Upper-Crossed Syndrome

Original Editor - Inga Balciuniene Top Contributors - Inga Balciuniene, Kim Jackson, Lucinda hampton and Joao Costa

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Clinically Relevant Anatomy

Upper-crossed syndrome (UCS) is also referred to as proximal or shoulder girdle crossed syndrome. In UCS, tightness of the upper trapezius and levator scapula on the dorsal side crosses with tightness of the pectoralis major and minor. Weakness of the deep cervical flexors ventrally crosses with weakness of the middle and lower trapezius. This pattern of imbalance creates joint dysfunction, particularly at the atlanto-occipital joint, C4-C5 segment, cervicothoracic joint, glenohumeral joint, and T4-T5 segment. Janda noted that these focal areas of stress within the spine correspond to transitional zones in which neighboring vertebrae change in morphology. Specific postural changes are seen in UCS, including forward head posture, increased cervical lordosis and thoracic kyphosis, elevated and protracted shoulders, and rotation or abduction and winging of the scapulae.. These postural changes decrease glenohumeral stability as the glenoid fossa becomes more vertical due to serratus anterior weakness leading to abduction, rotation, and winging of the scapulae. This loss of stability requires the levator scapula and upper trapezius to increase activation to maintain glenohumeral centration.

Mechanism of Injury / Pathological Process

The term functional is used to describe an approach to exercise prescription that tries to reproduce the same movements used in a functional activity. For example, some may classify the movement of an overhead lifting exercise as a functional movement. This is only an extrinsic viewpoint of function; it's important to first remember intrinsic function, or the function of structures and systems. By understanding the underlying function of these intrinsic processes, clinicians can better understand the pathology of functional lesions. Three intrinsic views of function are physiological, biomechanical, and neuromuscular function.

• Physiological function is the response of tissue to dysfunction and damage asn well as the healing process itself. Clinicians should be aware of these physiological

processes so they can better understand the consequences of dysfunction

and the process of rehabilitation.

• Biomechanical function encompasses the osteo- and arthrokinematics involved

in human movement and the resulting force vectors imparted on human tissues.

Recognizing the biomechanical functions of structures helps clinicians

understand the concept of chain reactions and how the entire kinetic chain is

involved in both movement and pathology.

• Neuromuscular function relates to the sensorimotor aspects of movement such

as proprioception and reflexes. Clinicians must also understand the processes

of motor control and motor relearning for effective exercise prescription.

Extrinsic function is made up of the specific, purposeful, and synergistic movements

that integrate the three intrinsic systems. Therefore, the three views of intrinsic function

are not independent of each other; rather, they are interdependent in all human

movement. For example, unbalanced biomechanical joint stresses that result from muscle imbalance may lead to joint damage, setting up a vicious cycle of pain and inflammation. The structural inflammation then affects the neuromuscular system of the joint, creating further dysfunction. Eventually, the body adapts the motor program for movement to compensate for the dysfunction. The functional cause of the problem is muscle imbalance, while the symptom is pain and inflammation resulting from a structural lesion. Therefore, it is possible to have both a structural and a functional lesion, but for accurate diagnosis and treatment, the clinician must decide which lesion is the actual cause of dysfunction.

Clinical Presentation

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Diagnostic Procedures

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Outcome Measures

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Management / Interventions

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Differential Diagnosis

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Resources

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