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Thoracic Outlet Syndrome: Assessing the Elevation Chain

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 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)


    • 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. Scapular & Elevation Chain Assessment

    Poor scapular alignment and limited mobility in the upper extremity elevation chain can contribute to TOS, especially with compressors. This chapter covers how to assess resting scapular position and dynamic control as well as performing the Passive Elevation Test to determine if further joint-specific testing is indicated at the acromioclavicular joint (ACJ) or sternoclavicular joint (SCJ).

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    2. Glenohumeral Joint Assessment

    Posterior glenohumeral joint (GHJ) tightness can contribute to poor scapular mechanics. In addition, end-range GHJ limitations can contribute to TOS “compressor” symptoms. This chapter covers how to assess posterosuperior and posteroinferior GHJ with the arm at the side as well as how the Passive Elevation Test can determine if further joint-specific testing is indicated at the GHJ at end-range.

    3. Cervicothoracic Assessment

    Stiffness in the upper thoracic spine can be a culprit with poor scapular mechanics and brachial plexus issues. This chapter covers how to assess upper thoracic extension and rotation mobility.

    More Courses in this Series

    Identification and Evaluation of Thoracic Outlet Syndrome

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

    Identification and Evaluation of Thoracic Outlet Syndrome

    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 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)


    • View full course details

    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

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