Identification and Evaluation of Thoracic Outlet Syndrome

presented by Ann Porretto-Loehrke

Accreditation Check:

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, 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 training in the evaluation and treatment of the upper quadrant. Ann completed a post-professional Doctorate in Physical Therapy (DPT) degree from Drexel University with a specialty in hand and upper quarter rehabilitation. Most recently, Ann has become certified in dry needling through Myopain Seminars, as a Certified Myofascial Trigger Point Therapist (CMTPT). She previously served as the Vice-Chair of the Examination committee for the Hand Therapy Certification Commission (HTCC). Ann also previously served as the Northeast District chair for the Wisconsin Physical Therapy Association from 2004 to 2008. She is a lead instructor who developed the Hand & Upper Extremity Track through IAOM, a set of six manual therapy courses designed specifically for hand and upper extremity specialists. Ann has presented at American Society of Hand Therapists (ASHT) annual conferences, Canadian Hand Conferences, Philadelphia meeting, and Teton Hand Conference.

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    Chapters & Learning Objectives

    Download Learning Objectives
    1. Types of Thoracic Outlet Syndrome

      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

      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

      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.