Anatomy, Function & Dysfunction Rhomboid Muscles - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes anatomy, function, and dysfunction of the rhomboids muscles in the posterior shoulder.

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The rhomboid muscles lie underneath the trapezius muscle. The rhomboid muscles connect the scapula to the vertebrae, so they are really helping to hold the scapula close to the thoracic wall. The rhomboid muscles get their name from their combined shape (having the shape of a rhombus). The word rhomboid means a “diamond” or “kite” shaped object. The rhomboid minor arises from the nuchal ligament and the spinous processes of C7 and T1 vertebrae. It inserts into the medial border of the scapula above the insertion of the rhomboid major muscle. The rhomboid major arises from the spinous processes from T2, T3, T4, and T5 vertebrae. It inserts into the medial border, which is the vertebral border of the scapula. From the level of the scapular spine to the inferior angle of the scapula. The rhomboids adduct or retract the scapula by pulling the scapula towards the vertebral column. The rhomboids work with the levator scapulae to elevate the medial border of the scapula. The rhomboids also rotate the scapula downwards with respect to the glenohumeral joint. The rhomboids participate in proper movement and stability of the scapula which is critical for shoulder function. Clinical entities related to the rhomboid major and rhomboid minor muscles is the brachial plexus injury. If the patient has a brachial plexus injury and the EMG shows evidence of an intact signal in the serratus anterior muscle (supplied by the long thoracic nerve) and also an intact signal in the rhomboid muscles (supplied by the dorsal scapular nerve), this situation indicates that the lesion of the brachial plexus is a postganglionic injury which will have a better prognosis than a preganglionic injury of the brachial plexus (poor prognosis). Preganglionic injury is associated with Horner’s Syndrome (ptosis, miosis, and anhidrosis) due to disruption of the sympathetic chain. There will also be medial winging of the scapula due to loss of the serratus anterior and the rhomboids muscle function. The inferior border of the scapula will move medially. In the pre-ganglionic injury the brachial plexus, there will be loss of the muscle function of the levator scapula and the rhomboids muscles. Basically, you will exam proximally the muscles that are innervated (root level motor branches, nerves that are coming out of the roots). Detecting if the brachial plexus injury is a preganglionic or postganglionic injury is important! A normal paraspinal muscle activity on EMG indicates a postganglionic injury which will have a good prognosis. Usually the patient will complain about superficial pain between the shoulder blades and the patient describes this pain as “ache” or that they feel “knots.” The pain is closer to the scapula than to the spine. The pain occurs especially at rest and movement does not influence the pain. The patient may also feel grinding, snapping, or a crunching noise during movement of the scapula. In this case, you need to rule out scapulothoracic impingement or a snapping scapula. Other muscle trigger points can be associated with rhomboid muscle trigger points. What may aggravate the condition of rhomboids trigger points? Painters who are holding their arm above the head for a long time. Bad posture may also cause aggravation. People who work habitually in a slumped forward, round shoulder position (protracted position) such as a computer related desk job, sewing, or reading. In this situation, the pectoralis muscle which is antagonistic to the retraction function of the rhomboid muscles, may have become shortened and over active. The rhomboids become stretched from trying to counter act the pull of the pectoralis muscle. To avoid aggravating the problem, some physicians believe it is better to work o stretching out the pectoralis first before working on the rhomboids, because if you stretch the rhomboids with a tight pectoralis muscle, this may increase the weakness and irritation of the rhomboids trigger points. Treatment of rhomboids trigger point pain include: anti-inflammatory medication, try to stretch the pectoralis muscle first, rhomboid trigger point release (tennis ball), and possible injection of the trigger points. It may be really hard to tell if it is the rhomboids that is causing the pain between the shoulder blades or other muscles that are inserted around the same area.

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