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Atlas · Chest

Serratus Anterior

Serratus anterior links the lateral ribs to the front of the medial scapular border. It helps the shoulder blade move forward and upward during reaching. Painful rib-side loading and true scapular winging require different assessment pathways.

Serratus Anterior
Body region
Chest
Trigger points
1
documented in this muscle
Common symptoms
3
patterns cataloged
Contributors
3
Factors to assess

Muscle overview

Symptoms and first steps

Practical first steps

  • Reduce provocative push-up or swim volume temporarily.
  • Start with supported reaching rather than floor push-ups.
  • Avoid pressure tools in the armpit or between ribs.

When to seek assessment

  • New winging or inability to hold the arm elevated warrants examination.
  • New breathing pain with breathlessness, fever or trauma needs medical assessment.

The long thoracic nerve runs superficially over serratus anterior. Persistent winging with weakness is a motor finding, not evidence of a tender point that needs stronger pressure.

Examination, palpation and treatment evidence

Illustrated overview

Serratus Anterior

Blue highlights the muscle. Crosses mark representative trigger-point sites; shaded areas show possible referred pain. These examples do not correspond one-to-one with the numbered points below. Patterns vary and cannot diagnose the cause of pain.

Illustrated overview

Serratus Anterior · Anatomy and referred pain 1

Representative source regions. The illustrated markers and pain pattern are not individual assignments to the numbered trigger points.

Open full-size image

Trigger points

1. Serratus Anterior

Location. Side of ribs, under arm

Trigger point map
Serratus Anterior — Serratus Anterior · Trigger-point examples 1Open full-size image

Regional muscle reference; this is not an individual map of the selected numbered trigger point.

Referred pain map
Serratus Anterior — Serratus Anterior · Referred-pain pattern 1Open full-size image

Regional muscle reference; this is not an individual map of the selected numbered trigger point.

Pain referral. Lateral chest wall and scapular region

Pain Pattern

  • Lateral ribs
  • Scapular region

What This Pain Feels Like

Side-of-rib soreness may accompany pushing or reaching. Pain with breathing, especially if new or accompanied by breathlessness, needs a chest/rib assessment rather than being treated as a hallmark of muscle referral.

What Patients Report

  • Side-of-rib soreness during pushing
  • Fatigue while reaching
  • Discomfort near the shoulder blade

What Makes It Worse

  • Pushing
  • Repeated reaching
  • Swimming
Browse related exercises (16)

Symptoms patients report

Lateral rib soreness during pushing Compare arm loading with breathing and chest symptoms.

Reaching fatigue Record height and repetitions before symptoms.

Scapular prominence or winging A persistent change with weakness requires motor assessment.

Contributors to assess

Increased push-up or swimming volume Reaching load may exceed current tolerance.

Chest-wall trauma or surgery May affect ribs, muscle or the long thoracic nerve.

Shoulder motion loss Can alter scapular demands without establishing a serratus lesion.

For clinicians and supervised training

Clinical reference

Pain during breathing or under the arm is not specific to serratus. Evaluate chest, ribs, skin and neurological features when indicated.

Anatomy and palpation

Anatomical relationships

Digitations arise from the upper eight or nine lateral ribs and wrap to the costal surface of the medial scapular border, with a substantial lower attachment near the inferior angle.[1]

  • Lateral ribs below the axilla.
  • Medial scapular border and inferior angle orient the insertion on the hidden anterior surface.

Nearby structures. Long thoracic nerve crosses the superficial muscle; intercostal structures and pleura lie deeper. Latissimus and external oblique border or overlap inferior digitations.

Palpation

Patient position. Side-lying with examined arm supported forward at a comfortable elevation.

Find the landmarks

  • Identify the lateral rib surfaces beneath the supported arm.
  • Locate the anterior edge of latissimus to orient the accessible serratus digitations, without entering the axillary apex.

Examination sequence

  1. Ask for a gentle forward reach to orient to serratus activity.
  2. Relax and use broad light contact over the lateral muscle digitations.
  3. Compare familiar pain with the reaching task and note focal rib tenderness separately.

Document the findings

  • Local muscular sensitivity differs from focal bony pain or visible winging with force loss.

Limits and precautions

  • Do not press between ribs or provoke tingling; chest-wall pain with breathing requires appropriate assessment.
[1][4]

Examination and tests

2

Wall-supported push and winging observation[2][1]

Assess scapular control under modest pushing load.

Position
Standing facing a wall, hands at comfortable chest height, elbows slightly bent.
Technique
Perform several small wall pushes while the examiner watches both scapulae. Record familiar pain, medial-border prominence and ability to keep the arm supported.
Positive finding
Marked persistent winging, force loss or familiar load-related pain.
Interpretation
Painful preserved movement guides graded loading; marked winging with weakness prompts long-thoracic-nerve assessment.
Limitations
This task is not diagnostic alone; winging may reflect several muscles or compensation.

Supported forward-reach strength[1]

Compare protraction effort with the wall task.

Position
Supine, arm supported toward the ceiling at a comfortable angle, elbow straight.
Technique
Ask the patient to reach the hand slightly upward by moving the shoulder blade, without turning the trunk. Apply light backward resistance if tolerated and compare sides.
Positive finding
Familiar lateral-rib pain or a repeatable inability to maintain the reach.
Interpretation
Quantifies low-load protraction tolerance; weakness persisting in the supported position needs assessment.
Limitations
A functional comparison rather than an isolated serratus trigger-point test.

Distinguishing other causes

Long thoracic nerve palsy[2][1]

Findings that matter. Persistent medial winging and protraction/elevation weakness, sometimes after injury or surgery.

Next step. Neurological and scapular assessment; consider electrodiagnostic testing when indicated.

Rib or pulmonary disorder[4]

Findings that matter. Focal rib pain after trauma, breathing pain, fever or breathlessness.

Next step. Medical chest/rib assessment rather than local pressure treatment.

Rotator-cuff or other scapular muscle dysfunction[3][2]

Findings that matter. Painful elevation, rotation weakness or a different winging pattern.

Next step. Compare shoulder motion, cuff strength and trapezius/rhomboid function.

Treatment selection and progression

Exercise and rehabilitation

Supported forward-reach loading[1]

Consider when. Preserved protraction without unexplained motor loss.

Lying on the back with arm supported upward, reach the hand a little toward the ceiling and lower the scapula gently.

Dose and review
Starting example: one set of 5–8 comfortable repetitions on alternate days; adjust to irritability and the next-day response.
Progression
Add a small load only when the movement and next-day response remain comfortable.
Stop or reassess
Reduce the load for a lasting flare; new marked weakness, numbness or sharp injury pain requires reassessment.
Evidence and limits
The cited references support anatomical orientation or regional care. The activity and starting dose are clinical adaptations, with no isolated-muscle efficacy established by those references.

Exercise and rehabilitation

Progress from table reach to wall push[1][2]

Consider when. Load-related discomfort that tolerates supported movement.

Begin with a forearm slide on a table, then a light wall push through a small arc, allowing natural scapular motion.

Dose and review
Starting example: one set of 5–8 comfortable repetitions on alternate days; adjust to irritability and the next-day response.
Progression
Increase support height or body lean gradually before returning to floor push-ups.
Stop or reassess
Reduce the load for a lasting flare; new marked weakness, numbness or sharp injury pain requires reassessment.
Evidence and limits
The cited references support anatomical orientation or regional care. The activity and starting dose are clinical adaptations, with no isolated-muscle efficacy established by those references.

Clinician-delivered care

Clinician-led rehabilitation for persistent winging or fatigue[2]

Consider when. Objective scapular weakness, altered motion or persistent reaching limitations.

Clarify nerve function and shoulder/rib contributors, then select supported strengthening and work/sport modifications matched to the deficit.

Dose and review
Try the change during the provoking task and review its effect on pain and task tolerance before continuing.
Progression
Measure reach endurance and scapular function; do not increase load through deteriorating motor control.
Stop or reassess
Reduce the load for a lasting flare; new marked weakness, numbness or sharp injury pain requires reassessment.
Evidence and limits
Scapular rehabilitation is commonly used; a nerve lesion changes prognosis and loading. No isolated serratus injection or toxin efficacy is established by these references.

Reassessment and follow-up

  • Compare comfortable reaching height with the same arm support and elbow position.
  • Record controlled wall-push repetitions at the same body lean, including fatigue and the next-day response before adding load.
  • Have persistent winging and protraction weakness reassessed; worsening motor control changes progression even when rib-side pain improves.

Evidence and sources

  1. University of Washington Muscle Atlas: Serratus Anterior

    2026 · University anatomical reference

    Accessed September 2026; access year. Used for attachments and actions, not treatment efficacy or point-map validation.

  2. AAOS OrthoInfo: Scapular (Shoulder Blade) Disorders

    2026 · Professional-society clinical guidance

    Access year. Supports examination of scapular motion and nerve-related winging; exercise examples here are practical adaptations.

  3. Desmeules et al. Rotator Cuff Tendinopathy Diagnosis, Nonsurgical Medical Care, and Rehabilitation

    2025 · Clinical practice guideline

    Adults with cuff tendinopathy, including partial-thickness tears; not full-thickness tears. Recommends active rehabilitation, distinguishes calcific from noncalcific shockwave indications.

  4. NHS: Chest pain

    2026 · National health-service guidance

    Access year. New or recurrent chest pain needs appropriate medical assessment; emergency features are not excluded by tenderness.

Associated Trigger Points