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Serratus Anterior Muscle: Rib, Arm, Finger and Upper Back Pain

Serratus Anterior Muscle Pain

The serratus anterior contributes to pain on the side of the ribcage and/or around the shoulder blade. Pain may radiate to the inside of the arm descending down to the hand and into the ring and little fingers. Pain and tightness may be felt in the chest. You may also experience difficulty breathing, pain when inhaling and the feeling that you cannot completely exhale.

Serratus Anterior Origin, Insertion, Action, Innervation
Serratus Anterior Referred Pain Pattern

Where Is The Serratus Anterior Muscle?

The serratus anterior attaches ribs 1-8 to the shoulder blade (scapula).

What Movements Does The Serratus Anterior Muscle Control?

  • Pulls shoulder blades forward toward the front of body
  • Aids with inhalation by raising the ribs
Serratus Anterior Origin, Insertion, Action
Serratus Anterior Muscle

Looking for detailed muscle anatomy? The Serratus Anterior Muscle Anatomy page has origin, insertion, innervation, and blood supply information. It also lists agonists and antagonists for each muscle action.

What Are The Signs and Symptoms of Serratus Anterior Trigger Points?

Serratus anterior trigger point (TrP) pain can be localized on the side of the ribs under the arm. The trigger point may refer pain into the inside of the arm that travels down into the hand to the ring and little fingers. It can also refer pain to the inside border of the shoulder blade.

Symptoms Include:

  • Pain in the ribs just under the armpit.
  • Pain down the inside of the arm to the fourth and fifth fingers
  • Pain below the shoulder blade
  • Pain when inhaling
  • The feeling that you cannot fully exhale
  • Sharp pain in the side (side stitch)
  • Pain and difficulty reaching behind the body
  • Pain and difficulty when pulling shoulders back
  • Sensitivity in and around the area of the breast
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Trigger points are small knots found in the muscle that when pressed increase pain in the area or send referred pain to another area of the body. To learn more about trigger points read Muscle Trigger Points and How They Contribute To Muscle and Joint Pain.

What Causes Trigger Points To Develop In The Serratus Anterior Muscle?

  • Hyperventilation
  • Intense coughing and sneezing
  • Slumping posture
  • Lifting or holding heavy objects overhead
  • Swimming
  • Tennis
  • Chin-ups
  • Push-ups
  • Weightlifting
  • Gymnastics specifically the rings and pommel horse
  • Riding a bicycle for an extended period of time (the up and down motion of peddling affects muscle)
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How To Avoid Development of Trigger Points

  • Pay attention to how you breathe. When inhaling and exhaling your abdomen should be rising and falling. The movement should not be in the chest. Concentrate on inhaling deeper until the abdomen expands then exhale slowly. Keep practicing until it becomes a habit.
  • If you find yourself hyperventilating, concentrate on slowing down your breathing. And yes, breathing into a paper bag works!
  • Stand and sit up straight. Slumping posture contributes to shallow or chest breathing which taxes the muscle.
  • When you find yourself becoming out of breath during exercise and other strenuous activities take a break and catch your breath. Straining to catch your breath is a major contributor to serratus anterior trigger points.
  • Coughing and sneezing are how the lungs and sinuses clear themselves and force out impurities. But if you are sick, have allergies, or a chronic condition that affects your breathing, you may need help suppressing continuous coughing and sneezing. Talk to your doctor about solutions that will work for you.
  • When exercising, pay attention to your form and do the exercise correctly. Don't push too far past your conditioning.
  • Athletes who swim, play tennis, golf or baseball are susceptible to trigger points in the serratus anterior due to overuse of the muscle. Make a habit of checking the muscle for tender points to stay on top of treatments.

Improper or irregular breathing is one of the main contributors to serratus anterior muscle dysfunction.  Learn To Breathe is a DVD by internationally renowned yoga instructor Max Strom that walks you through several breathing exercises that will help you improve your quality of breathing. The exercises are especially beneficial for people who suffer from breathing problems such as asthma,  emphysema,  COPD, and allergies.  I often recommend this DVD to friends and clients who have breathing problems. Yoga experience is not necessary.

Sombra Warm Therapy Gel is recommended for relaxing muscles and relieving pain. It warms without the burning heat of other gels. An excellent choice for pain caused by trigger points, muscle/joint over-use and stiffness, and arthritis. (Not sold in stores)

Serratus Anterior Trigger Point Treatment

The serratus anterior muscle is easily self-treated. The Trigger Point Therapy Workbook is an excellent book that will teach you how to locate and treat trigger points throughout the body.

If you would prefer someone to show you how to find and treat specific trigger points many chiropractors, physical therapists, and massage therapists are trained in trigger point therapy. Not all have the specific training, so be sure and ask before making an appointment.

The best resource to learn how to treat small painful knots is The Trigger Point Therapy Workbook. The authors explain trigger points and their effects in everyday language, not medical speak. I recommend this book to anyone interested in learning to treat their own muscle pain.

How Long Before I Feel A Reduction In Pain?

A reduction of pain and easier breathing is noticeable almost immediately. Treat the trigger point several times a day for 1-2 minutes for relief. It is important to continue treatment until the trigger point is deactivated and cannot be felt any longer. Treatment consistency is important for success!

Interesting facts about the serratus anterior muscle:

  • The serratus anterior is easily taxed by hard or heavy breathing. People with asthma and emphysema often suffer from symptoms of this muscle. Tightness and trigger points in the serratus anterior can contribute to headaches, jaw pain, dizziness, and numb hands for those who have difficulty breathing because of asthma, COPD, and emphysema.

Serratus anterior muscle pain and symptoms can be similar to, contribute to, and be affected by these medical diagnoses:

  • Thoracic outlet syndrome
  • Slipped rib
  • Intercostal muscle tear
  • Asthma
  • COPD
  • Emphysema
  • Pleurisy
  • C5 C6 C7 C8 radiculopathy
  • T1 T2 T3 T4 radiculopathy
  • Gallbladder Dysfunction
  • Pancreatitis
  • Ankylosing spondylosis
  • Heart Disease

 

Cureve Hot Cold Pack can be used for warm and cold treatments. To ease serratus anterior symptoms heat and drape horizontally across the back covering the sides and ribs. This large pack can be used on many areas of the body and can be wrapped around arms and legs for full treatment of a stiff painful area.

Other muscles that should be considered and examined in conjunction with the serratus anterior muscle:

Satellite trigger points associated with the serratus anterior muscle:

If you find trigger points in the serratus anterior it is likely you will find trigger points in some or all of these muscles:

  • Latissimus Dorsi
  • Scalenes
  • Sternocleidomastoid
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