We often overlook this area of the spine during our evaluation of patients complaining of neck, arm, and hand or radiating pain in the upper extremity. Edmonston and Singer (1997) suggest that there is a rapid clinical interest in the thoracic spine as it has been recognized as an important source of local and referred pain. In addition, the role of the thoracic spine in determining overall spinal posture and the influence of thoracic mobility on movement patterns in the other regions of the spine and shoulder girdle further establish its importance.
In the past, thoracic pain has been associated as a “red flag”, potential for visceral, respiratory, cardiac disease and as a common site for spinal tumour’s. In addition, the T4 syndrome has existed as a clinical concept for several decades and has been identified by many as a source of hand symptoms. (Evans, 1997, Conroy and Schneiders, 2005, Mellick and Mellick, 2006). However, there is no consensus or definition for this syndrome. Evans (1997) suggested that it should perhaps be called Upper Thoracic Syndrome, as symptoms may not only arise from the 4th thoracic vertebra. Several authors have presented their own interpretations of this condition.
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