Serratus Posterior Superior: Pain Pattern and Treatment
The serratus posterior superior is a thin sheet under the shoulder blade, running from the lower neck spine out to the upper ribs. It lifts those ribs on a deep breath. Its documented pattern is a deep ache under the shoulder blade that nothing seems to reach, with pain down the back of the shoulder and arm to the elbow and, at times, into the little finger. Because the blade covers the trigger point, this muscle is missed more than any other cause of pain under the blade.
Attachments and action
Origin: The lower part of the nuchal ligament and the spinous processes of the seventh cervical and the upper two or three thoracic vertebrae.
Insertion: The upper borders of the second through fifth ribs, just beyond their angles.
Action: Elevation of the upper ribs on inspiration; it works hardest in labored breathing.
Where the pain is felt: Deep under the upper shoulder blade, a spot that feels beneath the bone. The back of the shoulder. Down the back of the upper arm to the elbow. Sometimes the little-finger side of the forearm and hand, and the front of the chest on the same side.
Common causes: Labored breathing from asthma, a chest infection, or a long cough; a rounded, forward-shoulder posture that pins the blade over the muscle; a heavy backpack; a cast or sling that held the arm across the body; a fall onto the shoulder.
Patients say: "It is under my shoulder blade and I cannot get to it." "It runs down the back of my arm to the elbow." A dull ache into the pinky side of the hand. Chest pain on that side with a clean cardiac workup.
When to get evaluated: Chest pain with pressure, sweating, shortness of breath, or pain on exertion needs cardiac evaluation before anything else. Pain under the blade with a fever or a cough that brings up blood needs medical evaluation first.
How this muscle is examined and treated
Examination moves the shoulder blade out of the way by reaching the arm across the body, then presses the upper ribs beneath for the point that reproduces the ache and the arm pain. Needling here addresses the muscle over the ribs at a shallow angle, with the blade held aside. Assessment and treatment happen in the same visit.
Related conditions
Shoulder DysfunctionNeck & Cervical PainChronic Pain Patterns
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