T-4 Syndrome is an oddity that often confuses the majority of the doctors in the field due to the fact that it has no hard neurological signs (10). Literature as with so many syndromes/symptoms here again seems to be able to diagnose something, at least partially in this case, but has little to offer as far as solutions. T4 syndrome in the eyes of Dr. McDougle encompasses several aspects of the related shoulder anatomy. For example; in one study, thrust manipulation targeting the upper thoracic spine bilaterally and the second and third ribs on the symptomatic side showed significant reductions in pain and disability and improvement in perceived level of recovery (9). This study infers that there was still little outcome related responses that lead to a subsequent amount of reliable data to suggest a cure.  As there is typically “no hard neurological signs” (10) in the DeFranca study, Dr. McDougle suggests that there is compression of the T4 ganglion either by surrounding soft tissue or a neurological compression which stimulates a cascade effect into the upper extremities. We know that soft tissue compression syndromes do not follow a typical linear pattern due to variations in each human structure. Structural deviations also change this facture as well due to their own imperfections.

For these reasons, a comprehensive global assessment is needed to have a successful outcome. This may indeed require the complete or partial inclusion of treatment protocols for all of the various syndromes combined in order to achieve reduction in symptoms. It has been Dr. McDougle’s  experience that rarely do we have only one problem at a time, and T-4 syndrome should be an inclusive symptom of a cascade of events resulting in presentations as described herein.


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