Serratus Posterior Superior Muscle: Back, Arm, Hand Pain

Serratus Posterior Superior Pain

The serratus posterior superior muscle is located in the upper back. It contributes to pain in the upper back, chest, arm, and hand. Two indicators of this muscles’ dysfunction are a deep aching pain under the shoulder blade and/or in the little finger.

The muscle can also cause a sharp stabbing pain when you inhale making breathing difficult.

Contents Of Article:

Muscle Location

Trigger Point Symptoms 

Trigger Points Cause

Trigger Point Prevention

Trigger Point Treatment

Interesting Facts 

Muscle Strain

Strain Treatment and Prevention

Serratus Posterior Superior Muscle Pain Pattern Serratus Posterior Superior Referred Pain Pattern

Where is the serratus posterior superior muscle?

The serratus posterior superior muscle connects the bottom neck vertebrae (C7)  and the top upper back vertebrae (T1, T2, T3) to the 2nd – 5th ribs.

What Movements Does It Control?

  • Forced inspiration (breathing in sharply when gasping or breathing hard)
  • Raises the 2nd -5th ribs to assists inhalation
Serratus Posterior Superior Muscle Serratus Posterior Superior Muscle

Looking for detailed muscle anatomy? The Serratus Posterior Superior 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 Posterior Superior Trigger Points?

A deep aching pain under the shoulder blade is one indicator of trigger points (TrPs) in the muscles. Another tale-tell symptom of TrPs in this muscle is an aching pain in the little finger. Trigger points can also cause pain to run down the back of the arm concentrating in the point of the elbow. The pain often descends down the back of the forearm into the wrist, hand, and into the ring and little fingers.

The serratus posterior superior raises the upper ribs during inhalation. Trigger points in the muscle are also notorious for contributing to breathing difficulty, specifically taking a deep breath.

The symptoms:

  • Deep aching under the shoulder blade
  • Pain in the low point of the elbow
  • Pain in the wrist and hand extending into the little finger
  • Pain persists even at rest
  • Pain is occasionally felt in the chest muscles
  • Difficulty breathing especially inhaling

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 Posterior Superior Muscle?

  • Labored breathing (asthma, emphysema, bronchitis, pneumonia)
  • Gasping for air during sports activities
  • Extreme coughing or sneezing “fits”
  • Hyperventilation
  • A habit of shallow chest breathing
  • Lifting heavy objects with arms straight to the front of the body
  • Rounded shoulder posture

Improper or irregular breathing is a major contributor to serratus posterior superior muscle pain.  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.

How To Avoid Development of Trigger Points In The Serratus Posterior Superior Muscle

  • Pay attention to your posture. Standing, lifting, sitting, and sleeping with a curve in your upper back and/or keeping your shoulders rolled forward keeps the serratus posterior superior in a constant state of tension.
  • Not breathing properly is another big contributor to the development of trigger points. Make sure you are “belly breathing” which is breathing deeply so your belly extends while inhaling. Short shallow breathing, in which breathing movement is in the chest (chest or shallow breathing), overworks the muscle which will cause trigger points to develop.
  • Don’t lift or carry objects with your arms straightened in front of the body.

Keeping your spine aligned during your daily activities will help prevent many muscular aches and pains.

Serratus Posterior Superior Trigger Point Treatment

Trigger points in this muscle can be difficult to find and treat because the muscle is located under the shoulder blade. Fortunately, the trigger point can be uncovered by taking the hand of the affected side and grabbing the opposite shoulder which moves the shoulder blade and uncovers the TrP.

Once uncovered, the trigger points can be located and treated. A physical therapist, massage therapist, sports therapist, or a chiropractor trained in TrP therapy can show you how to find the trigger point and apply self-treatment. Not all have the specified training so be sure to inquire before making an appointment.

If you have time and patience, you can learn self-treatment. The Trigger Point Therapy Workbook is an excellent book to have on hand. It explains trigger points, how and why they develop and provides diagrams of their location in each muscle and how to apply self-treatment. The best thing about owning this book you can use it as a reference to learn how to treat muscle pain throughout the body.

If you use the workbook you will want to buy the Kieba Massage Lacrosse Balls. The massage balls are needed to apply the treatment.

If you have difficulty breathing due to a medical condition, checking for and treating the serratus posterior superior TrPs on a regular basis will help ease your breathing difficulty.

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.

If you are buying the Trigger Point Workbook to self-treat the serratus posterior superior you will need a hardball for treatment. The Kieba Massage Lacrosse Balls are a good choice to use on the thighs and other areas throughout the body.

How Long Before I Feel A Reduction In Pain?

Trigger points in the serratus posterior superior can be stubborn and take some time to fully deactivate but some relief is felt in just a few treatments. It is important to continue treatments until the trigger point is completely deactivated.

TrPs respond best to several 1-2 minute treatments throughout the day.

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)

Interesting facts about the serratus posterior superior muscle:

  • Sharp pain while inhaling is often a sign of a problem with the muscle
  • Unrelenting aching pain in the little little finger is another prime symptom

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

  • Chronic Obstructive Pulmonary Disease
  • Emphysema
  • Pleurisy
  • Thoracic outlet syndrome
  • Cubital tunnel syndrome
  • Epicondylitis
  • Scapulocostal syndrome
  • Deltoid tendonitis
  • Post injection soreness of the deltoid,
  • Shoulder pointer
  • Glenohumeral dislocation
  • Scoliosis
  • Spondylitis
  • Ankylosing spondylitis
  • C7 C8 T1 T2 T3 radiculopathy

If you have rounded shoulder or forward head posture correcting your posture will reduce your neck, back, and shoulder pain. I  recommend the HailiCare Posture Corrector The corrector fully supports the back and abdominal area while gently pulling your shoulder back which helps you retrain muscle memory to maintain proper posture. You will notice immediately a reduction of pain and tension. Start slowly, wearing the brace only 20-30 minutes a day slowly increasing the time you wear it. It is uncomfortable at first, but stay with it as it does get better! 

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

Satellite trigger points associated with the serratus posterior superior muscle:

  • Trapezius
  • Splenius
  • Latissimus dorsi
  • Scalenes
  • Rhomboid Major
  • Rhomboid Minor
  • Iliocostalis
  • Longissimus Thoracis
  • Multifidus

Serratus Posterior Superior Muscle Strains and Soreness

Serratus posterior superior strains are rare, what is more common is soreness from overworking the muscle.

Strains can happen if you lift or carry an object with your arms straightened in front of the body, using the strength of your upper back, shoulders, and arms to lift or carry the item. When lifting remember to keep the back straight, bend the knees, and use your legs for power. When carrying something keep your elbows bent and keep the object close to the body.

Another cause of muscle strain is chronic coughing and sneezing that is experienced during upper respiratory infections, pneumonia, and allergies. Talk to your doctor about medications that may help control your coughing or sneezing. This often will cause muscle soreness from overwork, and in most cases is not a strain.

Possibly the biggest contributor to soreness and pain in the serratus posterior superior muscle is shallow or chest breathing which overworks the muscle. If you are shallow breathing your chest will rise and fall with each breath. If you are breathing correctly the in and out movement should be in the abdomen.

The Learn To Breathe DVD is an excellent tutorial on how to breathe correctly. Practice the exercises that Max Strom teaches and it will help you develop the habit of deep breathing.


Chronic coughing and sneezing will often cause pain in the serratus posterior superior. 

Muscles strains occur when fibers in a muscle or tendon tear. Muscle Strains: Causes and Treatment explains how strains happen, how to know if you have strained a muscle, and recommended treatment.

The differences between a muscle strain and muscle soreness

It can be hard to differentiate between a muscle strain and soreness but there are two signs that may help you decide.

Most muscle strains are sudden onset and you know right away that it happened. There is usually a pulling, tearing, or popping sensation along with sudden pain when a muscle strain occurs.

Muscle soreness develops over time. It often starts as a feeling of tightness in the muscle and grows into an ache. You may go to bed at night without pain and awake in the morning with stiffness and aches.


Serratus posterior superior strain and soreness treatment

Because this muscle is a ‘breathing’ muscle it is impossible to rest the muscle. It is important to correct the factors that are causing your muscle pain. Correcting your posture and inhaling deeply are the two most important things you can do to take the stress off the muscle. Make sure to lift with your legs and when carrying something keep your elbows bent with the item close to the body. Don’t forget to check for trigger points in the muscle as they often develop when the muscle is stressed.

To help with your pain you can use warming gels or creams. I recommend Sombra Warming Gel. It gently warms the area, relaxes the muscle, and is great at relieving pain. (not sold in stores)

If you suspect a muscle strain, I recommend Biofreeze Professional Gel. It cools the area much like ice and may help to reduce inflammation. It is excellent for reducing pain.

It will take time for the muscle soreness to go away, but becoming aware of what is causing the pain and correcting those factors will put you on the road to recovery.

Biofreeze Professional Gel is what I recommend for the pain and symptoms of muscle strains. It provides excellent pain relief and may help reduce inflammation caused by a strain. Recommended by medical professionals and trainers. 


Other muscles with similar pain patterns:

Serratus Anterior

Latissimus Dorsi Muscle

Pectoralis Minor

Rhomboid Major and Rhomboid Minor

Triceps Brachii

Donna Martin

Massage Therapist Owner: Twelve years of experience working with clients with chronic pain, post injury pain, and post surgery pain. Muscle dysfunction is often overlooked but can hold the key to many pain conditions.

Leave a Reply