Thoracic Outlet Syndrome: Assessment and Therapeutic Strategies

presented by Joseph Muscolino

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The purpose of this course is to familiarize the therapist with the group of conditions known as thoracic outlet syndrome (TOS). This course describes the underlying etiologic mechanisms of TOS, its signs and symptoms, its postural, orthopedic testing, and palpation assessments, and soft tissue manipulation and stretching treatment protocols, along with client self-care recommendations.

Meet Your Instructor

  • Joseph Muscolino, DC

    Joseph Muscolino, DC

    Dr. Joseph Muscolino graduated from Western States Chiropractic College (WSCC) in Portland, Oregon with a wide breadth of assessment and treatment technique knowledge and has been in private practice as a licensed chiropractic physician since 1985. He has been teaching musculoskeletal and visceral anatomy, physiology, kinesiology, pathology, and palpation and assessment courses for 24 years. He also runs numerous advanced study workshops, including those on deep tissue, body mechanics, stretching, joint mobilization, and Anatomy in Clay®; cadaver labs; and in-services for Pilates and yoga instructors of manual and movement therapies. He has introduced CE home study courses on muscle and bone palpation, kinesiology, and the muscular system, and has also written extensively about manual and movement therapies. He is the author of numerous articles and textbooks, including The Muscle and Bone Palpation Manual, The Muscular System Manual, and Kinesiology and currently teaches anatomy and physiology at Purchase College, SUNY. He also writes a regular column article entitled Body Mechanics for the Massage Therapy Journal and has written articles for the Journal of Bodywork and Movement Therapies and numerous books on anatomy and kinesiology.

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Chapters & Learning Objectives

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  1. Introduction

    1. Introduction

    In the first chapter of this course, Dr. Muscolino defines Thoracic Outlet Syndrome (TOS), including the four types of TOS and the structures affected by TOS. He also covers the specific signs and symptoms of TOS.

  2. Orthopedic Assessment

    2. Orthopedic Assessment

    This chapter describes and demonstrates an orthopedic assessment for TOS, and discusses how the use of breach can affect the efficacy of TOS orthopedic assessment tests.

  3. Postural Assessment

    3. Postural Assessment

    In this chapter, Dr. Muscolino discusses postural assessment of TOS, including the involvement of forward head posture, rounded shoulder posture, and upper crossed syndrome and TOS.

  4. Palpation Assessment

    4. Palpation Assessment

    The final assessment portion of this course covers palpation procedures for identifying TOS. In particular, the importance of the scalenes, pectoralis minor, and subclavius are discussed.

  5. Soft Tissue Manipulation

    5. Soft Tissue Manipulation

    This chapter introduces treatment for TOS by describing soft tissue manipulation approaches, including manipulation of the scalenes, the pectoralis minor, and costoclavicular space.

  6. Stretching Part 1

    6. Stretching Part 1

    Stretching is an integral part of addressing TOS symptoms. This chapter introduces stretching components for the scalenes.

  7. Stretching Part 2 - Neural Inhibition Stretching

    7. Stretching Part 2 - Neural Inhibition Stretching

    This chapter concludes Dr. Muscolino's discussion of stretching by describing stretching techniques for the pectoralis minor, as well as the importance of the vertebral artery competency test.

  8. Self Care

    8. Self Care

    The final chapter of this course provides important information on TOS self care, including chin tick stretches, and the relationship between posture and TOS.