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

Presented by Ann Porretto-Loehrke

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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

    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…

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    Chapters & learning objectives

    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.

    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.

    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.

    More courses in this series

    Identification and Evaluation of Thoracic Outlet Syndrome

    Identification and Evaluation of Thoracic Outlet Syndrome

    Ann Porretto-Loehrke

    Treatment of Thoracic Outlet Syndrome: Where to Begin

    Treatment of Thoracic Outlet Syndrome: Where to Begin

    Ann Porretto-Loehrke

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

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

    Ann Porretto-Loehrke

    Thoracic Outlet Syndrome: Assessing the Elevation Chain

    Thoracic Outlet Syndrome: Assessing the Elevation Chain

    Ann Porretto-Loehrke