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Permalink Reply by Dick Wyatt on February 25, 2010 at 10:22am

The anterior autononomic rami at T4 are the highest - and closest to the vulnerable C/T - of the spinal heart controllers; the only thoracic level which supplies both the atrial and ventricular portions, AFAIK. I think that's the major significance.

The only authority I've ever heard giving forth on this subject was Wernham, who opined that the relative positions of the shoulders, neck and back could throw a convergent force at T4. It wasn't specifically mentioned when I was at college, though - they weren't at ease with Wernham, even when he was right!

I don't usually find any need to treat levels in isolation - they don't exist like that - but strain on/in the T4 autonomics, whether associated with the vertebrae or not (and not necessarily as Wernham described it, either) certainly do influence the heart. I treat deficiencies here fairly frequently, for instance in cases of palpitations. More cogently, I did the T4 autonomic thing on a chap with an implanted pacemaker, and astonished his cardiologist: so much better heart function. Still, what do they know?

The autonomics 're much more likely to be caught up in an ascending strain pathway from the low back in my experience, but Wernham was certainly in the ballpark.

Best with it!
Dick

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Permalink Reply by Clement Rhein on February 25, 2010 at 4:25pm

Thanks for that Dick, but i'm after what is called T4 syndrome, which gives certain symptoms, but with (i think) not much understanding of the physiology.

All I can remember from college is neurological signs in the arm(s) and pain on top of the head. And I can't really find much on the net.

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Permalink Reply by Lucy GArdner on April 13, 2010 at 10:34pm

Hi Clement, although this was not taught to us at college, one of my tutors mentioned this phenomena/syndrome to me as an explanation of rather odd bilateral sensory/autonomic phenomena of a patient. Magically it responded to manipulation. At the time i did some research on the net and saved some of the references. i have dug it out and copied some of it below.

1. 'a symptom complex originating in the upper thoracic spine and includes glove-like paresthesias of one or both upper limbs, referred pain into the neck and scapular regions, and a dull, aching generalized headache [21-23]. Successful treatment has been reported in case studies using manipulation and exercise intervention' reference from research article http://www.biomedcentral.com/1471-2474/9/140/

2. osteopathic research paper on T4 syndrome - http://linkinghub.elsevier.com/retrieve/pii/S0161475406000820


A patient may present with pain and stiffness in upper thoracic area usually T3 or T4 level but anywhere from T2 to T7;
Sensory phenomena into bi- or uni- lateral UEX, parasthesia in all over distribution, not dermatomal, feels swollen, vasomotor changes e.g. sweating.
Symptoms worse at night or on waking up
May be associated with headache.
Anterior Chest pain (pseudo-Angina)

I hope this helps

Lucy

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Permalink Reply by Clement Rhein on April 14, 2010 at 7:35pm

Merci beaucoup Lucy! I shall look at these references closely. Just what I was after. Thanks a lot

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Permalink Reply by Shahnaz Suteria on April 15, 2010 at 3:02am

Also check if the patient has ever has any nose bleeds. If that is the case, it might be tumours in the spine. Check for rigidity of the spine at those segments. A friend of mine, out of town, just got diagnosed with the tumours in its last stage. She was also having pain in the same segments that would not go away with allopathic medication. Unfortunately she never got to me or another osteopath in time.

Anterior Left Chest pains could also be the referral trigger points (Dr. Travell) for Pec muscle. Check for sidebending on the side of the chest pains (left, I presume if its pseudo-Angina).

Hope this gives another aspect to the lesion.
Shahnaz

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Permalink Reply by Theodore Jordan on June 9, 2010 at 3:40am

Look in "Grieve's Modern Manual Therapy", 2nd edition (NOT the current 3rd edition ed by Jull), and there are two pages on T4 syndrome with graphics. Thought to be a sympathetic NS mediated condtion. There are a few misc papers of poor quality on it. It is mostly a 'rule-out' condition and you only know if it is present if you mobilize the upper thoracics and the symptoms improve. I've seen a number of cases, truly bizarre patterns of unilateral (occ bilateral ) upper extremity numbness that show no abnormalities on EMG.

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