factors include poor movements and poor posture that occur around the level of the T4 and affect the surrounding structures. The common causes for T4 syndrome include; underlying thoracic dysfunction, change in routines which involve novel movements, sudden movement which may or may not overload/overextend the spine, heavy lifting or strenuous movement/activity, poor posture and hypermobility.

T4 syndrome typically presents as upper back stiffness with associated symptoms of upper extremity pain, numbness and/or paraesthesia (pins and needles), headaches and migraines.

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Karas, S. and Pannone, A., 2017. T4 syndrome: a scoping review of the literature. Journal of Manipulative and Physiological Therapeutics, 40(2), pp.118-125. https://www.shoulderdoc.co.uk/article/1630

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