Back Pain

T4 Syndrome In A Nutshell!


T4 Syndrome

refers to the pain or numbness occurring in the thoracic region of the spinal cord. Thoracic region of the spine comprises of 12 vertebrae (bones that make up the spine) starting at the upper back region, just below the neck, numbered from T1 to T12 (T for Thoracic). These vertebrae are connected with each other via facet joints on both sides and intervertebral discs in the centre.

Each of these vertebrae plays a crucial role in the movement of the spine and back as a whole. The joints and discs in the thoracic region are more prone to injury because they support the body weight. As a result of the injury, the local nerves might get damaged.

What is T4 Syndrome?

When the spine moves, facet joints and intevertebral discs at T4 vertebra can get stretched or compressed beyond their bearable capacity leading to injured joints and discs. This injury can in turn damage or irritate the nerves in and around T4 level. When this happens, the victim experiences numbness and diffuse pain in the upper arm. This condition is known as

T4 Syndrome



Primary cause of this syndrome is an injury to facet joints and/or intervertebral discs at T4 level. This could happen due to:

  • Excessive strain to the spine in thoracic region, especially during bending, twisting, pulling, shoveling and lifting heavy objects.
  • Poor posture.
  • Prolonged or repetitive force on T4 vertebra.
  • Sympathetic nervous system dysfunction sometimes leads to dysfunction of vertebrae in the thoracic region. This in turn leads to a reflex phenomenon in the hands or arms.

Symptoms of T4 Syndrome:

  • Sensory symptoms such as numbness or pins and needles in the upper arm.
  • Diffuse arm pain.
  • Pain in the upper back region.
  • Occasional pain in the neck region.
  • Pain on one side of the arm or upper back.
  • Pain may also be experienced in ribs, shoulder blade and chest.
  • Muscle spasms, restricted spine movement and stiffness of the affected area.
  • Pain levels may increase rapidly while performing activities such as ironing or driving which require the involvement of spine and outstretched hand movement.


A physical examination of the affected area by a physiotherapist can diagnose the problem. In some cases, MRI or CT scan is required to confirm the diagnosis.

How is T4 Syndrome Treated?

Shoulder Blade Squeezes –

These can relieve the pain effectively.

Sit or stand with your spine straight. Now slowly start squeezing your shoulder

blades out as far and as much as you can. Remain in the position for a count of 5. Repeat the exercise 7-10 times.


is the next best option that can treat this syndrome. This may involve:

  • Postural bracing or taping.
  • Soft tissue massage.
  • Electrotherapy.
  • Dry needling.
  • Mobilization and manipulation.
  • Clinical Pilates.
  • Activity modification device.
  • Hydrotherapy.
  • Ergonomic device.
  • Exercises to improve strength, flexibility, core stability and posture.


to the affected area can hasten the healing process. The less the activity in the affected area, the sooner the recovery as the resting period helps the damaged tissue to start the healing process.

Anti inflammatory medications and icing

may prove to be beneficial in relieving the pain soon after injury for up to 72 hours.

Avoid sitting

for longer periods as this may aggravate the symptoms associated with

T4 Syndrome

. If sitting is a compulsion, then make sure to sit with your spine straight and a support (pillow or towel) to your lower back.


The minimum period of recovery is 2-3 weeks with the involvement of ideal treatment options, although this may vary from patient to patient depending on the severity of the damage caused. Moreover, the affected area may require about 6 weeks to get back to its normal strength. Therefore, necessary care and precautions should be taken.

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