T4 Syndrome: A Scoping Review of the Literature

J Manipulative Physiol Ther. 2017 Feb;40(2):118-125. doi: 10.1016/j.jmpt.2016.11.002. Epub 2016 Dec 23.


Objective: The purpose of this scoping review was to identify any available evidence regarding T4 syndrome.

Methods: Databases were searched from inception through October 2015 and included PubMed, CINAHL, PEDro, Google Scholar, Osteomed-DR; Index to Chiropractic Literature, PROSPERO, and Chiroaccess. All studies with information about T4 syndrome that were published in a peer-reviewed journal or textbook were included. The information was organized in the format of the International Classification of Functioning, Disability, and Health. Studies were ranked using Sackett's levels of evidence.

Results: Eight articles met the inclusion criteria. Studied areas included theoretical pathophysiology and symptom etiology, diagnosis, symptoms, treatment, and outcomes of T4 syndrome. The methodological quality of included studies was low.

Conclusion: T4 syndrome is a diagnosis of exclusion that appears to be rare. It has been treated conservatively in the literature using mobilization and exercise. There is no high-quality evidence published about T4 syndrome, and we caution clinicians when considering it as a primary means to determine patient care.

Keywords: T4 Syndrome; Thoracic Spine.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Humans
  • Musculoskeletal Diseases / complications
  • Musculoskeletal Diseases / diagnosis*
  • Skull* / pathology
  • Somatosensory Disorders / etiology
  • Syndrome
  • Thoracic Vertebrae* / pathology
  • Thoracic Vertebrae* / physiopathology
  • Upper Extremity* / pathology