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Resolution of T4 Syndrome Following Chiropractic Care: A Case Report

Philip Librone, BA, DC & Ella Kalantarov, BA, DC


Annals of Vertebral Subluxation Research ~ September 29, 2014 ~ Pages 161-168



Objective: The purpose of this case study was to describe a patient who presented with symptoms that closely resembled the T4 syndrome and to raise awareness in clinical practices.


Clinical Features: The patient typically presents with upper thoracic pain, bilateral paresthesia and numbness in the hands with no neurological signs present. The cause appears to be from upper thoracic subluxation referring symptoms to the upper limbs. Onset is insidious with no identifiable precipitating event. Characteristic symptoms of pain and/or paresthesia in a glove-like distribution of the hands can lead to misdiagnosis; therefore a thorough exam must be performed.


Intervention and Outcomes: Chiropractic adjustments to reduce subluxation consisted of a high velocity, low-amplitude thrust delivered by hand, accompanied by therapeutic modalities and muscle exercises. By the fifth visit, the patient reported complete remission of thoracic pain and hand numbness. 


Conclusion: The T4 Syndrome is comprised of unilateral or bilateral upper extremity pain and paresthesia that originates from the upper thoracic spine. There are no neurological or vascular changes in the classic T4 syndrome upon examination. Case of a sixty-four year old female demonstrated resolution of upper thoracic pain and hand numbness and paresthesia in a case of T4 syndrome through chiropractic care.


Keywords: T4 syndrome, chiropractic, thoracic pain, autonomic nervous system, vertebral subluxation complex, glove-like distribution, paresthesia 

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