Posterior View Fig 227

Look for the following:

Fig. 2-27 Posterior aspect of the cervical spine. Boney alignment.

External occipital protuberance

External occipital protuberance

Cervical facet joint

Cervical spinous process

Cervical facet joint

Cervical spinous process

Cranial Position

Check the cranial position and resulting compensatory mechanics. If the head is side bent toward and rotated away form the direction of pain, a torticollis can exist.

If the athlete has a short neck and low posterior hairline, with gross limitation in ranges, he or she may have Klippel-Feil Syndrome (congenital fusion of the cervical spine). Associated facial asymmetry, torticollis, webbing of the neck, Sprengel deformity, and scoliosis may also be present.

Spinous Process Alignment

The cervical and thoracic spinous processes should line up vertically in a straight line without any concave or convex curves. If there are curves, it suggests cervical joint dysfunction, unilateral muscle spasm, or compensatory spinal alterations.

Muscle Spasm (suboccipitals, erector spinae, trapezius, levator scapulae)

Muscle spasm of these muscles occurs with nearly all the cervical conditions; it protects the underlying cervical dysfunction. According to Yanda, the upper trapezius, levator scapulae, and suboccipital muscles will develop tightness. Poor posture (forward head) or trauma can accelerate the tightness and lead to muscle imbalances, which can lead to cervical dysfunction.

Scapular Position and Interscapular Space

Weakness of the scapular retractors (rhomboids, serratus anterior) will cause the scapula to rotate and wing, resulting in increased interscapular space. Tightness of the upper trapezius and levator scapulae accompany this weakness. This pattern of weakness accompanies the forward head position and leads to excess stress in the cervicocranial and eervicothoracic junctions.

A very small and elevated scapula may be present on one side. This is called Sprengel deformity (embryological, undescended scapula) and it is sometimes attached to the cervical spine by the omohyoid muscle.

Downward and lateral displacement of the scapulae occurs with middle and lower trapezius muscle weakness. Prominence of the vertebral border of one scapula (winging) suggests long thoracic nerve neuritis with weakness or paralysis of the serratus anterior on that side.

Prominence of both scapular vertebral borders suggests problems with serratus anterior (myopathic lesion) or its nerve root.

Shoulder Joint

One shoulder lower than the other, without scoliosis, suggests a leg-length discrepancy.

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