POSTEROLATERAL NECK EXTENSORS
The muscles acting in this test are chiefly the splenius capitis and cervicis, semispinalis capitis and cervicis, and cervical erector Spinae. (See pp. 176 and 177.)
Patient: Prone, with elbows bent and hands overhead, resting on the table.
Fixation: None necessary.
Test: Posterolateral neck extension, with the face turned toward the side being tested. (See Note.)
Shortness: The right splenius capitis and left upper trapezius are usually short, along with the sternocleido-mastoid, in a left torticollis. The opposite muscles are short in a right torticollis.
Note: The upper trapezius, which is also a posterolateral neck extensor, is tested with the face turned away from the side being tested. (See p. 158.)
Pressure: Against the posterolateral aspect of the head in an anterolateral direction.
Patient: Sitting. Fixation: None necessary.
Test: Elevation of the acromial end of the clavicle and scapula and posterolateral extension of the neck, bringing the occiput toward the elevated shoulder with the face turned in the opposite direction.
The upper trapezius can be differentiated from the other elevators of the scapula because it is the only one that elevates the acromial end of the clavicle and the scapula. It also rotates the scapula laterally as it elevates, in contrast with the straight elevation that occurs when all elevators contract, as in shrugging the shoulders.
Pressure: Against the shoulder in the direction of depression, and against the head in the direction of flexion anterolaterally.
Weakness: Unilaterally, weakness decreases the ability to approximate the acromion and the occiput. Bilaterally, weakness decreases the ability to extend the cervical spine (e.g., to raise the head from a prone position)
Shortness: Results in an elevation of the shoulder girdle (commonly seen in prize-fighters and swimmers). In a faulty posture with forward head and kyphosis, the cervical spine is in extension, and the upper trapezius muscles are in a shortened position.
Contracture: Unilateral contracture is frequently seen in cases of torticollis. For example, the right upper trapez-ius is usually contracted along with the right sternoclei-domastoid and scaleni. (See also p. 156.)
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