Upper-Crossed Syndrome
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Clinically Relevant Anatomy[edit | edit source]
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[edit | edit source]
Janda thought that the muscular system lies at a functional crossroads since it is influenced by both the CNS and the PNS. Muscles must be able to respond to a variety of simultaneous factors such as gravity, repetitive movement, and upright posture. Muscles are influenced by both neurological reflexes and biomechanical demands; therefore, muscles can be considered to be a window into the function of the sensorimotor system. Postural defects resulting from muscular imbalance also provide clues to sensorimotor function.
He subsequently found that patients with chronic musculoskeletal pain (most notably chronic low back pain) exhibit the same patterns of muscle tightness and weakness as patients with CNS disorders exhibit, a finding that indicates a link between muscle imbalance and the CNS.
Clinical Presentation[edit | edit source]
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Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
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Management / Interventions[edit | edit source]
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Differential Diagnosis[edit | edit source]
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