It works to some extent in the select few chest exercises that involve scapular protraction A few examples include: Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. When it overlies the apex of the lung, it gives rise to the companion shadow; when overlying . Solidify your knowledge about the serratus anterior and other thoracic muscles with our quiz: A damage of the long thoracic nerve can lead to a functional loss of the serratus anterior. It inserts on the front border of the scapula. Since the serratus anterior attaches to the side of your rib cage, an injury to your ribs may also cause damage to the muscle. In addition, the long thoracic nerve (LTN), thoracodorsal nerve (TDN), and thoracodorsal artery lie in the fascial plane superficial to the serratus anterior muscle (SAM), between SAM and the latissimus dorsi muscles. When the shoulder blade is in fixed position the accessory inspiratory muscles (used in respiratory distress) are activated e.g breathing after a boxing bout, person with emphysema. means you'll never forget the nerve roots associated with it! Recognition of the various possible patterns is important to prevent overdiagnosis of disease, particularly asbestosis. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Its also a key scapular stabilizer, keeping the shoulder blades against the ribcage when at rest and during movement. Learn everything about the muscles of the thoracic wall with our video tutorials, quizzes, labeled diagrams, and articles: The vascular supply to the serratus anterior comes from the superior and lateral thoracic arteries (branches of the axillary artery)as well as branches from the thoracodorsal artery(branch of subscapular artery). Radiology and Imaging Specialists (RIS) is Central Florida's local, physician-owned radiology team. The radiographic appearance of the serratus anterior muscle shadow is analyzed. Orthopedic Physical Assessment. Our team of more than 40 board-certified physicians includes specialists and subspecialists in all aspects of diagnostic radiology. 1173185, Exercises for Activating Serratus Anterior. Read more, Physiopedia 2022 | Physiopedia is a registered charity in the UK, no. The serratus anterior block was performed at the T8 to T9 point after anesthesia induction, before cutting leather (T0), stamp card placement (T1), 2 groups of patients' heart rate (HR), blood pressure were recorded, at the same time dosage of analgesic drugs and postoperative 0.5, 6, 12, 24 hours when resting visual analogue scale (VAS . Kenhub. Elsevier. Just a few of our diagnostic tests include: 64-Slice Cardiac Somatom Computed Tomography (CT) Scan. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. The top of this muscle attaches to the ribs near where they attach to the sternum, forming a "c" shape with the rib cage. The serratus anterior is a flattened sheet of muscle originating from the first through the ninth ribs and inserting along the medial border of the costal surface of scapula. When refering to evidence in academic writing, you should always try to reference the primary (original) source. Stand about two feet from a wall, facing it. There are three divisions of the serratus anterior. Its main part lies deep under the scapula and the pectoral muscles. If one shoulder blade wings out, there may be weakness in your serratus anterior on that side. The therapist resists the maximally protracting force by the patient. It then courses around the side of your rib cage and underneath your scapula. Serratus anterior muscle (Musculus serratus anterior) The serratus anterior muscle is a fan-shaped muscle at the lateral wall of the thorax.Its main part lies deep under the scapula and the pectoral muscles. To do this test: Have someone watch the position of your shoulder blades. If any exercise causes pain, stop and visit your healthcare provider . 2018;97(40):e12515. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. A rib fracture can cause the muscle tissue of the serratus to pull away, resulting in an avulsion fracture. Injury to the long thoracic nerve during axillary surgery causes winging of the scapula as serratus anterior no longer holds the scapula against the chest wall. Serratus Anterior. 1. Author: J Exerc Sports Orthop. Tennis. King of the gym Serratus anterior Available: Serratus anterior muscle video - Kenhub, Serratus anterior muscle - lateral view. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. Curated learning paths created by our anatomy experts, 1000s of high quality anatomy illustrations and articles. This shifting now enables to lift the arm above 90 (elevation). In case of serratus anterior muscle weakness the patients scapula is pushed into a retracted and internally rotated position leading to scapular winging appearance. and grab your free ultimate anatomy study guide! He teaches as an Assistant Professor of Orthopedics at Emory School of Medicine in Atlanta, Georgia. 1 January 1999 | RadioGraphics, Vol. Read more. backpack) and trauma. The constellation of symptoms arising from scapulothoracic bursitis is commonly referred to as snapping scapula syndrome 1, although there are other causes of this syndrome 4. Shoulder Elbow. It is the most powerful and prominent part. Damage to the long thoracic nerve can weaken, or even paralyze, the serratus anterior. General Anatomy and Musculoskeletal System. The serratus anterior lifts the ribcage and thus supports breathing. This brachial neuritis may cause weakness in your serratus and manifest as the telltale scapular winging. It also helps to experience how your ribs feel, so that you can distinguish the ribs and this thin and superficial muscle. Treatments that you may encounter during rehab for your serratus anterior may include: These treatments are designed to improve the way your shoulder moves and functions. Middle / Intermedius: 2nd to 3rd rib medial border of scapula. Injury to the long thoracic nerve during axillary surgery causes winging of the scapula as serratus anterior no longer holds the scapula against the chest wall. Lower / Inferior: 4th to 9th rib medial border and inferior angle of scapula. Schuenke M, Schulte E, Schumacher U et-al. All content published on Kenhub is reviewed by medical and anatomy experts. 6th edition. All rights reserved. A condition known as Parsonage-Turner Syndrome may affect your brachial plexus and the long thoracic nerve. The Anatomy of the Serratus Anterior Muscle. 2014. The muscle helps to move your scapula in various directions and is essential for proper shoulder function. 2017;9(1):80-83. doi:10.1177/1941738116670636, Gooding BW, Geoghegan JM, Wallace WA, Manning PA. Scapular winging. Serratus anterior pain is common in sports with repetitive motions, such as swimming, tennis, or . The 3 tests below can be used to examine the serratus anterior muscle weakness and scapula winging. Kim Bengochea, Regis University, Denver. 2022 Dotdash Media, Inc. All rights reserved. Injury to the serratus anterior is rare, but if it happens, you may require . It is easy to palpate between the pectoralis major and latissimus dorsi muscles. Due to the pull of the inferior part at the lower scapula, the shoulder joint is shifted superiorly. Upper / Superior: 1st to 2nd rib superior angle of scapula. I would honestly say that Kenhub cut my study time in half. Upper three digitations are termed the superior fibers , lower six digitations are termed the inferior fibers. This muscle lies between the back of your rib cage and your shoulder blade near the subscapularis (one of the four rotator cuff muscles). . The muscle helps to move your scapula in various directions and is essential for proper shoulder function. HSS J. David J. Magee. The serratus anterior is trained indirectly in all anterior deltoid exercises. Image 7: SA seen her between the pectoralis major and latissimus dorsi muscles. 2. Serratus anterior muscle is one of the four muscles of the pectoral region. 2010;6(2):199-205. doi:10.1007/s11420-010-9176-x, Day J. Common causes for this include: The serratus anterior muscle is very thin and covers the side of the ribcage. Origin: Superolateral surfaces of upper 8 or 9 ribs at the side of chest. It is easy to palpate between the pectoralis major and latissimus dorsi muscles.In athletic bodies the muscle may be even visible to the naked eye along the ribs underneath the axilla. Kinesiologic considerations for targeting activation of scapulothoracic muscles-part 1: serratus anterior. Women's Diagnostic Imaging from Radiology Associates offers a complete range of women's imaging services, including 3-D Mammography screening, breast ultrasound and MRI, image-guided breast biopsy, pelvic ultrasound and bone density testing, in each of our ACR Accredited centers, by our caring and supportive staff. It passes inferolaterally and inserts onto the superior border, just lateral to the angles of the 2 nd to 5 th ribs 1-3. Injury to the serratus can result in a condition called a winged scapula. Effect of Exercise Position on Percent Changes in Serratus Anterior Muscle Thickness. lymph node removal), a compression due tocarrying heavy loads (e.g. Instructions. Winged scapula caused by dorsal scapular neuropathy combined with suprascapular neuropathy: a case report. Register now Due to its course it has a serrated or saw-toothed appearance. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The serratus anterior muscle arises from the lateral 1st to 8th or 9th ribs as muscle slips that run posterosuperiorly around the chest wall, under the scapulato insert onto the costal surface of the medial scapular border 2. When the muscle is well developed, the medial edge of this silhouette may be superimposed upon the air shadow of the lung in a variety of ways. This means that they pull them forward around your rib cage. See Dynamic Stabilisers of the Shoulder Complex and Scapulohumeral Rhythm. When your arm and shoulder are in a fixed and stable position, the serratus anterior helps to elevate your ribs. Therapist applies a downwards resisting force against the scapular plane abduction of the shoulder at about 120130 and against upward rotation of the scapula. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Place both hands on the wall with your shoulders elevated to about 90 degrees. This limits overhead range of motion and reduces overall scapular/shoulder stability, increasing the risk of injury to the rotator cuff and shoulder girdle. It acts on the scapula and is the prime mover in both scapular protraction and scapular upward rotation. When it overlies the apex of the lung, it gives rise to the companion shadow; when overlying . Often thought of as solely a chest exercise, the dumbbell pullover actually trains lats, shoulders, chest, core, and the serratus anterior. [13] The thoracodorsal artery runs with the thoracodorsal nerve and serves as a landmark for the appropriate level of blockade at the midaxillary line, targeting ribs 4 and 5. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Knipe H, Deng F, Bell D, et al. Image 4: The serratus anterior is also known as the boxers muscle, as it is largely responsible for the protraction of the scapula which occurs when throwing a punch. It arises by fleshy digitations from the outer surfaces and superior borders of the upper eight or nine ribs, and from the aponeuroses covering the intervening Intercostales. Severe coughing or hyperventilation may also strain the muscle. The take home message: use your serratus and bring those shoulder blades around your ribs to get your hands up and out safely and with good connection. Thus, the serratus anterior muscles are considered secondary muscles of respiration. The block has been used for different thoracoscopic and open chest wall incisions as well as chest tube placements and rib fractures. Dumbbell Pullover. If the serratus anterior becomes inhibited, it may fail to adequately hold your shoulder blade to your ribs, leading to scapular winging. Reviewer: Common causes are operations in the axilla (e.g. Telsa 1.5 High Field Open MRI (Magnetic Resonance Imaging) X-ray and Diagnostic Imaging. Serratus anterior injuries can be seen in baseball pitchers and rowers, with varying degrees of severity including avulsion from the origin at the ribs 2. The muscle is further divided into three parts: The inferiorpart of the muscle is the most prominent and powerful one. [1], Watch this comprehensive video from Kenhub (3 minutes) [3]. Your healthcare provider can determine the cause of your problem and refer you to the right professional to help regain function of your serratus muscle. Oluseun Olufade, MD, is a board-certified orthopedist. Finally, in a fixed scapula the muscle lifts the ribs and acts as an accessory inspiratory muscle. Medicine (Baltimore). We describe a case of free serratus anterior artery perforator flap for the reconstruction of a dorsal defect of the foot, followed by an anatomic and radiological study. The radiographic appearance of the serratus anterior muscle shadow is analyzed. In athletic bodies the muscle may be even visible to the naked eye along the ribs underneath the axilla. 2017 Jan; 4(1): 1-6. doi:10.15226/2374-6904/4/1/00153. These are: Each of the divisions of the muscle function together to move your scapula in various directions. This pain may also result from serratus anterior myofascial pain syndrome (SAMPS), a rare. . Thank you, {{form.email}}, for signing up. The inferior and superior aspect of the serratus also helps to stabilize your shoulder blade against your rib cage. overuse. Its main part lies deep under the scapula and the pectoral muscles. Lie down on your side. Our handy trunk wall muscle anatomy chart has your back. There are also more than a few risk factors involved with serratus anterior muscle pain. Serratus anterior muscle: want to learn more about it? Reading time: 5 minutes. In contrast, the superior part depresses the scapula and thus acts antagonistically. We have several convenient outpatient imaging centers in Lakeland, Plant City and Kissimmee, Florida. Keep in mind that these are just examples, as lifting any item over your head may cause strain or damage to the serratus anterior muscle. It also acts with the upper and lower fibers of the trapezius muscle to sustain upward rotation of the scapula, which allows for overhead arm movement[1]. 1 If this muscle becomes weak or fatigued, it can lead to unwanted movement within the shoulder joint (excessive humeral . Making Advanced Technology Affordable and Accessible At SimonMed 1, Journal of Computed Tomography, Vol. Manual techniques to improve shoulder and scapular. The serratus anterior muscle is a fan-shaped muscle at the lateral wall of the thorax. The long thoracic nerve is susceptible to damage (causing backpack palsy ) due to its long and superficial course either from direct trauma or stretching of the nerve. The long thoracic nerve is included Make sure to cover the entire muscle. Introduction. Terminology. Last reviewed: October 28, 2021 2014;23(17-18):2525-31. doi:10.1111/jocn.12443, Feinberg JH, Radecki J. Parsonage-turner syndrome. A small fluid-filled sac called a bursa lies between the subscapularis and serratus anterior that allows the scapula to glide and slide normally during movement. If you suspect you have an injury to your serratus or find that your shoulder blade is winging, you should visit your healthcare provider for a full assessment. A 17-year-old boy reported a fracture of the first and second metatarsal bone of the left foot, with a dorsal skin defect, due to a motorcycle accident. Injury to the long thoracic nerve may occur during lymph node resection in patients with breast cancer. The nerve can also be overstretched during athletic activity. The innervation is supplied by the long thoracic nerve (C5-7), a branch of the brachial plexus. (The side that will be stretched will be the one that is closest to the floor.) [6]. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-23255, medial (ulna) collateral ligament complex, lateral (radial) collateral ligament complex, accessory flexor digitorum superficialis indicis, accessory head of the flexor pollicis longus, superficial palmar branch of the radial artery, draws the scapula anteriorly against the chest wall, when the scapula is fixed, assists in respiration, union with fibers of the insertion of the. Exercises that may be done to improve the strength and function of your serratus anterior may include: Be sure to check with your healthcare provider before starting this, or any other, exercise program for your shoulders or serratus anterior. Enter your email address below and we will send you the reset instructions. Serratus anterior injuries can be seen in baseball pitchers and rowers, with varying degrees of severity including avulsion from the origin at the ribs 2. Also, the serratus anterior assists in keeping the shoulder blade close to your rib cage and prevents it from winging out to the side. 2022 This occurs during normal breathing. The serratus anterior is a muscle that originates on the surface of the 1st to 8th ribs at the side of the chest and inserts along the entire anterior length of the medial border of the scapula.The serratus anterior acts to pull the scapula forward around the thorax. Dynamic Stabilisers of the Shoulder Complex, Serratus Anterior Strength Test or Push Out Test. Original Editor - Esraa Mohamed Abdullzaher, The serratus anterior (SA) is a fan-shaped muscle that originates on the superolateral surfaces of the first to eighth or ninth ribs at the lateral wall of the thorax and inserts along the superior angle, medial border, and inferior angle of the scapula. If the address matches an existing account you will receive an email with instructions to reset your password. Learn more. When the serratus anterior is inhibited, lengthened or weakened, scapular protraction and scapular upward rotation are impaired. 10, No. In frontal and near-frontal views, it produces a bowling-pin silhouette. In frontal and near-frontal views, it produces a "bowling-pin" silhouette. Image 5: When the shoulder blade is in fixed position the accessory inspiratory muscles (used in respiratory distress) are activated. Shoulder abduction test. 2014;6(1):4-11. doi:10.1111/sae.12033, Lee SY, Lee HD, Cho YS, Han SH. Sports Health. Read our, At-Home Exercises and Physical Therapy for Calcific Tendonitis, First Steps to Help Treat a Frozen Shoulder, Exercises to Improve Stability After a Shoulder Labrum Tear, The Anatomy of the Pectoralis Minor Muscle, Shoulder Replacement vs. Rotator Cuff Surgery: Uses, Benefits, Side Effects & More, improve the strength and function of your serratus anterior, Traumatic avulsion of the serratus anterior muscle in a collegiate rower: a case report, Winged scapula caused by dorsal scapular neuropathy combined with suprascapular neuropathy: a case report, Incidence and risk factors for winged scapula after surgical treatment for breast cancer. The serratus anterior (SA) is a fan-shaped muscle that originates on the superolateral surfaces of the first to eighth or ninth ribs at the lateral wall of the thorax and inserts along the superior angle, medial border, and inferior angle of the scapula. Neurogenic scapular winging (i.e. Thieme. 'SALT' stands for 'SerratusAnterior =LongThoracic' and will help you remember the name of the nerve, while knowing'C5, 6, 7 raise your arms to heaven!' Our licensed physicians and certified technologists administer tests to find the smallest of medical conditions, before they turn into major problems. Effect of Exercise Position on Percent Changes in Serratus Anterior Muscle Thickness. Think of a boxer throwing a punch; as his arm comes forward, the serratus anterior contracts to pull the shoulder blade around the ribs and forward. Carr JB, John QE, Rajadhyaksha E, Carson EW, Turney KL. Content is reviewed before publication and upon substantial updates. A weak serratus anterior would result in the patient failing to resist the therapists force resulting in the shoulder breaking into adduction and the scapula can't rotate upwards significantly. In frontal and near-frontal views, it produces a "bowling-pin" silhouette. An injury here can cause pain, limited motion, scapular winging, and difficulty using your arm normally. Understanding the anatomy and function of your serratus anterior can help you properly rehab it after an injury. There, it inserts along the medial border of your scapula. Apply an appropriate amount of your body weight on top of the foam roller. The distinction is often clinically difficult, as symptomatic . The serratus anterior is a fan-shaped muscle located on the mid-to-upper back, which ultimately ends in the scapula. Verywell Health's content is for informational and educational purposes only. The radiographic appearance of the serratus anterior muscle shadow is analyzed. The Serratus anterior ( Serratus magnus, boxer's muscle) is a thin muscular sheet, situated between the ribs and the scapula at the upper and lateral part of the chest. Chin-ups, push-ups. The main part of the serratus anterior lies deep to the scapula and the pectoral muscles and is easily palpated between the pectoralis major and latissimus dorsi muscles.[1]. Unable to process the form. While some guys like to approach this movement by laying their upper back across a flat bench in a sort of balancing act, I say why bother. This can be a painful injury and limit function of the serratus anterior. The fibers run obliquely (to varying degrees) between these septa, forming a multipennate muscle architecture. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. The contraction of the entire serratus anterior leads to a anterolateral movement of the scapula along the ribs. In most cases Physiopedia articles are a secondary source and so should not be used as references. It originates on the top lateral surface of the eight or nine upper ribs. Athletic Injuries of the Thoracic Cage. It can be felt as a ridge running across your chest, and it helps raise the scapula. This manifests as a visual bump in your back where your shoulder blade resides.. The innervation for the serratus anterioris very easy to remember if you just know the rightmnemonics! Incidence and risk factors for winged scapula after surgical treatment for breast cancer. Learning anatomy is a massive undertaking, and we're here to help you pass with flying colours. In the third test the patient is in a seated or supine position, with his arm flexed 90-100 degrees and his elbow fully extended. Another classic sign is the medial wing-like tilting of the scapula (scapula alata). J Clin Nurs. Dimitrios Mytilinaios MD, PhD Copyright The most common causes of muscle pain include: tension. When the muscle is well developed, the medial edge of this silhouette may be superimposed upon the air shadow of the lung in a variety of ways. Sowmya L. Varada, Charles A. Popkin, Elizabeth M. Hecht, Christopher S. Ahmad, William N. Levine, Marc Brown, Tony T. Wong. Achudhan Karunaharamoorthy Get instant access to this gallery, plus: Introduction to the musculoskeletal system, Nerves, vessels and lymphatics of the abdomen, Nerves, vessels and lymphatics of the pelvis, Infratemporal region and pterygopalatine fossa, Meninges, ventricular system and subarachnoid space, Superior and lateral thoracic arteries, thoracodorsal artery branches, Serratus anterior muscle (ventral view) -Yousun Koh, Long thoracic nerve (ventral view) -Yousun Koh, Trunk wall(cadaveric dissection) - Prof. Carlos Surez-Quian. The Serratus Anterior Muscles. Serratus anterior muscle. The serratus posterior superior muscle forms from a thin, broad aponeurosis which is attached to the lower part of the ligamentum nuchae, spinous processes of C7 to T3 vertebrae, and intervening supraspinous ligament. The muscle is named from Latin: serrare = to saw, referring to the shape, anterior = on the front side of the body. The most common causes of serratus muscle pain include: tension; stress; overuse. Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea. How do work on my Serratus Anterior: The information we provide is grounded on academic literature and peer-reviewed research. ADVERTISEMENT: Supporters see fewer/no ads. Is a key scapular stabilizer, keeping the shoulder blades against the ribcage when at rest and during movement. The main actions are protraction and upward rotation of the scapulothoracic joint.[8]. Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. If this occurs in the context of mechanical symptoms, it is called scapulothoracic crepitus. 19, No. The Anatomy of the Serratus Anterior Muscle. Action: Draws scapula forward and upward; abducts scapula and rotates it; stabilizes vertebral border of scapula. Wondering how you're going to revise the anatomy of the serratus anterior muscle? Innervation: Long thoracic nerve (C5, C6, C7) The "serratus wall test" is often performed to assess the function of the serratus anterior. Place a foam roller underneath the Serratus Anterior muscle. When the muscle is well developed, the medial edge of this silhouette may be superimposed upon the air shadow of the lung in a variety of ways. (2010) ISBN:1604062924. Your serratus anterior is a major scapular stabilizer that essentially holds your shoulder blades to your rib cage. Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you top results faster. (2021) RadioGraphics. Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. The risk of injury to . Anatomy, thorax, serratus anterior muscles. Injury to the long thoracic nerve during axillary surgery causes winging of the scapula as serratus anterior no longer holds the scapula against the chest wall. The serratus anterior upwardly rotates the shoulder blade and protracts the shoulder blade (move it away from the midline of the body). This article will discuss the anatomy of the serratus anterior muscle. The serratus anterior flap is very versatile because variable sizes of flap and pedicle lengths can be taken. https://www.ncbi.nlm.nih.gov/books/NBK531457/, https://www.kingofthegym.com/serratus-anterior/, https://www.kenhub.com/en/library/anatomy/serratus-anterior-muscle, https://www.healthline.com/human-body-maps/serratus-anterior-muscle#2, https://www.kenhub.com/en/library/anatomy/anatomy-of-breathing, https://www.healthline.com/health/serratus-anterior-pain#causes. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. Conditions like rotator cuff tear or a shoulder separation may cause pain and inhibition of the muscles that support your shoulder. Roll your body over the foam roller. The serratus anterior is a muscle that attaches your shoulder blade, known as your scapula, to your rib cage. Another function of the serratus anterior is the active stabilization of the scapula within the shoulder. That is usually the journal article where the information was first stated. The serratus anterior muscle originates at the 1st to 8/9th rib and inserts at the anterior surface of the medial border of the scapula (extending from the superior to inferior angles). Typical symptoms includetrouble elevatingthe arm and a generally unstable shoulder. SimonMed See Tomorrow Today Schedule Locations Check Walk-in X-ray Queue Who We Are Largest outpatient physician radiology group in the country. The lowest four digitations of the serratus anterior interdigitate with the fibers of the external oblique. The serratus anterior is innervated by the long thoracic nerve. How We're Different Convenient care and advanced technology at a lower cost. The serratus anterior is a muscle that attaches your shoulder blade, known as your scapula, to your rib cage. The serratus anterior originates via eight muscular "slips" that attach to the side of your ribs. Damage to the nerve may also occur during surgical procedures including thoracoplasty, axillary nodal clearance, mastectomy and resection of the first rib. Serratus anterior free flaps are often used for reconstruction of anatomic structures such as parts of the face, limbs, or diaphragm. An injury to your serratus anterior may cause scapular winging, shoulder motion limitations, and difficulty with normal upper extremity function. minor injuries. [5] It then wraps posteromedially around the ribcage, passing beneath the scapula to insert on the underside of the scapula on its medial border. The serratus anterior muscle protracts the shoulder blades. The serratus anterior muscle originates from the 1st to 8th or 9thribs and inserts at the anterior surfaceof the scapula. Insertion: Vertebral border of scapula. Working with a physical therapist can help you recover after an injury to your serratus.. Check for errors and try again. What We Do Comprehensive medical imaging services with advanced technology. As the muscle extends from the ribs, it is divided by tendinous septa into nine finger-like groupings of muscle fibers called digitations., Image 2: Serratus anterior muscle seen from a lateral view. An injury to your shoulder or rotator cuff may also cause scapular winging. By Brett Sears, PT Sometimes, serratus anterior weakness and winging of the scapula can occur for no apparent reason. . You can feel it by putting your hand just below the arm pit. When they contract together, they work with the rhomboid muscles to pull your scapula tight against the back of your ribs. The serratus anterior is one of those structures, keeping it strong and loose are two keys to using the serratus to protect your ribs. [5] The muscle is divided into three parts: Image 3: Insertional area of SA on scapula. Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy. Key Points Serratus anterior block is indicated for anterolateral chest wall incisions, targeting the lateral and postcutaneous branches of upper and middle thoracic dermatomes. The function of serratus anterior is to protract . When it overlies the apex of the lung, it gives rise to the companion shadow; when overlying the midlateral lung edge and costophrenic angle it may mimic pleural and/or extrapleural disease. 3, 2022 Radiological Society of North America, The Ribs: Anatomic and Radiologic Considerations. Serratus anterior injuries can be seen in baseball pitchers and rowers, with varying degrees of severity including avulsion from the origin at the ribs 2. Its main part lies deep under the scapula and the pectoral muscles. doi:10.1097/MD.0000000000012515, Mastrella Ade S, Freitas-junior R, Paulinelli RR, Soares LR. stress. It is is common in sports with repetitive motions, eg swimming, tennis, or weightlifting (especially with heavy weights). Injury to the serratus anterior is rare, but if it happens, you may require rehabilitation to get your shoulder moving and functioning normally again.. [7]The other accessory inspiratory muscles include sternocleidomastoid, scalene muscles, pectoralis major, pectoralis minor, trapezius, latissimus dorsi, erector spinae, iliocostalis lumborum, quadratus lumborum[9]. Image from: Kenhub - Illustrator: Yousun Koh, Serratus anterior muscle - lateral view image: Kenhub. This nerve originates from the brachial plexus, a bundle of nerves that emerge from your cervical spine and course down your shoulders and arms. https://www.physio-pedia.com/index.php?title=Serratus_Anterior&oldid=298472. Weakness of the serratus anterior leads to altered line of pull of the. Traumatic avulsion of the serratus anterior muscle in a collegiate rower: a case report. Grounded on academic literature and research, validated by experts, and trusted by more than 2 million users. Read more. You have two serratus anterior muscles; there is one on each side of your body. One common cause of a serratus anterior injury is a problem with the long thoracic nerve. This nerve resides near your armpit, and it may be damaged during surgical procedures involving your shoulder. Furthermore, using these flaps does not typically produce major functional or aesthetic sequelae. 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