Effect of Upper Cross Syndrome on Hand Grip Strength and Cubital Angle- A Cross-sectional Study

Upper Cross Syndrome (UCS) is a postural disorder, characterized by the tightness and weakness of the muscles of cervical, thoracic, shoulder girdle and scapular region that cross between the dorsal and ventral side of the body. It refers to the tightness of the upper trapezius, levator scapulae, sternocleidomastoid and pectoralis muscles as well as weakness of the deep cervical flexors, lower trapezius, serratus anterior and rhomboid muscles. Dr. Vladamir Janda introduced the term “Upper Cross Syndrome” to describe this phenomenon. UCS is also known as Cervical Cross Syndrome or Proximal/Shoulder Girdle Crossed Syndrome.1 Janda named this syndrome as “upper crossed” because of its “X” or “cross” pattern of muscle imbalance in the upper quarter of the body. The cross demonstrates the muscles which are tight or hyperactive on one side and weak or over-inhibited on the other side. Individuals exhibiting UCS display particular postural alterations, that involve forward head posture (FHP), increased cervical lordosis, elevated and protracted shoulder (rounded shoulder), thoracic hyper kyphosis, reduced thoracic spine movement and scapular winging with increased abduction and inward rotation.Using the purposive sample technique, participants were chosen in accordance with the selection criteria. Each subject voluntarily agreed to participate in the research by signing written consent forms. Initially demographics details were collected about the participants which typically included.
The participant was instructed to stand upright, with their back, sacrum, and heels touching the wall, and their head in a neutral position (i.e., to look directly at an imaginary point). The Occiput Wall Distance (OWD) was then measured by placing one ruler on the landmark (Occiput) and using the other to measure the distance perpendicular to the first ruler.
To measure Craniovertebral Angle (CVA) and Shoulder Angle (SA) photographic method was implemented. A marker was used to identify the three anatomical landmarks of the right acromion process, C7 spinous process, and ear tragus. The participants were then instructed to stand in the assigned spot next to the wall, with their left arm facing the wall and their eyes fixed on an imaginary point. Hand grip strength was evaluated with the help of hand-held dynamometer as per the guidelines of American Society of Hand Therapists (ASHT). The participants were placed in a high sitting position with their arm supported & adjacent to the trunk, shoulder in neutral, elbow in 90° flexion, forearm in mid-prone position, with wrist between the range of 0° to 30° extension and 0° to 15° ulnar deviation. The carrying angle was measured with the help of universal full-circle goniometer. The stationary arm of the goniometer was aligned along the long axis of the arm to be tested, pointing toward the acromion process, while the movable arm was aligned along the long axis of the forearm to be examined pointing toward the middle finger.