Serratus Anterior: Pain Pattern and Treatment
The serratus anterior wraps the side of the rib cage and holds the shoulder blade flat against it. Its documented pattern is pain at the side of the chest at mid‑rib level, a “stitch in the side,” with referral down the inner arm toward the palm and a described component at the inner border of the shoulder blade.
Attachments and action
Origin: The outer surfaces of the upper eight or nine ribs.
Insertion: The costal surface of the medial border of the scapula.
Action: Protraction and upward rotation of the scapula, holding the blade flat to the rib cage during pushing and overhead reach.
Where the pain is felt: At the side of the chest over the mid ribs, sometimes with a breath‑catching quality; down the inner arm toward the palm and ring‑side fingers; a described spot at the inner border of the shoulder blade.
Common causes: Running beyond conditioning, push‑up volume, hard coughing fits, rapid anxious breathing, heavy bench pressing.
Patients say: “A stitch in my side that never quite leaves.” Discomfort taking a full deep breath. Side‑chest ache after a hard run or a chest workout.
When to get evaluated: New chest or rib pain with shortness of breath, fever, or pain on every breath needs medical evaluation before any myofascial work.
How this muscle is examined and treated
Examination tests scapular control against the wall and full inhalation, then maps the rib attachments along the side of the chest for the points that reproduce the stitch. Needling over the ribs here is precise, shallow, and angle‑controlled. Assessment and treatment happen in the same visit.
Related conditions
Chronic Pain PatternsSports & Performance InjuriesShoulder Dysfunction
This page is educational. It describes muscle referral patterns commonly associated with pain; it does not diagnose your condition. Individual patterns vary. For evaluation of your specific pain, see a licensed clinician. Seek immediate medical care for emergencies. Eugene Baek, L.Ac. · New Jersey License 25MZ00080600