ANTERIOR NECK FLEXORS
Patient: Supine, with the elbows bent and the hands overhead, resting on the table.
Fixation: Anterior abdominal muscles must be strong enough to give anterior fixation from the thorax to the pelvis before the head can be raised by the neck flexors. If the abdominal muscles are weak, the examiner can provide fixation by exerting firm, downward pressure on the thorax. Children approximately 5 years of age and younger should have fixation of the thorax provided by the examiner.
lest: Flexion of the cervical spine by lifting the head from the table, with the chin depressed and approximated toward the sternum.
Pressure: Against the forehead in a posterior direction. (For grading, see facing page.)
Modified Test: In cases of marked weakness, have the patient make an effort to flatten the cervical spine on the table, approximating the chin toward the sternum.
Pressure: Against the chin in the direction of neck extension.
Note: The anterior vertebral flexors of the neck are the longus capitis, longus colli and rectus capitis anterior. In this movement, they are aided by the sternocleidomastoid, anterior scaleni, suprahyoids and infrahyoids. The platysma will also attempt to aid when the flexors are very weak.
Weakness: Hyperextension of the cervical spine, resulting in a forward-head position.
Contracture: A neck flexion contracture is rarely seen except unilaterally, as in torticollis.
ERROR IN TESTING NECK FLEXORS
If the anterior vertebral neck flexors are weak and the sternocleidomas-toid muscles are strong, an individual can raise the head from the table (as illustrated) and hold it against pressure. This is not an accurate test for the neck flexors, however, because the action is accomplished chiefly by the sternocleidomastoids aided by the anterior scaleni and the clavicular portions of the upper trapezius.
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Grading: Because most grades of 10 are based on adult standards, it is necessary to acknowledge when a grade of less than 10 is normal for children of a given age. This is particularly true regarding the strength of the anterior neck and the anterior abdominal muscles. The size of the head and trunk in relation to the lower extremities as well as the long span and normal protrusion of the abdominal wall affect the relative strength of these muscles. Anterior neck muscles may have a grade of approximately three in a 3-year-old child and of approximately five in a 5-year-old child. The grade will then increase gradually and reach the 10 standard of performance by as early as 10 to 12 years of age. Even so, many adults will exhibit no more than a grade of six. This need not be interpreted as neurogenic, however, because it usually is associated with faulty posture of the head and upper back.
ANTEROLATERAL NECK FLEXORS
The muscles acting in this test are chiefly the sternocleidomastoid and scaleni.
Patient: Supine, with elbows bent and hands beside the head, resting on table.
Fixation: If the anterior abdominal muscles are weak, the examiner can provide fixation by exerting firm, downward pressure on the thorax.
Test: Anterolateral neck flexion.
Pressure: Against the temporal region of the head in an obliquely posterior direction.
Contracture and Weakness: A contracture of the right sternocleidomastoid produces a right torticollis. The face is turned toward the left, and the head is tilted toward the right. Thus, a right torticollis produces a cervical scolio-sis that is convex toward the left with the left stern-ocleidomastoid elongated and weak.
Contracture of the left sternocleidomastoid, wi* weakness of the right, produces a left torticollis witha cervical scoliosis that is convex toward the right.
In a patient with habitually faulty posture and (° ward head, the sternocleidomastoid muscles remain shortened position and tend to develop shortness.
Note: With neck muscles just strong enough to hold but not strong enough to Hex completely, a patient can lift the head from the table by raising the shoulders. A patient will do this especially during tests for the right and left neck flexors by taking some weight on the elbow or hand to push the shoulder from the table. To avoid this, keep the patient's shoulder flat against the table.
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