Treatment of Thoracic Outlet Syndrome: Where to Begin

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

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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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Accreditation Check:

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)

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. Joint-Specific Treatment to Address 1st & 2nd Rib Limitations

This chapter covers the manual therapy techniques to address limitations at the 1st and 2nd ribs. 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.

2. Addressing Scapular Alignment & Dynamic Control

Poor scapular alignment and limited mobility in the upper extremity elevation chain can contribute to TOS, especially with compressors. This chapter covers how to address poor resting scapular position and dynamic control with scapular taping techniques and therapeutic exercise.

3. Joint-Specific Treatment to Address Limitations at the Acromioclavicular and Sternoclavicular Joints

TOS patients who experience their symptoms with overhead motion can sometimes present with clavicular dysfunction. This chapter covers joint-specific techniques to address limitations at the sternoclavicular joint (SCJ) or acromioclavicular joint (ACJ).