OBJECTIVE: To discuss two cases of the T4 syndrome in order to raise awareness and aid its clinical recognition.

CLINICAL FEATURES: Paresthesias, numbness, or upper extremity pains associated with or without headaches and upper back stiffness characterize the T4 syndrome. In addition, no hard neurological signs are present. Upper thoracic joint dysfunction, especially in the region of the T4 segment, appeared to be the major cause of the upper extremity symptoms and headaches. A nontraumatic onset is common and the peculiar glove-like distribution of hand or forearm pain can often lead to a mistaken diagnosis, including psychogenesis.

INTERVENTION AND OUTCOME: Joint manipulation, stretching, and strengthening exercises directed at the upper thoracic dysfunctional segments were used with good results.

CONCLUSION: Upper extremity symptoms of nocturnal or early morning paresthesias, especially in a glove-like distribution, coupled with headaches and a stiff upper thoracic spine without neurological signs of disease may indicate a T4 syndrome. Manipulation of the dysfunctional upper thoracic segments may relieve these symptoms.

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