Cureus. The long thoracic nerve supplies the serratus anterior muscle via three spinal nerve roots, which cut through the clavicle area to the right of the brachial plexus. So, the serratus anterior is a fan-shaped muscle that’s located on each of your sides. [3], The serratus anterior is innervated by the long thoracic nerve (Nerve of Bell), a branch of the brachial plexus. The serratus anterior is a muscle that is located on each side of the chest. The serratus anterior muscle is a fan-shaped muscle at the lateral wall of the thorax. Treasure Island (FL): StatPearls Publishing; 2019 Jan. Berthold JB, Burg TM, Nussbaum RP. Serratus Posterior Superior. Left scapula, costal surface. The serratus anterior is one of the most overlooked muscles of the body. Additionally, all three parts can lift the ribs when the shoulder girdle is fixed, and thus assist in respiration.[1]. In cursorial animals, the thorax is hanging between the scapulae at the serratus anterior and pectoralis muscles.[7]. Nerves of the left upper extremity. The long thoracic nerve supplies motor function to the serratus anterior muscle. Make a fist and then punch up towards the ceiling. Caitilin Kelly, MD, is a clinical physician at Indiana University Health Bloomington Hospital and is board-certified in internal medicine. In the serratus plane block, local anaesthetic is injected in fascial plane between the latissimus dorsi and serratus anterior muscle at the level of 5 th rib. During these surgical procedures, the long thoracic nerve is protected by your surgeon and proper surgical technique, but occasionally difficulties arise during surgery and the nerve may become injured. After surgery, you will likely wear a sling on your arm for a few weeks, and then gentle range of motion (ROM) exercises will be initiated. • Patients cannot forward flex the shoulder past 90° and exhibit scapular winging when the serratus anterior is not functioning. - Discussion: - serratus anterior arises from upper eight ribs, inserts on vertebral border of scapula, is innervated by long thoracic nerve, and functions to draw scapula forward in sports such as a jab in boxing; - paralysis produces characteristic prominence ("medial winging") of vertebral border of the Weakness or paralysis of the serratus anterior muscle will result in a winged scapula. As the thoracic intercostal nerve reaches the midaxillary line, the lateral cutaneous branch of the intercostal nerve pierces the internal intercostal muscle, external intercostal muscle, and serratus anterior muscle to innervate the musculature of the thorax. Place both hands on the wall, and gently push against it. Attachments: Origin: The lower part of the ligamentum nuchae, and the cervical and thoracic spines (usually C7 – T3). Hold this position for three seconds, and then slowly release. einer Läsion dieses Nerves, kann es zu der sogenannten Scapula alata kommen. This innervation supplies from your 5th through 7th cervical spine and is important for the mobility of your neck. An electromyographic (EMG) test may be done to examine the function of the long thoracic nerve. • Innervation Route: C5, C6, C7, C8 → long thoracic nerve → serratus anterior branches. The nerve is especially vulnerable during certain types of surgery (for example, during lymph node clearance from the axilla (e.g., in case of axillary dissection in a surgery for breast cancer)). It is utilized vigorously in push-ups and bench presses. It is considered one of the four muscles of the pectoral region. Rib Fracture related pain; Regional Anesthesia for Chest Tube Placement; Axillary abscess drainage; Preparation: Anesthetic. 3 ways SA is affected: 1. Since the long thoracic nerve is superficially located on the lateral side of your chest, it may be subject to injury during sports or surgical procedures. This muscle attaches to the under-surface of your shoulder blade and inserts as muscular slips to your ribs. Nerv und Muskel kommen beidseitig, links und rechts vor. [2] It is separated from the rib by the scapulothoracic (infraserratus) bursa. forced Make sure your motion is steady and deliberate, and keep your elbow straight. The intercostobrachial, long thoracic, and thoracodorsal nerves lie on this muscle. superficial to serratus anterior. [5], The muscles of the shoulder can be categorized into three topographic units: the scapulohumeral, axiohumeral, and axioscapular groups. INDICATIONS: Breast surgeries- mainly wide local excisions; Axillary clearance/sentinel node biopsy. … The long thoracic nerve terminates at the lower portion of the serratus anterior muscle, sending small nerve tendrils to each of that muscle's projections where it attaches to the ribs. We performed a systematic review to establish the current state of evidence for the analgesic role of these fascial plane blocks in these clinical settings. In: StatPearls . Lung K, Lui F. Anatomy, thorax, serratus anterior muscles. Long thoracic nerve injury can occur acutely from a blow to the shoulder, or with activities involving chronic repetitive traction on the nerve (e.g., tennis, swimming, baseball). Holding a small dumbbell in your hands can make the exercise more challenging. If axons are supplied by the eighth cervical nerve they supply the lowest digitations. Perform 10 to 15 repetitions. The serratus anterior acts to pull the scapula forward around the thorax. A compromised serratus anterior muscle can lead to altered timing in glenohumeral rhythm and scapular stabilization. [6], Functional demands have resulted in the evolution of individual muscles from the basal unit formed by the serratus anterior. By using Verywell Health, you accept our, Pectoral Girdle: Anatomy, Function, and Treatment. The thoracodorsal artery is superficial to this muscle. The nerves lie in the tissue plane between the serratus anterior and the latissimus dorsi muscles. The serratus anterior muscle spans the upper eight or nine ribs. After injection deep underneath serratus anterior, the mean (SD) duration of action was 386 (160) min for the intercostal nerves and 502 (150) min for the motor nerves (Table 3). Anatomy, thorax, serratus anterior muscles. The nerve also has a smaller diameter when compared to other cervical and brachial plexus nerves, increasing its susceptibility to injury. Serratus Anterior: The Serratus Anterior muscle is utilized in activities which draw the scapula forwards. Lesen Sie hier mehr zu dem Thema Scapula alata. [Updated 2018 Dec 9]. If one of your shoulder blades sticks out abnormally, then you may have a winged scapula. The SA is seen alongside the pec minor. Serratus anterior plane and pectoral nerves blocks are recently described alternatives to established regional anaesthesia techniques in cardiac surgery, thoracic surgery and trauma. 2017;117(2):133-137. doi:10.7556/jaoa.2017.025, Vetter M, Charran O, Yilmaz E, et al. It’s situated right on top of the ribs. This muscle attaches to the under-surface of your shoulder blade and inserts as muscular slips to your ribs. This occurs when the serra… The roots from C5 and C6 pierce through the medial scalene muscle to join the C7 nerve root. Treasure Island (FL): StatPearls Publishing; 2019 Jan. The image below shows the distribution of the block (in green): Dermatomes T2-T9 (feel free to use/share!) This is my story of the injury i got on my Thoracic nerve which cause my serratus anterior to stop working. This innervation supplies from your 5 th through 7 th cervical spine and is important for the mobility of your neck. Images. The serratus anterior muscle is a fan-shaped muscle at the lateral wall of the thorax. Deep dissection, anterior view. This nerve characteristically arises from the anterior rami of three spinal nerve roots: the fifth, sixth, and seventh cervical nerves (C5-C7), although the root from C7 may be absent. Scapulae are shown as semi-transparent. Serratus Posterior Superior. In our previously described block, Pecs II, we targeted it by an anterior approach near pectoralis minor. Im weiteren Verlauf nach distal gibt jeder Truncus einen vorderen und einen hinteren Ast ab (Divisiones anteriores et posteriores), die wiederum die Faszikel (Bündel) oder Sekundärstämme bilden. Methods: Serratus anterior function wa s restored through decompress ion, neurolysis, and tetanic electrical stimulation of the long thoracic nerve. Long thoracic nerve injury caused by overhead weight lifting leading to scapular dyskinesis and medial scapular winging, Winged scapula: A comprehensive review of surgical treatment. 5 Minute Sono Injury to the this nerve in turn causes weakness of the serratus anterior muscle, which can manifest clinically as scapular winging. But given how important this muscle is, this is problematic. In cursorial mammals (for example the horse and other quadrupeds), the scapula is hanging vertically on the side of the thorax and the clavicle is absent. The long thoracic nerve supplies the serratus anterior muscle via three spinal nerve roots, which cut through the clavicle area to the right of the brachial plexus. Anterior thoracic wall. Dieser Nerv entstammt aus dem Rückenmarksegment C5-C7. The serratus anterior is a fan shaped muscle, which structurally may be divided into 3 sets of fibers. Like the PECS blocks, the SAPB was developed as an alternative to thoracic epidural, paravertebral, intercostal, and intrapleural blocks. Indications. The muscle has an irregular quadrilateral form, and it is larger than the serratus posterior superior.Both serratus posterior muscles are separated by a wide interval. Video: Why Serratus Anterior Matters: I've written and spoken a lot about the importance of proper serratus anterior function for shoulder health. 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