Tingling, numbness, or upper extremity pains associated with or without headaches and upper
back stiffness is characteristic of T4 syndrome.
T4 refers to the 4th thoracic vertebra, located in the upper back between the shoulder blades.
Often dysfunction of the upper back’s vertebral joints are present. Multiple nerves and blood
vessels run in close approximation of the joints between spinal vertebrae, and when they
become irritated at the T4 level, it is referred to as T4 syndrome. These vessels supply parts of
the arms, and therefore symptoms such as pain or numbness are experienced in the arms. The
onset of symptoms is often non-traumatic, may gradually worsen or appears suddenly.
Typical symptoms of T4 syndrome:

● Pain in the upper back between the shoulder blades, neck and/or arms
● Numbness or pins & needles in the arms, bilateral or unilateral
● Heavy feeling in the arms
● Hot or cold feeling in hands
● Aches and pains in forearms
● Associated headaches might be present
● Stiffness in the upper back
● Other symptoms: trouble sleeping, anxiety

Poor posture, upper back stiffness or occupation can contribute to T4 syndrome. People with
desc jobs or jobs requiring repetitive back movements is strongly associated with this condition.
Physiotherapy can be very effective to manage the symptoms of T4 syndrome, such as pain,
discomfort, loss of function and posture related problems.

There are many different techniques a physiotherapist can perform to treat this syndrome.
Firstly, your physiotherapist will assess you and determine if your symptoms are associated with
T4 syndrome, and also what the possible cause of it can be. Based on these findings, specific
exercises, stretches and home management strategies will be prescribed to you. Other
treatments such as massage, dry needling, joint mobilisations and posture re-education can
also be used.