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

presented by Ann Porretto-Loehrke

Accreditation Check:

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)


  • 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 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. Joint-Specific Treatment to Address Glenohumeral Joint Limitations

      1. Joint-Specific Treatment to Address Glenohumeral Joint Limitations

      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 treat posterior GHJ tightness and limitations at end-range.

    2. Joint-Specific Treatment to Address Limitations at the Cervicothoracic Junction

      2. Joint-Specific Treatment to Address Limitations at the Cervicothoracic Junction

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

    3. Treatment Strategies for Addressing Adverse Neural Tension Issues and Chronic Pain

      3. Treatment Strategies for Addressing Adverse Neural Tension Issues and Chronic Pain

      Patients with TOS often present with longstanding issues. Nerve gliding must be performed cautiously to avoid an exacerbation of the patient’s symptoms. This chapter covers neural flossing techniques and chronic pain considerations with TOS.