Index to Chiropractic Literature
Index to Chiropractic Literature
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Monday, October 27, 2025
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Article ID
Title
URL http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Citation&list_uids=16762670
Journal J Manipulative Physiol Ther. 2006 Jun;29(5):403-408
Author(s)
Subject(s)
Peer Review Yes
Publication Type Case Report
Abstract/Notes OBJECTIVE: The aim of the study was to describe 2 representative cases of patients presenting to an osteopathic pain practice with signs and symptoms consistent with the fourth thoracic (T4) syndrome. In addition, this article reports the application of quantitative thermosensory testing and dynamometer strength testing to confirm associated sensory and motor strength changes. Nonmanipulative therapeutic interventions are reported for the first time.

CLINICAL FEATURES: Two patients experienced paresthesias in all digits of the hands, glove-like numbness of the hands and forearm, weakness (unable to open jars), hand clumsiness, upper extremity coldness, fullness or tightness, deep aching pain, and other signs and symptoms consistent with T4 syndrome. The patients were evaluated using quantitative thermosensory testing and handgrip dynamometry before and after treatment.

INTERVENTION AND OUTCOME: Relief of bilateral arm pain, numbness, and paresthesias occurred after intramuscular injections of 1 to 2 mL of 0.5% bupivacaine at the fourth thoracic paraspinal level. Additional therapy for associated signs and symptoms was provided using an anticonvulsant (gabapentin).

CONCLUSION: The clinical presentation of the patients reported in this article provides a description and additional information regarding T4 syndrome.

Click on the above link for the PubMed record for this article; full text by subscription. This abstract is reproduced with the permission of the publisher.

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