Prevalence of Upper Cross Syndrome in Patients Having Open Heart Surgeries: A Cross-Sectional Survey

Background: Open heart surgery is commonly used to treat cardiovascular conditions such as coronary artery disease and valvular disorders. However, standard surgical approaches may cause postoperative pain, muscle imbalance, and limited upper-body mobility. These complications can contribute to postural issues like upper cross syndrome, characterized by forward head posture, rounded shoulders, and increased thoracic kyphosis due to muscular imbalance in the cervical and thoracic regions. Objective: To determine the prevalence of upper cross syndrome among patients who underwent open heart surgery. Methodology: This cross-sectional survey was conducted at Rehman Medical Institute, Peshawar, on 100 patients having open-heart surgery. Participants included both male and female patients aged between 30 and 70 years undergoing CABG or valve replacement surgery, who were assessed four weeks postoperatively. Patients with pre-existing spinal deformities, neurological disorders affecting posture, or recent trauma were excluded. Data was collected using a structured assessment form. Upper cross syndrome was assessed by photogrammetry using ImageJ software when participants exhibited postural deviations such as forward head posture with a craniovertebral angle less than 50°, rounded shoulders with a shoulder protraction angle greater than 54°, and thoracic kyphosis exceeding 40°. Descriptive statistics such as frequency, percentage, mean, and standard deviation were calculated. Results: The results revealed that 58% of participants demonstrated clinical signs of Upper Cross Syndrome. Forward head posture was the most frequently observed postural deviation (61%), followed by rounded shoulders (56%) and thoracic hyperkyphosis (48%). The majority of participants were middle-aged and male, and coronary artery bypass grafting was the most commonly performed surgical procedure. Conclusion: Upper cross syndrome is a relatively common postural abnormality among patients recovering from open-heart surgery. Early identification and physiotherapy-based postural rehabilitation may help prevent long-term musculoskeletal complications and improve functional recovery in postoperative cardiac patients.