What is the most likely diagnosis for a patient presenting with pain between their shoulder blades and numbness in the left hand following a stocking glove pattern?

• A. Cervical Radiculopathy
• B. T4 Syndrome
• C. Thoracic Outlet Syndrome
• D. Herniated Disc

Answer: (B)

The most likely diagnosis for a patient presenting with pain between their shoulder blades and numbness in the left hand following a stocking glove pattern is T4 Syndrome. This condition is characterized by upper back pain, often described as being located around the thoracic spine (around T4) and can lead to referred neurological symptoms in the upper extremities, which may present as numbness or tingling. The stocking-glove pattern of numbness suggests a diffuse neurological involvement that aligns with the upper thoracic region's influence on upper limb sensation.

In T4 Syndrome, the sympathetic nervous system may be involved due to dysfunction or irritation in the thoracic spine, which can manifest as pain and altered sensation. Pain between the shoulder blades is a classic symptom of this condition, and it could correlate with the segmental anatomy served by the T4 nerve root, leading to referred symptoms in the hands.

This pattern of symptoms, particularly with the combination of thoracic spine pain and upper extremity sensory disturbances, strongly supports T4 Syndrome as the primary diagnosis in this scenario. Other conditions may present with similar symptoms, but the specific symptom complex detailed here aligns most closely with T4 Syndrome and its mechanisms.