Serratus Anterior: Difference between revisions

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'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} </div>
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== Introduction ==
[[File:Muscles connecting the upper limb to the trunk deep muscles Primal.png|right|frameless]]
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.  Its main part lies deep under the [[scapula]] and the [[Pectoralis major|pectoral muscles]].<ref name=":2" />


* It acts on the scapula and is the prime mover in both scapular protraction and scapular upward rotation.
* Is a key scapular stabilizer, keeping the shoulder blades against the ribcage when at rest and during movement.<ref name=":4">King of the gym Serratus anterior Available:https://www.kingofthegym.com/serratus-anterior/ (accessed 9.1.2022)</ref>.


Image 1: Serratus Anterior.


== Description  ==
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.
It is easy to palpate between the [[pectoralis major]] and [[Latissimus Dorsi Muscle|latissimus dorsi]] muscles.


[[File:Download (1).jpg|thumb]]
== Origin ==
== Origin ==
It originates on the top lateral surface of the eight or nine upper [[ribs]]. <ref name=":0">https://www.healthline.com/human-body-maps/serratus-anterior-muscle#2</ref>
[[File:Serratus anterior muscle - Kenhub.png|alt=Serratus anterior muscle - lateral view|right|frameless|400x400px|Serratus anterior muscle - lateral view <ref>Serratus anterior muscle - lateral view. Image from: © Kenhub - Illustrator: Yousun Koh https://www.kenhub.com/en/library/anatomy/serratus-anterior-muscle</ref>]]
It originates on the top lateral surface of the eight or nine upper [[ribs]]. <ref name=":0">https://www.healthline.com/human-body-maps/serratus-anterior-muscle#2</ref> It then wraps posteromedially around the ribcage, passing beneath the scapula to insert on the underside of the scapula on its medial border.
 
As the muscle extends from the ribs, it is divided by tendinous septa into nine finger-like groupings of muscle fibers called “digitations.”
 
* The fibers run obliquely (to varying degrees) between these septa, forming a multipennate muscle architecture.
* Upper three digitations are termed the superior fibers , lower six digitations are termed the inferior fibers.
* The lowest four digitations of the serratus anterior interdigitate with the fibers of the external oblique.
 
Image 2: Serratus anterior muscle seen from a lateral view. <ref > Serratus anterior muscle - lateral view image: © Kenhub https://www.kenhub.com/en/library/anatomy/serratus-anterior-muscle</ref>


== Insertion==
== Insertion==
It inserts exactly at the front border of the scapula, or shoulder blade.<ref name=":0" />
[[File:Serratus Anterior origin .png|right|frameless|alt=|335x335px]]
The muscle is divided into three parts :
It inserts on the front border of the scapula.<ref name=":0" /> The muscle is divided into three parts :
* Upper / Superior : 1st to 2nd rib → superior angle of scapula.
* Upper / Superior : 1st to 2nd rib → superior angle of scapula.
* Middle / Intermedius : 2nd to 3rd rib → medial border of scapula.
* Middle / Intermedius : 2nd to 3rd rib → medial border of scapula.
Line 25: Line 35:


[https://www.kenhub.com/en/library/anatomy/serratus-anterior-muscle]
[https://www.kenhub.com/en/library/anatomy/serratus-anterior-muscle]
</ref>
</ref>  
 
Image 3: Insertional area of SA on scapula.
== Nerve ==
The long thoracic nerve, which arises from C5 to C7 nerve roots of the [[brachial plexus]].<ref name=":2">Lung K, Lui F. [https://www.ncbi.nlm.nih.gov/books/NBK531457/ Anatomy, Thorax, Serratus Anterior Muscles.] InStatPearls [Internet] 2018 Dec 9. StatPearls Publishing.</ref>
 
== Blood supply ==
Lateral thoracic artery, the superior thoracic artery and the thoracodorsal artery.<ref name=":2" /> 


== Action ==
== Nerve and Blood Supply ==
The main actions are protraction and upward rotation of the scapulothoracic joint, moving the scapula forward across the thoracic wall. It also keeps the medial boarder and inferior angle of the scapula close to the thoracic wall.<ref>Richard D. Gray’s anatomy for students.</ref>


{{#ev:youtube|kTxqYkDdle4}}
# The long thoracic [[Neurone|nerve]], which arises from C5 to C7 nerve roots of the [[Brachial Plexus|brachial plexus]].<ref name=":2">Lung K, Lui F. [https://www.ncbi.nlm.nih.gov/books/NBK531457/ Anatomy, thorax, serratus anterior muscles.] StatPearls [Internet]. 2020 Jul 10. Available: https://www.ncbi.nlm.nih.gov/books/NBK531457/ (accessed 9.1.2022)</ref>
# Lateral thoracic [[Arteries|artery]], the superior thoracic artery and the thoracodorsal artery.<ref name=":2" /> 


== Functional Considerations  ==
== Function ==
Scapular protraction function of serratus anterior occurs simultaneously when reaching forward or pushing objects away from the body, increasing the functional length of the arm. Also in push-up plus exercise, the reverse protraction action of both serratus anterior results in lifting the trunk and ribs upwards.
[[File:Boxing gym.jpeg|right|frameless]]
The main actions are protraction and upward rotation of the [[Scapulothoracic Joint|scapulothoracic joint]].<ref>Richard D. Gray’s anatomy for students.</ref> 


The force-couple of the serratus anterior and trapezius muscles results in scapula upwards rotation which is essential during shoulder abduction and flexion.  
It’s also a key scapular stabilizer, keeping the shoulder blades against the ribcage when at rest and during movement. 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<ref name=":2" />. See [[Dynamic Stabilisers of the Shoulder Complex]] and [[Scapulohumeral Rhythm]].
[[File:Bower.jpeg|right|frameless]]
When the shoulder blade is in fixed position the [[Muscles of Respiration|accessory inspiratory muscles]] (used in respiratory distress)  are activated e.g breathing after a boxing bout, person with [[emphysema]]. The serratus anterior lifts the ribcage and thus supports breathing.<ref name=":1" />The other accessory inspiratory muscles include sternocleidomastoid, scalene muscles, pectoralis major, pectoralis minor, trapezius, latissimus dorsi, erector spinae, iliocostalis lumborum, quadratus lumborum<ref>Ken hub [https://www.kenhub.com/en/library/anatomy/anatomy-of-breathing Anatomy of breathing] Available:https://www.kenhub.com/en/library/anatomy/anatomy-of-breathing (accessed 9.1.2022)</ref>


The serratus anterior and trapezius muscles form another forcre-couple that guides scaplular posterior tilt and outwards rotation, which maintains the volume of the subacromial space.<ref name=":3">Neumann DA, Camargo PR. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6849091/ Kinesiologic considerations for targeting activation of scapulothoracic muscles-part 1: serratus anterior.] Brazilian journal of physical therapy. 2019 Nov 1;23(6):459-66.</ref>
Image 4: The serratus anterior is also known as the “boxer’s muscle,” as it is largely responsible for the protraction of the scapula which occurs when throwing a punch.


When the shoulder blade is in fixed position , e.g : breathing after a sprint , the serratus anterior lifts the ribcage and thus supports breathing.<ref name=":1" />
Image 5: When the shoulder blade is in fixed position the [[Muscles of Respiration|accessory inspiratory muscles]] (used in respiratory distress)  are activated.


==Clinical Relevance==
==Clinical Relevance==
[[File:Bench press.jpeg|right|frameless]]
The most common causes of serratus muscle pain include: tension; [[Stress and Health|stress]]; overuse.


=== Scapular Winging ===
* It is is common in sports with repetitive motions, eg swimming, tennis, or weightlifting (especially with heavy weights).
Dysfunction of the serratus anterior muscle is from the causes of [[Winged scapula|scapular winging]]. Weakness of the serrratus anterior muscle, leads to the unopposed action of the glenohumeral abductors which result in scapula downwards rotation, inwards rotation and anterior tilt during shoulder abduction and flexion. If this position is maintained it’d lead to adaptive shortening of the [[Pectoralis Minor|pectoralis minor]] muscle resulting in more scapular anterior tilt and inwards rotation. Explaining the scapular “winging” posture associated with weak serratus anterior.<ref name=":3" />
* This pain may also result from serratus anterior myofascial pain syndrome (SAMPS), a rare [[Myofascial Pain|myofascial pain]] syndrome.<ref>Health Line Serratus Anterior Available: https://www.healthline.com/health/serratus-anterior-pain#causes (accessed 9.1.2022)</ref>
Image 6: Bench press, stresses SA


The most common cause of scapular winging is injury to the long thoracic nerve, leading to serratus anterior palsy. The long thoracic nerve descends across the lateral thoracic wall, making it susceptible to injury during anterolateral thorax surgeries . Other causes of isolated serratus anteiro palsy  are traumas, strenrous work, athletics, anesthesia, infection and idiopathic causes. Neuropraxia of the long thoracic nerve could result from compression or stretch injuries.  
When the serratus anterior is inhibited, lengthened or weakened, scapular protraction and scapular upward rotation are impaired. This limits overhead range of motion and reduces overall scapular/shoulder stability, increasing the risk of injury to the rotator cuff and shoulder girdle. Common causes for this include:


Muscular avulsion of the serratus anterior muscle is from the less recognized causes of scapular winging.<ref>Didesch JT, Tang P. Anatomy, etiology, and management of scapular winging. The Journal of hand surgery. 2019 Apr 1;44(4):321-30.</ref>
*[[Upper-Crossed Syndrome|Upper Crossed Syndrome]]
* Damage to the long thoracic nerve can weaken, or even paralyze, the serratus anterior. Neurogenic scapular winging (i.e. [[Winged scapula|scapular winging]] caused by [[Neuropathies|nerve damage]]) requires a doctor to verify if scapular winging is neurogenic<ref name=":4" />.
* Weakness of the serratus anterior leads to altered line of pull of the [[Rotator Cuff|rotator cuff]] muscle which could increase the risk of [[Subacromial Pain Syndrome|subacromial impingement syndrome]].<ref name=":3">Neumann DA, Camargo PR. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6849091/ Kinesiologic considerations for targeting activation of scapulothoracic muscles-part 1: serratus anterior.] Brazilian journal of physical therapy. 2019 Nov 1;23(6):459-66.</ref>
==Assessment==
[[File:Axilla .png|right|frameless|300x300px]]


=== Subacromial Impingement ===
=== Palpation ===
Weakness of the serratus anterior leads to altered line of pull of the [[Rotator Cuff|rotator cuff]] muscle which could increase the risk of [[Subacromial Pain Syndrome|subacromial impingement syndrome]].
The serratus anterior muscle is very thin and covers the side of the ribcage. 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.<ref name=":2" />
 
Also, serratus anterior is needed for scapula upward rotation. posterior tilt and, to a lesser extent, external rotation of the scapula which may increase or maintain the volume of the subacromial space reducing the likelihood of subacromial impingement.<ref name=":3" />
 
=== Serratus Anterior Muscle Pain Syndrome (SAMPS) And Trigger Points ===
Chronic chest pain of noncardiac origin is a heterogeneous disorder, and myofascial pain syndrome is often an overlooked cause that can affect a single muscle or several functional muscle units; it is characterized by taut bands, commonly described as [[Trigger Points|trigger points]].
The syndrome includes a constellation of symptoms one of which is pain overlying the fifth to seventh ribs in the midaxillary line.
Referred pain may radiate toward the anterior chest wall, the medial aspect of the arm, and finally, toward the ring and little finger on the ipsilateral side .
The pain of SAMPS can be intermittent or constant.
The serratus mainly contributes to :
* Pain between shoulder blades
* Golfers elbow pain
* Rib pain
* Arm pain<ref>Calais-German, Blandine. Anatomy of Movement. Seattle: Eastland Press, 1993. Print
Davies, Clair, and Davies, Amber. The Trigger Point Workbook: Your Self-Treatment Guide For Pain Relief. Oakland: New Harbinger Publications, Inc., Print
Simons, David G., Lois S. Simons, and Janet G. Travell. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore, MD: Williams & Wilkins, 1999. Print.
Schünke, Michael., Schulte, Erik, and Schumacher, Udo. Prometheus: Lernatlas der Anatomie. Stuttgart/New York: Georg Thieme Verlag, 2007. Print
 
[https://www.muscle-joint-pain.com/trigger-points/trigger-point-self-treatment/serratus-anterior/]
</ref>
'''Differential Diagnosis'''
 
Intercostal Nerve Neuralgia


It can be differentiated through palpation.
Image 7: SA seen her between the pectoralis major and latissimus dorsi muscles.  
In SAMPS , palpation of trigger points will produce the pain that occurs spontaneously.
In intercostal neuralgia , palpation will not produce pain or referred pain  because the pain of intercostal neuralgia is situated along a dermatome.
==Assessment==
=== Palpation ===
The serratus anterior muscle is very thin and covers the side of the ribcage.
* You can feel it by putting your hand just below the arm pit.
* You can feel it by putting your hand just below the arm pit.
* It also helps to experience how your ribs feel, so that you can distinguish the ribs and this thin and superficial muscle.
* It also helps to experience how your ribs feel, so that you can distinguish the ribs and this thin and superficial muscle.
* To do so, just feel the first ribs under your nipple.
* Now you will be able to distinguish the muscle from the ribs.


=== Muscle Test ===
=== Muscle Test ===
First, the [[Serratus Anterior Strength Test or ( Punch out test )|Wall push up test]], the patient is asked to flex his arm to 90 degrees and do a wall push up. Weak serratus anterior muscle would result in winging of the scapula medial border. <ref>David J. Magee. Orthopedic Physical Assessment. 6th edition. Elsevier. 2014.</ref>
The 3 tests below can be used to examine the serratus anterior muscle weakness and scapula winging
{{#ev:youtube|7I3XKowVwP4}}
The second is the shoulder abduction test, the therapist applies a downwards resisting force against the scapular plane abduction of the shoulder at about 120–130° and against upward rotation of the scapula. A weak serratus anterior would result in the patient failing to resist the therapist’s force resulting in the shoulder breaking into adduction and the scapula can't rotate upwards significantly. <ref name=":3" />


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. The therapist resists the maximally protracting force by the patient. In case of serratus anterior muscle weakness the patient’s scapula is pushed into a retracted and internally rotated position leading to scapular winging appearance.<ref name=":3" />
# [[Serratus Anterior Strength Test or ( Punch out test )|Serratus Anterior Strength Test or Push Out Test]] is used to examine the serratus anterior muscle weakness and scapula winging. <ref>David J. Magee. Orthopedic Physical Assessment. 6th edition. Elsevier. 2014.</ref>
# Shoulder abduction test. Therapist applies a downwards resisting force against the scapular plane abduction of the shoulder at about 120–130° and against upward rotation of the scapula. A weak serratus anterior would result in the patient failing to resist the therapist’s force resulting in the shoulder breaking into adduction and the scapula can't rotate upwards significantly. <ref name=":3" />
# 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. The therapist resists the maximally protracting force by the patient. In case of serratus anterior muscle weakness the patient’s scapula is pushed into a retracted and internally rotated position leading to scapular winging appearance.<ref name=":3" />See video below.
{{#ev:youtube|9Jqy6CoknGU}}
{{#ev:youtube|9Jqy6CoknGU}}


== Exercises for Activating Serratus Anterior ==
== Exercises for Activating Serratus Anterior ==
[[Press-Up|Push-up plus]]
[[File:Plank exercise.jpg|right|frameless]]
The serratus anterior is trained indirectly in all anterior [[deltoid]] exercises. It works to some extent in the select few chest exercises that involve scapular protraction A few examples include:
 
* Isometric Exercises: [[Plank exercise|Plank]] (emphasizing protraction); Straight arm plank (emphasizing protraction)
* Incline shoulder raise
* Flat shoulder raise
* Overhead shrug
* [[Press-Up|Push-up plus]]
* Serratus anterior punch<ref name=":3" />
Image 8: Plank exercise.


Dynamic hug


Serratus anterior punch
== Resources==
Watch this comprehensive video from Kenhub (3 minutes)  <ref > Serratus anterior muscle video -  © Kenhub https://www.kenhub.com/en/library/anatomy/serratus-anterior-muscle</ref>


Wall slide tasks<ref name=":3" />
{{#ev:youtube|kTxqYkDdle4}}


== References==
== References==

Latest revision as of 19:02, 8 March 2024

Original Editor - Esraa Mohamed Abdullzaher

Top Contributors - Lucinda hampton, Kholoud Abd Elghany, Kim Jackson, Joao Costa, Lilian Ashraf, Esraa Mohamed Abdullzaher and Oyemi Sillo

Introduction[edit | edit source]

Muscles connecting the upper limb to the trunk deep muscles Primal.png

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. Its main part lies deep under the scapula and the pectoral muscles.[1]

  • It acts on the scapula and is the prime mover in both scapular protraction and scapular upward rotation.
  • Is a key scapular stabilizer, keeping the shoulder blades against the ribcage when at rest and during movement.[2].

Image 1: Serratus Anterior.


Origin[edit | edit source]

Serratus anterior muscle - lateral view

It originates on the top lateral surface of the eight or nine upper ribs. [4] It then wraps posteromedially around the ribcage, passing beneath the scapula to insert on the underside of the scapula on its medial border.

As the muscle extends from the ribs, it is divided by tendinous septa into nine finger-like groupings of muscle fibers called “digitations.”

  • The fibers run obliquely (to varying degrees) between these septa, forming a multipennate muscle architecture.
  • Upper three digitations are termed the superior fibers , lower six digitations are termed the inferior fibers.
  • The lowest four digitations of the serratus anterior interdigitate with the fibers of the external oblique.

Image 2: Serratus anterior muscle seen from a lateral view. [5]

Insertion[edit | edit source]

It inserts on the front border of the scapula.[4] The muscle is divided into three parts :

  • Upper / Superior : 1st to 2nd rib → superior angle of scapula.
  • Middle / Intermedius : 2nd to 3rd rib → medial border of scapula.
  • Lower / Inferior : 4th to 9th rib → medial border and inferior angle of scapula. It is the most powerful and prominent part.[6]

Image 3: Insertional area of SA on scapula.

Nerve and Blood Supply[edit | edit source]

  1. The long thoracic nerve, which arises from C5 to C7 nerve roots of the brachial plexus.[1]
  2. Lateral thoracic artery, the superior thoracic artery and the thoracodorsal artery.[1] 

Function[edit | edit source]

Boxing gym.jpeg

The main actions are protraction and upward rotation of the scapulothoracic joint.[7]

It’s also a key scapular stabilizer, keeping the shoulder blades against the ribcage when at rest and during movement. 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]. See Dynamic Stabilisers of the Shoulder Complex and Scapulohumeral Rhythm.

Bower.jpeg

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. The serratus anterior lifts the ribcage and thus supports breathing.[6]The other accessory inspiratory muscles include sternocleidomastoid, scalene muscles, pectoralis major, pectoralis minor, trapezius, latissimus dorsi, erector spinae, iliocostalis lumborum, quadratus lumborum[8]

Image 4: The serratus anterior is also known as the “boxer’s muscle,” as it is largely responsible for the protraction of the scapula which occurs when throwing a punch.

Image 5: When the shoulder blade is in fixed position the accessory inspiratory muscles (used in respiratory distress) are activated.

Clinical Relevance[edit | edit source]

Bench press.jpeg

The most common causes of serratus muscle pain include: tension; stress; overuse.

  • It is is common in sports with repetitive motions, eg swimming, tennis, or weightlifting (especially with heavy weights).
  • This pain may also result from serratus anterior myofascial pain syndrome (SAMPS), a rare myofascial pain syndrome.[9]

Image 6: Bench press, stresses SA

When the serratus anterior is inhibited, lengthened or weakened, scapular protraction and scapular upward rotation are impaired. This limits overhead range of motion and reduces overall scapular/shoulder stability, increasing the risk of injury to the rotator cuff and shoulder girdle. Common causes for this include:

Assessment[edit | edit source]

Axilla .png

Palpation[edit | edit source]

The serratus anterior muscle is very thin and covers the side of the ribcage. 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]

Image 7: SA seen her between the pectoralis major and latissimus dorsi muscles.

  • You can feel it by putting your hand just below the arm pit.
  • It also helps to experience how your ribs feel, so that you can distinguish the ribs and this thin and superficial muscle.

Muscle Test[edit | edit source]

The 3 tests below can be used to examine the serratus anterior muscle weakness and scapula winging

  1. Serratus Anterior Strength Test or Push Out Test is used to examine the serratus anterior muscle weakness and scapula winging. [11]
  2. Shoulder abduction test. Therapist applies a downwards resisting force against the scapular plane abduction of the shoulder at about 120–130° and against upward rotation of the scapula. A weak serratus anterior would result in the patient failing to resist the therapist’s force resulting in the shoulder breaking into adduction and the scapula can't rotate upwards significantly. [10]
  3. 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. The therapist resists the maximally protracting force by the patient. In case of serratus anterior muscle weakness the patient’s scapula is pushed into a retracted and internally rotated position leading to scapular winging appearance.[10]See video below.

Exercises for Activating Serratus Anterior[edit | edit source]

Plank exercise.jpg

The serratus anterior is trained indirectly in all anterior deltoid exercises. It works to some extent in the select few chest exercises that involve scapular protraction A few examples include:

  • Isometric Exercises: Plank (emphasizing protraction); Straight arm plank (emphasizing protraction)
  • Incline shoulder raise
  • Flat shoulder raise
  • Overhead shrug
  • Push-up plus
  • Serratus anterior punch[10]

Image 8: Plank exercise.


Resources[edit | edit source]

Watch this comprehensive video from Kenhub (3 minutes) [12]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Lung K, Lui F. Anatomy, thorax, serratus anterior muscles. StatPearls [Internet]. 2020 Jul 10. Available: https://www.ncbi.nlm.nih.gov/books/NBK531457/ (accessed 9.1.2022)
  2. ↑ 2.0 2.1 King of the gym Serratus anterior Available:https://www.kingofthegym.com/serratus-anterior/ (accessed 9.1.2022)
  3. ↑ Serratus anterior muscle - lateral view. Image from: © Kenhub - Illustrator: Yousun Koh https://www.kenhub.com/en/library/anatomy/serratus-anterior-muscle
  4. ↑ 4.0 4.1 https://www.healthline.com/human-body-maps/serratus-anterior-muscle#2
  5. ↑ Serratus anterior muscle - lateral view image: © Kenhub https://www.kenhub.com/en/library/anatomy/serratus-anterior-muscle
  6. ↑ 6.0 6.1 M. Schünke/E. Schulte/U. Schumacher: Prometheus – LernAtlas der Anatomie – Allgemeine Anatomie und Bewegungssystem, 2.Auflage, Thieme Verlag (2007), S.294-295 J. E. Muscolino: The muscular system manual – The skeletal muscles of the human body, 2.Auflage, Elsevier Mosby (2005), S.214-217 P. Berlit: Klinische Neurologie, 3.Auflage, Springer Verlag (2011), S.345 [1]
  7. ↑ Richard D. Gray’s anatomy for students.
  8. ↑ Ken hub Anatomy of breathing Available:https://www.kenhub.com/en/library/anatomy/anatomy-of-breathing (accessed 9.1.2022)
  9. ↑ Health Line Serratus Anterior Available: https://www.healthline.com/health/serratus-anterior-pain#causes (accessed 9.1.2022)
  10. ↑ 10.0 10.1 10.2 10.3 Neumann DA, Camargo PR. Kinesiologic considerations for targeting activation of scapulothoracic muscles-part 1: serratus anterior. Brazilian journal of physical therapy. 2019 Nov 1;23(6):459-66.
  11. ↑ David J. Magee. Orthopedic Physical Assessment. 6th edition. Elsevier. 2014.
  12. ↑ Serratus anterior muscle video - © Kenhub https://www.kenhub.com/en/library/anatomy/serratus-anterior-muscle
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