Clinical Presentation, Quantitative Sensory Testing, and Therapy of 2 Patients with Fourth Thoracic Syndrome
Received 20 May 2005; received in revised form 23 August 2005
Abstract
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.
aPresident, American Pain Specialists, Grafton, Ohio
bProfessor, Department of Emergency Medicine, Medical College of Georgia, Augusta, Ga
Submit requests for reprints to: Gary A. Mellick, DO, President, American Pain Specialists, PO Box 85, Grafton, OH 44044.
ABSTRACT