So over the past few weeks I have been experiencing some weird changes in body, like constant clammy sweats, tingling in my fingers and sleepless nights. I put the sweats down to drinking coffee as they would generally only occur after I’d have a cup. So I cut out coffee for a few days and the sweats continued.
I also noticed that my finger tips were getting like pins and needles throughout the day and of course I put this down to my spinal cord injury playing havoc with my body.
My sleeping pattern was all over the place and I was noticing that during the night when I would get up to go to the bathroom, it was a real struggle and I was feeling quite a lot of pressure on my chest. This was when I started to really worry as I have a couple of visits from phenomena and it was definitely something I didn’t want to experience again.
Just as I was about to pick up the phone and make an appointment to see my doctor, I remember I had an appointment to see my amazing physiotherapist, who I have nicknamed “The Death Doctor”, because usually after a session with him my body feels like it’s been hit by a Mac Truck.
So off I went to see “The Death Doctor”, and after briefly explaining to him what was going on, and also that I was feeling a bit of a pinch in my back, he poked around and asked me; “Have you been sweating and getting clammy?” YES. “Pins and needles in your hands and arms? YES. “Breathing seems hard?” YES. “Not sleeping and feeling very restricted in moving” YES, YES!
Rhiannon, you have T4 SYNDROME!
Now even after all the knowledge I have gained since this horrible spinal cord injury took over my body 3 years ago, this was something I had never actually heard of, but apparently is really common.
So here’s what you need to know..
What is T4 syndrome?
The upper back (thoracic spine) comprises of many bones known as vertebrae. There are 12 thoracic vertebrae named T1 to T12 from the top of the upper back to the bottom of the upper back. Each of these vertebrae connects with the vertebra above and below via two types of joints: the facet joints on either side of the spine and the discs centrally (figure 1). These joints are designed to support body weight and enable spinal movement. In close proximity to these joints are nerves, which can be damaged or irritated upon injury to either the disc or the facet joint at a particular level (figure 1).
During certain movements of the spine, stretching or compressive forces are placed on the facet joints and discs at the T4 level. If these forces are excessive and beyond what the joints can withstand, injury to the facet joints or discs may occur. When this results in irritation or damage to the adjacent nerves at the T4 level and the patient experiences diffuse arm pain, pins and needles or numbness in the upper arm, the condition is known as T4 syndrome.
Causes of T4 syndrome
T4 syndrome typically occurs due to injury to the facet joints or disc at T4 which then affects the nerve root at that level. Injury to these structures can occur during excessive bending, lifting, arching, or twisting movements or due to poor posture. This may occur traumatically or due to repetitive or prolonged forces.
Signs and symptoms of T4 syndrome
Patients with this condition usually experience diffuse arm pain and sensory symptoms such as pins and needles or numbness in the upper arm. Pain may also be felt in the upper back and occasionally, the neck may be affected.
Symptoms may develop suddenly during the causative activity, however, it is also common for patients to experience pain and stiffness after the provocative activity, particularly the next morning. Symptoms are typically felt in one arm or on one side of the upper back although occasionally both sides may be affected. Pain may also be referred into the shoulder blade, ribs and chest. Muscle spasm, stiffness and restricted spinal movement may also be experienced, particularly around the affected joint. Symptoms are generally exacerbated with activities that involve twisting, lifting, arching backwards, bending forwards or sideways, sitting for prolonged periods of time, coughing or sneezing, or performing activities that involve using the hands in front of the body such as driving or ironing.
Diagnosis of T4 syndrome
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose T4 syndrome. Investigations such as an MRI or CT scan may be required to confirm diagnosis.
Prognosis of T4 syndrome
The recovery time for patients with T4 syndrome may vary from case to case depending on a variety of factors such as the severity of injury and compliance with physiotherapy advice. With ideal treatment, patients may be pain free in as little as several days, although typically this may take 2 – 3 weeks. It is important to note, however, that injured tissue takes approximately six weeks to restore the majority of its strength in ideal healing conditions. Care must therefore be taken when returning to activity during this period. In severe cases or in those patients who do not rest adequately from aggravating activities, symptoms may persist for many months or even years.
Physiotherapy for T4 syndrome
Physiotherapy for patients with this condition can hasten the healing process, ensure an optimal outcome, and reduce the likelihood of future recurrence. Treatment may involve:
- soft tissue massage
- electrotherapy (e.g. ultrasound)
- postural taping or bracing
- dry needling
- activity modification advice
- ergonomic advice
- the use of a lumbar support for sitting
- Clinical Pilates
- exercises to improve flexibility, strength, posture and core stability
- a gradual return to activity program
Contributing factors to the development of T4 syndrome
There are several factors that may contribute to the development of T4 syndrome. These factors need to be assessed and corrected with direction from a physiotherapist and may include:
- poor posture
- thoracic spine stiffness
- a sedentary lifestyle
- poor core stability
- muscle weakness or tightness
- inappropriate lifting technique
- a lifestyle involving large amounts of sitting, bending, lifting or activities involving the use of hands in front of the body
Other intervention for T4 syndrome
Despite appropriate physiotherapy management, a small percentage of patients with T4 syndrome fail to improve and may require other intervention. This may include pharmaceutical intervention, investigations such as an X-ray, CT scan or MRI, or assessment from a specialist. A corticosteroid injection into the joints of T4 may sometimes be used to help alleviate symptoms. The treating physiotherapist can advise on appropriate management and can refer to the appropriate medical authority if it is warranted clinically.
Exercises for T4 syndrome
The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed provided they do not cause or increase symptoms.
Shoulder Blade Squeezes
Begin sitting or standing tall with your back straight. Squeeze your shoulder blades together as hard and as far as possible without pain (Figure 3). Hold for 5 seconds and perform 10 repetitions provided the exercise does not cause or increase symptoms. Repeat 5 times daily.
Figure 3 – Shoulder Blade Squeezes
Begin sitting or standing tall with your back and neck straight, shoulders should be back slightly. Tuck your chin in until you feel a mild to moderate stretch without pain (figure 4). Keep your eyes and nose facing forwards. Hold for 2 seconds and perform 10 repetitions provided the exercise does not cause or increase symptoms. Repeat 5 times daily.
Figure 4 – Chin Tucks
So as you can see, its not all to complex. But before you start self diagnosing yourself like I tend to do, go and speak to your physiotherapist. You just may have T4 Syndrome as well!