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Proximal Screening for the Hand Therapist

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

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Target Audience:

Disclosure Statement:

Financial: Ann Porretto-Loehrke receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course.

Nonfinancial: Ann Porretto-Loehrke is an instructor for the International Academy of Orthopedic Medicine—US.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

MedBridge is committed to accessibility for all of our subscribers. If you are in need of a disability-related accommodation, please contact [email protected]. We will process requests for reasonable accommodation and will provide reasonable accommodations where appropriate, in a prompt and efficient manner.

Accreditation Check:
Video Runtime: 49 Minutes; Learning Assessment Time: 28 Minutes

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, PT, DPT, CHT, COMT, CMTPT

Ann Porretto-Loehrke is a skilled clinician with a passion for teaching and clinical treatment of upper extremity disorders. She serves as the clinical development coordinator at the Hand to Shoulder Center in Appleton, Wisconsin. Ann is a Certified Hand Therapist (CHT) and a Certified Orthopedic Manual Therapist (COMT) for treatment of the upper quadrant through…

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Chapters & Learning Objectives

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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.

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