Effect of Mobilization and Screw Thrust Mobilization in T4 Syndrome

Introduction: The thoracic spine, consisting of twelve vertebrae (T1–T12), plays a crucial role in spinal stability and autonomic nervous system function. T4 syndrome, a dysfunction localized at the T4 vertebral level, presents with a combination of musculoskeletal and autonomic symptoms, including upper limb paresthesia, thoracic stiffness, and sympathetic nervous system disturbances. Although the exact pathophysiology is unclear, mechanical irritation of the sympathetic chain by hypomobile thoracic joints is hypothesized to contribute to symptom development.  Methods: 50 participants aged 18 to 50 years with a clinical diagnosis of T4 syndrome were selected for the study. The participants were randomly divided into two groups of 25 each. Group A received mobilization therapy daily for one week, while Group B received screw thrust mobilization therapy on alternate days over the course of one week.  Results: Both interventions resulted in statistically significant improvements across all measured outcomes. In Group A (mobilization), VAS scores decreased by 4.40 points (p < 0.0001), flexion and extension ROM increased by 0.464 and 0.368 units, respectively (p < 0.0001), and PSFS scores improved by 2.86 points (p < 0.0001). In Group B (screw thrust), VAS scores decreased by 3.76 points (p < 0.0001), with flexion and extension gains of 0.468 and 0.228 units, respectively, and PSFS scores increased by 2.40 points (p < 0.0001). Although mobilisation showed slightly greater improvements in pain reduction, flexion ROM, and functional ability, the differences were not statistically significant, except for thoracic extension ROM, where mobilisation significantly outperformed screw thrust (p = 0.0087).  Conclusion: Both mobilisation and screw thrust mobilization techniques are effective in reducing pain, improving thoracic mobility, and enhancing functional activity in patients with T4 Syndrome. Mobilization demonstrated slightly greater clinical benefits, particularly in thoracic extension. These findings support the use of manual therapy as a primary intervention for managing T4 Syndrome and emphasize the need for further research to explore long-term outcomes and autonomic nervous system modulation.