Nonspecific pain syndromes of the upper limb present a challenge to the clinician entrusted with the care of these difficult cases. Success depends on a comprehensive understanding of the anatomy of this region. Further, the clinician must be able to apply anatomic knowledge to clinical presentation to derive effective treatment. In part one of this course the anatomy of the scalene triangle and its relationship to the first rib is explored. Assessment techniques specific to this region are reviewed and treatment strategies are presented. Relationships to scapulothoracic movement and posture are also presented. Mobilization techniques are blended with corrective exercise and relevant ergonomic education to present a comprehensive approach to treatment.

Level of Instruction:  Intermediate




Course Objectives

  • Identify the relevant anatomic structures of the scalene triangle and articulate their relationship to TOS symptom presentation.
  • Identify and apply at least three clinical assessment techniques applicable to TOS assessment.
  • Identify and implement at least one mobilization and one exercise technique appropriate to management of TOS through the scalene triangle or scapulothoracic region
  • Identify and implement 2 postural/ergonomic techniques to control TOS symptoms during return to work or activities of daily living.

Course Agenda

  • Anterior and lateral neck anatomy relevant to TOS
  • Clinical Evidence
  • Assessment of symptom presentation including video of: Cervical Spine Screening Supraclavicular fossa test Scalene flexibility assessment Ipsilateral/Contralateral Addison’s test Elevation and stiffness of the first rib assessment Scapula release test
  • Treatment intervention Scalene flexibility exercises Cervical retraction in the forward head presentation Deep neck flexor activation First/Second rib mobilization Ergonomic interventions including workstation and sleeping positions
  • Q/A and review of demonstrated techniques per request



PAUL J. BONZANI, OTR/L, CHT, M.H.S. currently maintains a very busy clinical practice in Concord, NH. Throughout his career he has had the fortunate opportunity to work with some of the finest hand surgeons and therapists in the country having held management positions at both The University of Vermont — Fletcher Allen Medical Center and Duke University Medical Center. Additionally he has been an adjunct instructor in both the Duke University Physical Therapy Program and the Program in Occupational Science at the University of North Carolina-Chapel Hill. Mr. Bonzani brings 21 years of clinical experience in orthopedic and industrial rehabilitation. Paul has presented nationally in the areas of biomechanics and rehabilitation of the shoulder, nerve compression syndromes, RSI/CTD management and pain syndromes. He has published on the subjects of CTD/RSI management, thumb reconstruction and management of the rheumatoid elbow. Clinical specialties include rehabilitation of the elbow and hand, chronic pain syndromes, TOS, nerve compression syndromes and neural tension disorders of the upper limb. Current research interest’s include functional outcome measures following fractures and upper quadrant sensate deficits. Paul is a clinician, researcher and educator and considered to be one of the leading hand therapists in the care of shoulder, elbow and hand injuries in North America.



Contact Hours: 1.5

Price: $49


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