Middle shoulder blade pain – T4 Syndrome

Tenderness along upper spine between the shoulder blades, coupled with vague pain down the arm may indicate a condition known as T4 syndrome. T4 is the term given to the 4th thoracic bony vertabra of the spine, where restriction above and below this vertebral joint can lead to referred pain into the upper arm and hand alongside immediate tenderness at the T4 or upper spinal region. The restriction prevents this area of the upper spine from bending, twisting and turning within its true capable range of motion. This restriction can explain the local spinal pain felt, however the explanation of T4 restriction to the cause of accompanying symptoms of numbness and pins & needles to the upper arm and hand remains unknown.

Factors that bring about T4 syndrome include:

  • Lifting heavy objects that you are not used to lifting

  • Overstretching the upper spinal area, for example when suddenly bending forward to tie a shoe lace.

  • Pushing activities such as pushing a heavy trolley or repositioning heavy furniture in your house.

  • Trauma to the spinal region such as when playing sport or being involved a in car accident.

  • Jobs that require frequent stooping and bending

  • Forward head posture, with an upper thoracic spine excessive curvature, tight chest muscles and weak upper paraspinal muscles.

Signs & Symptoms

  • Experiencing Pins & needles and numbness into the upper arm and hand in the early morning or at night-time.

  • Tenderness & stiffness felt in the upper spine, below the neck

  • Some patients suffer from headaches, with pain into the back of the head and neck

  • A vague pain can be felt into the upper arm, forearm and hand region

  • Pain can occur when bending forwards or backwards and when twisting to the side. Driving & sitting for prolonged periods also exacerbate the symptoms.

Treatment & Management

When treating a person with the symptoms of T4 syndrome, the first goal of my treatment plan is to mobilize the restricted vertebral segments of the Thoracic spine (middle spine). This is achieved through graded manual mobilization techniques. Strengthening of the weak muscles between the shoulder blades through exercise is then very important and this must be aided by posture correction when sitting and standing. Finally, it is vital that the pectoral chest muscles are stretched out manually by the physical therapist in order to maintain a painfree mid thoracic spine.

Next week I will discuss further painful conditions of the spine.

Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy and is

based in Clonmel & Thurles.

Contact Number: 0504 26672

Email your queries to: tomaspryan@gmail.com

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Physiotherapy & Injury Rehabilitation Clinic in Tipperary

0504 26672


The Surgery, Fianna Road, Thurles


Riverside Medical Centre, 7 Upper

Irishtown, Clonmel

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Insurers : You can receive rebates on your Physical Therapy visits.Tax relief is available on all Physical Therapy costs, Tax relief may be claimed by filling in the MED 1 form available from www.revenue.ie.

Receipts are provided after each treatment for tax or health insurance companies.