Clinical Presentation, Quantitative Sensory Testing, and Therapy of 2 Patients with Fourth Thoracic Syndrome

Gary A. Mellick, Larry B. Mellick

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)403-408
Number of pages6
JournalJournal of Manipulative and Physiological Therapeutics
Issue number5
StatePublished - Jun 2006


  • Gabapentin
  • Manipulation, Spinal
  • Pain Measurement
  • Paresthesia
  • Thoracic Vertebrae

ASJC Scopus subject areas

  • Chiropractics


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