Serratus Anterior Muscle Anatomy, winged scapula - Everything You Need To Know - Dr. Nabil Ebraheim

Educational video describing the anatomy of the Serratus Anterior muscle.
Serratus anterior muscle originates on the superolateral surfaces of the upper 8 or 9 ribs and inserts into the medial border on the anterior side of the scapula. The serratus anterior muscles are divided into 3 parts: serratus anterior superior, serratus anterior intermediate, serratus anterior inferior.
The serratus anterior muscle is the most powerful “protractor” of the scapula. The scapula is moved laterally and anteriorly along the chest wall. The serratus anterior muscles are sometimes called the “boxer’s muscle” or the “big swing muscle” . with the same motion that occurs from throwing a punch, the serratus anterior muscles are responsible for pulling of the scapula forward and around the rib cage. The serratus anterior muscle is innervated by the long thoracic nerve.
The deficit of the serratus anterior muscle is most commonly caused due to impingement injury of the long thoracic nerve. The long thoracic nerve arises from three nerve roots, the fifth, sixth, and seventh cervical nerves. The long thoracic nerve then passes between the clavicle and first rib, then down along the lateral chest wall giving innervation to the serratus anterior muscle. If the serratus anterior muscle becomes paralyzed, the condition known as “medial winging of the scapula” may occur. The long thoracic nerve can be injured by:
•Trauma
•Pressure
•Neuritis/inflammation
•Surgery
Signs/symptoms of long thoracic nerve injury
•Medial winging of the scapula
•Difficulty elevating arm
•Weakness
•Pain
•Spasms: periscapular muscles trying to compensate for deformity
•Cosmetic deformity
Clinical evaluation tests for medial winging of the scapula:
•Wall test: the patient is asked to face a wall, standing about two feet from the wall and then push against the wall with flat palms at waist level in order to identify a long thoracic nerve injury.
•The resistance of forward flexion test: this is the resisted forward flexion test in which the patient resists the examiner’s attempt to bring down the forward flexed upper limbs.
Lateral scapular winging is different than medial winging of the scapula. Lateral scapular winging is due to dysfunction of the trapezius muscle. Lateral scapular winging involves injury to the spinal accessory nerve.
Treatment of medial scapular winging
•Non-operative:
•Observation for a minimal of 18 months- wait for nerve to recover without surgery
•MRI to indicate if a lesion is pressing on the nerve
•Muscle test and EMG
•Serratus anterior strengthening
Operative
•Pectoralis major transfer
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