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Identification and Evaluation of Thoracic Outlet Syndrome

presented by Ann Porretto-Loehrke

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Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

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What do I do with patients that hurt all over? Why do carpal tunnel symptoms seem to keep coming back? This course is designed to assist practicing therapists in identifying key features of thoracic outlet syndrome and provide guidance for evaluating these patients using a manual therapy approach. Obtaining a pertinent history and performing a thorough physical examination will give therapists the tools to identify disputed neurogenic TOS and prioritize the patient’s impairments.

CHTs, when submitting this for recertification through HTCC, this course can be used for CAT B (hand therapy courses < 3 hours in length); however, if this course certificate is submitted with the following course certificates listed below (or any combination totaling 3 hours or more), they can be submitted under CAT A (hand therapy courses > 3 hours in length).
  • Identification & Evaluation of Thoracic Outlet Syndrome (2 hours)
  • Thoracic Outlet Syndrome: Assessing the Elevation Chain (1.25 hours)
  • Treatment of Thoracic Outlet Syndrome: Where to Begin (1.75 hours)
  • Treatment of Thoracic Outlet Syndrome: Addressing Shoulder and Upper Thoracic Limitations (1.5 hours)


  • Meet Your Instructor

    Ann Porretto-Loehrke, PT, DPT, CHT, COMT, CMTPT

    Ann Porretto-Loehrke is a skilled clinician and dynamic instructor. She is the therapy manager of a large department at the Hand to Shoulder Center. Ann is a Certified Hand Therapist (CHT) and a Certified Orthopedic Manual Therapist (COMT) for treatment of the upper quadrant through the International Academy of Orthopedic Medicine (IAOM). She has extensive…

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    Chapters & Learning Objectives

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    1. Types of Thoracic Outlet Syndrome

    This chapter covers the anatomy of the thoracic outlet and the types of thoracic outlet syndrome (TOS). It is important to differentiate vascular versus neurogenic TOS to identify the most appropriate therapy intervention.

    2. Clinical Testing for TOS

    This chapter identifies key information to glean from the patient history, as well as instruction on how to perform a cervical screen and clinical testing for disputed neurogenic TOS. Therapists will develop an understanding of a cluster of tests needed to confirm the diagnosis of TOS.

    3. 1st & 2nd Rib Mobility Assessment

    This chapter covers the mechanics of the 1st and 2nd ribs, reviews how motion occurs at both the costovertebral and costotransverse joints, followed by instruction in how to assess 1st and 2nd ribs mobility. This is critical for TOS patients, as an elevated 1st rib can contribute to brachial plexus irritation at both the scalene triangle and costoclavicular space.

    More Courses in this Series

    Treatment of Thoracic Outlet Syndrome: Where to Begin

    Presented by Ann Porretto-Loehrke, PT, DPT, CHT, COMT, CMTPT

    Treatment of Thoracic Outlet Syndrome: Where to Begin

    Subscribe now, and access clinical education and patient education—anytime, anywhere—with video instruction from recognized industry experts.
    Now that you’ve determined that your patient has disputed neurogenic thoracic outlet syndrome (TOS), what should be addressed first? This course will provide a step-by-step process for how to address your patient’s impairments at the 1st and 2nd ribs, scapular resting position and acromioclavicular, and sternoclavicular joints.

    CHTs, when submitting this for recertification through HTCC, this course can be used for CAT B (hand therapy courses < 3 hours in length); however, if this course certificate is submitted with the following course certificates listed below (or any combination totaling 3 hours or more), they can be submitted under CAT A (hand therapy courses > 3 hours in length).
  • Identification & Evaluation of Thoracic Outlet Syndrome (2 hours)
  • Thoracic Outlet Syndrome: Assessing the Elevation Chain (1.25 hours)
  • Treatment of Thoracic Outlet Syndrome: Where to Begin (1.75 hours)
  • Treatment of Thoracic Outlet Syndrome: Addressing Shoulder and Upper Thoracic Limitations (1.5 hours)


  • View full course details

    Treatment of Thoracic Outlet Syndrome: Addressing Shoulder and Upper Thoracic Limitations

    Presented by Ann Porretto-Loehrke, PT, DPT, CHT, COMT, CMTPT

    Treatment of Thoracic Outlet Syndrome: Addressing Shoulder and Upper Thoracic Limitations

    Subscribe now, and access clinical education and patient education—anytime, anywhere—with video instruction from recognized industry experts.
    Now that you’ve determined that your patient has disputed neurogenic thoracic outlet syndrome (TOS), how should you address issues at the shoulder and upper thoracic spine? Following the first TOS course, this course addresses limitations at the glenohumeral joint and cervicothoracic junction and introduces neural flossing techniques.

    CHTs, when submitting this for recertification through HTCC, this course can be used for CAT B (hand therapy courses < 3 hours in length); however, if this course certificate is submitted with the following course certificates listed below (or any combination totaling 3 hours or more), they can be submitted under CAT A (hand therapy courses > 3 hours in length).
  • Identification & Evaluation of Thoracic Outlet Syndrome (2 hours)
  • Thoracic Outlet Syndrome: Assessing the Elevation Chain (1.25 hours)
  • Treatment of Thoracic Outlet Syndrome: Where to Begin (1.75 hours)
  • Treatment of Thoracic Outlet Syndrome: Addressing Shoulder and Upper Thoracic Limitations (1.5 hours)


  • View full course details

    Thoracic Outlet Syndrome: Assessing the Elevation Chain

    Presented by Ann Porretto-Loehrke, PT, DPT, CHT, COMT, CMTPT

    Thoracic Outlet Syndrome: Assessing the Elevation Chain

    Subscribe now, and access clinical education and patient education—anytime, anywhere—with video instruction from recognized industry experts.
    What do I do with patients that hurt all over? Why does the carpal tunnel symptoms seem to keep coming back? This course continues with the examination process for disputed neurogenic thoracic outlet syndrome with emphasis on joint-specific testing for compressors.

    CHTs, when submitting this for recertification through HTCC, this course can be used for CAT B (hand therapy courses < 3 hours in length); however, if this course certificate is submitted with the following course certificates listed below (or any combination totaling 3 hours or more), they can be submitted under CAT A (hand therapy courses > 3 hours in length).
  • Identification & Evaluation of Thoracic Outlet Syndrome (2 hours)
  • Thoracic Outlet Syndrome: Assessing the Elevation Chain (1.25 hours)
  • Treatment of Thoracic Outlet Syndrome: Where to Begin (1.75 hours)
  • Treatment of Thoracic Outlet Syndrome: Addressing Shoulder and Upper Thoracic Limitations (1.5 hours)


  • View full course details

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