Serratus Anterior Pain Syndrome: Symptoms And Treatment

The serratus muscle is in the structure of a fan on the thoracic lateral wall. The key component is deep under the pectoral muscles of the scapula. The pectoralis major and the latissimus dorsal muscles are easy to palpate. These muscles may even be visible to the naked eyes in an athletic body along with the ribs under the axilla. 

The anterior serrate typically originates from the first to the ninth ribs or the first to the eighth ribs by nine or ten slips (muscular branches). Because two bends generally come out of the second rib, the number of slips exceeds the number of ribs from which they emerge.

The position of the muscle is between the upper and lower angles along the medial border of the scapula and is placed in the thoracic vertebral position. The muscle is divided into three sections according to the insertion points – Near the top angle, the anterior serratus superior is inserted.

The intermediate serratus anterior is inserted along the medial boundary. Near the lower angle, the anterior lower serratus is inserted. The anterior serratus sits deeply on the subscapularis, from which it is divided by the supraserratus bursa. The scapulothoracic (infraserratus) bursa separates from the rib.

The anterior serratus is inserted into the brachial plexus of the long thoracic nerve (Bell’s Nerve). The long thoracic nerve moves throughout, on the serratus’ surface. In certain forms of surgery, the nerve is particularly sensitive (e.g., during clearing axilla of the lymph node, when surgery requires axillary dissection); The most common cause of winged scapula is damage to this nerve. Serratus anterior muscle is seen in a human cadaver. 

The scapula around the thoracic, which is important for anterior arm, is pulled all three pieces mentioned above. Thus the muscle is a rhomboid antagonist. However if the bottom and top components act in unison, they hold the scapula together with the rhomboids and thus also act as a rhomboid synergist. The inferior portion will pull the bottom end of the scapula side-by-side and rotate the scapula so the arm can be raised. 

Also, the shoulder girdle may be fixed in all three places and thus contribute to breathing. Big swing muscle or boxer muscle is the other name for serratus anterior. Its main cause is scapula retraction, which is the forward and around the movement of ribcage. This phenomenon happens when someone throws a rock.

The anterior serratus also plays an important role as the scapula rotates upwards when the weight is lifted overhead. This is achieved in combination with high and lower trapezoidal fibres. Another forcing pair type serratus anterior and trapezius, which directs the saplitan posterior tilting and external switch, which holds the subacromial space volume.

The serratus anterior raises the ribcage and thus facilitates breathing if the shoulder blade is in the fixed location e.g. during the sprint. Protraction and upward rotation of the scapulothoracic joint are the key movements, which force the scapula through the thoracic wall. It also retains near the thoracic wall the medial border and lower angle of the scapula.

Serratus  anterior pain

In sports with repetitive movements like swimming, tennis, or lifting,  pain is normal in Serratus (especially with heavyweights).  This pain may also be caused by serratus myofascial anterior syndrome (SAMPS). 

SAMPS may be diagnosed with difficulty and is often achieved by exclusion–  so that other reasons for the pain are ruled out. One may experience pain in the chest or the arm or the hand. This is an unusual syndrome or myofascial. There could be several reasons for muscle pain such as other minor injuries, stress or tension. 

Other than these reasons there could be medical reasons that can lead to the pain in the serratus anterior like a broken rib, inflammation or infection in the lungs, arthritis or asthma. 

Symptoms of serratus anterior pain

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Serratus Anterior

Problems of anterior serratus contribute to the chest, back or arm pain most commonly. It may also be difficult to raise the arms overhead or with the arm and shoulder, or have a natural range of motion.

You will feel this:

  • arm or finger pain
  • tightness
  • pain in the chest 
  • sensitivity
  • difficulty with deep breathing
  • shoulder blade pain

One may not require to visit a doctor for serratus anterior pain, but if you experience the following symptoms, it indicates immediate medical attention.

  • Difficulty in breathing
  • High fever and sour neck
  • Dizziness
  • Pain in the back or chest tends to worsen and does not even improve with rest
  • Muscle pain after starting a new medication or increasing the dosage of an existing medication
  • A tick bite or bull’s-eye rash
  • Pain that disturbs your daily activities  These could be signs of something more serious and should be evaluated as soon as possible.

Serratus Anterior pain will also transmit in other parts of the body, which makes it possible to not always see where the symptoms are caused by the examination and assessment by the doctor in such circumstances. In cases of extreme pain, the doctor prescribes imagery tests for muscle pain including an MRI or x-ray scan. You may want to rule out additional conditions because it is not clear what causes serratus anterior pain. This may lead to further evaluations or referrals to other experts.

Serratus anterior treatment

This is usually a sign of a pulled muscle when you feel muscle pain during an exercise. In these cases, a revised RICE version is recommended:

  • Resting–   Take it easier and try to rest your muscle as much as possible in your everyday activities.
  • Ice–   Using a towel wrapped icepack for 20 minutes, many times a day to the sore portion of the muscle.
  • Compression– Compression to the serratus anterior can be difficult to apply.  Bandages can be applied to the region to minimize swelling.

Non-steroidal anti-inflammatory medicines (NSAIDs) can be helpful to lessen swells and discomfort, such as aspirin (Bufferin) or ibuprofen (Motrin IB or Advil), oral steroids, muscle relaxers, stronger pain medication, joint injections. One can also opt for a massage to loosen muscles.

Serratus anterior pain may be uneasy but normally resolves on its own without any treatment. Remember, stretching before and after activities can reduce the risk of injury — particularly for the muscles, such as the serratus anterior, which we usually do not think about. Call your doctor to rule out something severe if you think you have anterior pain of serratus and do not solve it in a few days.

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