The Fourth Thoracic Syndrome (T4 Syndrome) is related to joint dysfunction in the upper thorax in the region of the T4 segment.


Clinical features:

(1) paresthesias, numbness or pain in the upper extremities, often in a glove-like distribution involving the fingers, hands and forearms

(2) hand weakness and clumsiness

(3) coldness of the upper extremity

(4) variable headache

(5) variable stiffness and aching pain in the upper back

(6) absence of neurologic complaints at other spinal levels


The patient may or may not have a history of trauma.


Delayed diagnosis or misdiagnosis are common. The patient may be misdiagnosed as having a psychogenic disorder.


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