![]() ![]() Poor responses to muscle relaxants, absence of an inflammatory pain pattern and a clear association between a patient’s movement impairment and their clinical symptoms are also important considerations in this clinical diagnosis. Symptoms that do not appear wholly somatic in origin or those which are likely to be sympathetically maintained also provides clues towards the diagnosis (for example, a non dermatomal referral and pain patterns). Pain provocation with palpation has been advocated as a reliable means for identifying symptomatic structures in T4 syndrome and is an important factor in clinical decision making. In the absence of a gold standard for diagnosing this poorly understood condition, the patient’s symptomatology coupled with the ability to elicit/reproduce comparable symptoms with manipulation over the relevant thoracic spinal level forms the basis of this clinical diagnosis. ![]() Positive upper limb tension tests, often limited on both sides by pain across upper thoracic spine.Local hypomobility of the vertebral segment associated with symptoms.Local tenderness and symptoms reproduced with mobilisation of the spine anywhere between levels T2-7 (historically including T4).Notable restriction in upper thoracic movement.Minimal thoracic movement during single arm elevation to either side.Increased cervical lordosis and cervico-thoracic kyphosis.Position of most comfort tends to be laying completely flat (supine). ![]()
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