Serratus Anterior Pain: What Is It?
The serratus anterior muscle is located at the front of your upper back near the neck. Its main function is to extend and retract your shoulder blades (scapulae). You may have heard it referred to as the “upper trapezius” or even just “the trapezius”. The serratus anterior is one of the most common muscles involved in shoulder extension. It is also known as the “trapezius capitis” because it extends from the top of your head down to your collar bone.
It is not uncommon for patients with shoulder problems to experience tightness in their serratus anterior. This can cause pain when performing any type of shoulder flexion such as reaching overhead, bending over, extending the arm forward or backward, or even simply lifting up off the floor.
What Causes It?
There are several possible causes of serratus anterior pain. Some of these include:
Anatomy – The serratus anterior is made up of two muscles, the long head and short head. Both originate from the same origin point which is in the thoracic spine. However, they branch out into different areas within the chest region. The long head of the muscle attaches to the inside of the scapula or shoulder blade.
The short head attaches to the outer edge or ribs. Overactive or underactive muscles can lead to pain because they are either too short or too long.
Overuse – The serratus anterior is a core muscle used in many day-to-day activities as well as most upper body exercises. From heavy lifting to simple pushups, it is very important for proper posture and movement. When overused or strained, the pain is felt in the front of the shoulder and can range from a dull ache to a sharp pain.
Weak Core – Many times the cause of shoulder pain is from weak core muscles. The scapula (shoulder blade) is a segment of the body that requires stability and strength. A lot of people suffer from scapula dysfunction because of a weak core. This causes the muscles to be unbalanced or weak which leads to pain and injury.
The best treatment for serratus anterior pain is rest. It is important not to overuse or strain the muscle. If you continue to work the muscle, then you may cause more damage or prolonged inflammation. If the pain is severe, you may want to talk to your doctor about non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen.
In addition to rest, you can perform simple stretches to relieve the tension of the muscle.
Reach your arm over your head and gently pull your elbow back as far as possible, but do not force it. Hold for about 30 seconds and repeat several times.
Reach your arm across your chest and gently press your shoulder blade back and hold for about 30 seconds. If this does not cause pain, you can gently roll your shoulder forward and then backward.
If these stretches do not cause pain, you can add some resistance by placing your arm against a wall and attempting to push it forward. You should feel a nice gentle stretch in the front of your shoulder. If this causes pain or discomfort, stop and consult your physician.
In addition to rest and stretching, you can perform the following exercise to strengthen the muscle:
Lay on your back and place both of your arms at your sides, relaxed. Press down on your knees to straighten your legs. You should feel the muscle stretch in your abdomen and lower back region. While keeping your knees close to the floor, raise your upper body off the floor by using your core muscles.
Hold for a count of 5 and repeat 8 times.
In most cases, rest, stretching, and strengthening exercises will relieve the pain. If the pain persists or gets worse, you may want to see your primary care physician or an orthopedic specialist. They can determine if you have an overuse injury or torn muscle and determine the best course of treatment. They may also refer you to a physical therapist who can assess your range of motion, strength, and how your body reacts to certain movements and exercises.
A physical therapist can design an individualized program just for you.
In some severe cases, surgery may be required to repair any tears or work to restore the normal functioning of the muscle.
You can take a few steps to prevent serratus anterior pain or injury:
As with most muscle and joint pain, serratus anterior pain is caused by overusing or straining the muscle. During exercise, it is important to maintain good posture and form. This will lessen the strain on the muscle and prevent injury. When starting any new exercise, you should slowly increase the time or intensity to allow your muscles to get used to the new activity.
Your posture has a direct effect on your muscles, joints, and ligaments. Slouching or standing with poor posture can place excess stress on the muscle causing pain and injury. It is important to maintain good posture and keep your head and shoulders back, chest out, and stomach in.
Most of us spend a lot of time sitting. This can also cause problems for your serratus anterior muscle. It is important to get up and move around every hour or so to give the muscle a break
Serratus Anterior Muscle Strains
Serratus anterior muscle strains are relatively uncommon and usually caused by extreme or sudden movements of the arm. In addition to pain, you may also experience a “popping” sound during the injury. Extreme pain will cause you to feel as if you can’t take a deep breath and may limit your ability to move your arm.
The treatment for this type of injury is rest, ice, compression and elevation (RICE). You should also apply the PRICE principle to your serratus anterior muscle:
Protract your shoulder blades. This will cause your scapula to move upward and backward to take some of the strain off of the muscle. You can do this while sitting or lying down by just tucking your elbows close to your sides.
Restrict your movements. Avoid any activities that cause you pain and only perform activities that do not stress the muscle.
Apply ice or a cold pack to the injured area to reduce pain and inflammation. You can also soak the area in cold water. Never place ice directly on your skin; instead place it in a towel first.
Wrap your chest with an elastic bandage (an ACE bandage) to help stabilize the area and take pressure off of the muscle. Do not wrap it so tight that it impairs blood flow. You should be able to still breathe comfortably.
Take over-the-counter pain medication to reduce pain.
If you follow this routine for a few days, you should start to feel better. If the pain persists, you may have strained a muscle in your chest, and should see a doctor. They can give you further guidance on your treatment plan.
Prevention of serratus anterior muscle strains is key. Just as you would work slowly back into shape, you should take it easy on your serratus anterior muscle. This means no exercise that involves raising your arms over your head or out to the sides until you have worked back up to that level of activity.
Most importantly, listen to your body and don’t do anything that causes pain.
Serratus Anterior Muscle Tear
A torn serratus anterior muscle is a serious injury typically caused by extreme trauma to the area. The most common causes are falling on an outstretched hand or being punched with a clenched fist.
You will experience severe pain in your chest or shoulder. You may also hear a popping or cracking sound at the time of the injury. It will be impossible to raise your arm and you may have difficulty taking a deep breath.
Treatment for this type of injury is similar to other muscle tears: rest, ice, compression and elevation (RICE). You should apply ice or a cold pack to the injured area to reduce pain and inflammation. Do not place ice directly on your skin; instead place it in a towel first. You should also elevate your arm to help reduce swelling.
If you do not experience improvement or the pain becomes unbearable, you will need to see a doctor. They can provide you with stronger pain medication and may be able to give you a cortisone shot to reduce the inflammation.
Sources & references used in this article:
Ultrasound-guided serratus anterior plane block versus thoracic epidural analgesia for thoracotomy pain by AE Khalil, NM Abdallah, GM Bashandy… – Journal of Cardiothoracic …, 2017 – Elsevier
Isolated paralysis of the serratus anterior. A report of 20 cases by CL Foo, M Swann – The Journal of bone and joint …, 1983 – online.boneandjoint.org.uk
Stress fracture of the first rib from serratus anterior tension: an unusual mechanism of injury by AC Mintz, A Albano, EJ Reisdorff, KA Choe… – Annals of emergency …, 1990 – Elsevier
Long thoracic nerve injury. by JM Wiater, EL Flatow – Clinical orthopaedics and related research, 1999 – europepmc.org
Avulsion injury of the serratus anterior: a case history by KM Gaffney – Clinical Journal of Sport Medicine, 1997 – journals.lww.com
Serratus Anterior Dysfunction: Recognition and Treatment. by JJP Warner, RA Navarro – Clinical Orthopaedics and Related …, 1998 – journals.lww.com
“A tale of two planes”: deep versus superficial serratus plane block for postmastectomy pain syndrome by MM Piracha, SL Thorp, V Puttanniah… – … Anesthesia & Pain …, 2017 – rapm.bmj.com