Proximal Screening for the Hand Therapist
Presented by Ann Porretto-Loehrke
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This course is part of our CHT Prep Program. Learn more about the full prep program here: MedBridge CHT Prep Program.
Have you had a patient who underwent a carpal tunnel release three months ago, only to return to your clinic with the same symptoms? Do you suspect there is something going on more proximally? This course reviews the current understanding of the double crush phenomenon and provides a framework for why performing proximal screening is so important. This course will review the anatomy of the cervical spine and present potential pain generators in this region that can refer symptoms to the distal upper extremity. Testing of the cervical spine will be covered to identify a cervical radiculopathy from a disc issue. An overview of thoracic outlet syndrome will also be provided, as well as techniques for screening this region.
Meet your instructor
Ann Porretto-Loehrke
Ann Porretto-Loehrke is a skilled clinician with a passion for teaching and clinical treatment of upper extremity disorders. She has been practicing for 30 years and teaching continuing education courses for the past 20. She is the Clinical Development Coordinator at the Hand to Shoulder Center in Appleton, Wisconsin. Ann is…
Chapters & learning objectives
1. Understanding the Double Crush Phenomenon
This chapter covers the history and current research to support the double crush phenomenon. Gain an appreciation of the relationships between cervical radiculopathy, thoracic outlet syndrome, and more distal nerve compression to sharpen your evaluation skills and ultimately optimize your patient outcomes.
2. Cervical Screening
Through lecture and demonstration, this chapter covers the importance of how specific structures in the cervical spine can produce distal symptoms, including paresthesias and/or pain. Clinical testing for cervical radiculopathy, including reflexes, myotomes, and dermatomes, will be covered to help gain a better understanding of problems originating at the cervical spine.
3. Screening for Thoracic Outlet Syndrome
Through lecture and demonstration, this chapter covers the clinical reasoning and special tests to screen for thoracic outlet syndrome (TOS). This is critically important in patients who present with distal nerve symptoms to determine if the issue is originating more proximally.