International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
Bootstrap Slider

Indexed and Abstracted in: SCOPUS, Crossref, CAS Abstracts, Publons, CiteFactor, Open J-Gate, ROAD, Indian Citation Index (ICI), Indian Journals Index (IJINDEX), Internet Archive, IP Indexing, Google Scholar, Scientific Indexing Services, Index Copernicus, Science Central, Revistas Medicas Portuguesas, EBSCO, BOAI, SOROS, NEWJOUR, ResearchGATE, Ulrich's Periodicals Directory, DocStoc, PdfCast, getCITED, SkyDrive, Citebase, e-Print, WorldCat (World's largest network of library content and services), Electronic Journals Library by University Library of Regensburg, SciPeople.

Search Articles

Track manuscript

Readers around the world

Full Html

IJCRR - Vol 05 Issue 15 , August, 2013

Pages: 52-54

Date of Publication: 17-Aug-2013


Print Article   Download XML  Download PDF

SERRATUS POSTERIOR MUSCLES: ANATOMICAL PROPERTIES, FUNCTIONAL AND CLINICAL SIGNIFICANCE

Author: Sachin Patil

Category: Healthcare

Abstract:There is significant paucity in the literature regarding serratus posterior superior and inferior muscles. Most standard textbooks mention conflicting views on the role of serratus posterior superior and inferior muscles in respiration. This study was aimed at providing a more accurate review about the serratus posterior superior and inferior muscles and their functional importance. For the preparation of this paper we consulted scientific articles published in English and textbooks. The articles were accessed from a basic search in PubMed database. Recent studies have shown that there is no electromyographic evidence supporting a role for either the serratus posterior superior and inferior muscles in respiration. These muscles may function primarily in proprioception and are clinically important.The serratus posterior superior and inferior muscles are considered to be source of myofascial pain, which presumably originates from trigger points within the muscles. Both muscles are implicated in chronic pain syndromes like idiopathic myalgia or painful shoulder syndrome and scapulocostal syndrome. Further investigation need to be done on these muscles to confirm their functional and clinical importance.

Keywords: serratus posterior, scapulocostal syndrome, trigger points, myofascial pain

Full Text:

INTRODUCTION

Serratus posterior superior (SPS) is a thin quadrilateral muscle, which arises by a thin aponeurosis from the lower part of the nuchal ligament, the spines of the seventh cervical and upper two or three thoracic vertebrae and their supraspinous ligaments.1 But study by Satoh describes origin of SPS as high as third cervical vertebrae while lower limit of origin is upto second thoracic vertebrae.2 Textbook of anatomy by Cunningham’s mentions inferior limit of origin upto fourth thoracic vertebrae.3 SPS is inserted as four digitations attached to the upper borders and external surfaces of the second, third, fourth and fifth ribs, just lateral to their angles. Serratus posterior superior is innervated by the second, third, fourth and fifth intercostals nerves.1

Serratus posterior inferior (SPI) arises from the spines of the lower two thoracic and upper two or three lumbar vertebrae and their supraspinous ligaments by a thin aponeurosis that blends with the lumbar part of the thoracolumbar fascia.1 Textbook of anatomy by Cunningham’s mentions thoracolumbar fascia as only origin of this muscle.3 But study by Satoh describes origin of SPI as high as eleventh thoracic vertebrae.4  It ascends laterally, and its four digitations pass into the inferior borders and outer surfaces of the lower four ribs, a little lateral to their angles. Serratus posterior inferior is innervated by ventral rami of the ninth, tenth, eleventh and twelfth thoracic spinal nerves.1

There is no electromyographic evidence supporting a role for either the SPS or SPI  in respiration. Thus, the main evidence  suggesting  such  a role is one the basis of their attachments. The clinical importance of these muscles is that both are implicated in chronic pain syndromes like idiopathic  myalgia  or painful  shoulder  syndrome and scapulocostal syndrome.

 

Figure 1- Serratus posterior superior (SPS) and serratus posterior inferior (SPI) muscles

MATERIALS AND METHODS

For the preparation of this paper we consulted scientific articles published in English and textbooks. The articles were accessed from a basic search in PubMed database (http://www.ncbi.nlm.nih.gov/pubmed), using terms like serratus posterior superior, serratus posterior inferior and scapulocostal syndrome. The data concerning anatomy, function and clinical significance of serratus posterior superior and inferior muscles was collected and analysed.

DISCUSSION

The standard textbook of Anatomy mentions conflicting views on function of these muscles.The British edition of Gray's Anatomy  indicates that  the  role of the  serratus  posterior  superior is  uncertain  in  man  whereas   the  American   edition   describes   a  specific function   for  this  muscle,  namely,   elevating  the  ribs during  deep  inspiration.  Similarly,  for the presumably related  muscle,  serratus  posterior   inferior ,  the British edition  indicates  that  the  muscle's action is to draw  the   lower  ribs  downward   and   backward,  although  possibly  not  in respiration.  In  contrast,  the American  edition of this text  states  that  the muscle  is active  during  forced  expiration.5 Hollinshead’s Anatomy mentions the serratus posterior muscles as inspiratory muscles which is similar to that stated in clinical anatomy by  Moore  and  Dalley .6,7 But Snell anatomy  indicates  that  the  SPS is active  in inspiration  and  the  SPI  in expiration.8

Regarding the function of muscles other different views are present in previous literatures. Travell and Simons suggested  that  the  SPI  functions synergistically  with  the  ipsilateral  iliocostalis  and longissimus  for rotation  (unilateral)  and extension   (bilateral)  of  the  spine while in  respiration,   the  muscle  acts synergistically with  the quadratus lumborum.5

Vilensky et al suggested that  the  SPS and  SPI  have  reflex  connections  with   the   respiratory   muscles   such  that   overstretching   results    in    compensatory    movements. The muscles  may  function  to measure stress  levels  at the  superior  and  inferior  limits  of the  thoracic  spine.  Considering,   the  ambiguous   relationship   between    muscle   spindle   density   and   presumed   proprioceptive    function,   they  suggested  that  better electromyographic   recordings  and electroneurography of the motor and sensory nerves  of these  muscles, rather  than  further  histological  analysis, would  be the best  approach  to understanding   their  function. Authors further stated that  until  there  is supportive  evidence,  no respiratory  function  be attributed to  either   the  SPS  or  the  SPI,  and  that  the  possible clinical  importance   of these  muscles  as generators  of pain,  especially   shoulder   pain,  which  is  one  of  the frequent  locations  of myofascial  pain, should be  mentioned    in  gross  anatomy  courses and  textbooks.5

The scapulocostal syndrome, an insufficiently understood condition was clinically studied in 201 cases by Fourie   LJ in 1991. The pain was the presenting symptom in all cases and important cause was from an enthesopathy of the serratus posterior superior muscle. The operation of 'serratotomy' (severing the serratus posterior superior muscle) was performed with excellent results in 6 patients in whom conservative treatment failed. This study supports that SPS is one of the cause of  painful  shoulder  syndrome and scapulocostal syndrome.9

Recent study  by Loukas M et al supported that SPS and SPI have role in role in respiration based on their findings that no morphometric difference exists between the SPS and SPI of COPD patients versus controls.10

Further investigation need to be done on these muscles to confirm their functional and clinical importance.

CONCLUSION

We undertook this study with the aim of providing a more accurate report about the serratus posterior superior and inferior muscles, because of  interesting relationship with  chronic pain syndromes like idiopathic  myalgia  or painful  shoulder  syndrome and scapulocostal syndrome. Finally, this study shall be useful for  clinicians, surgeons and academics that manipulate and keep  particular interest for these mysterious muscles .

ACKNOWLEDGEMENT

Authors acknowledge the great help received from the scholars whose articles cited and included in references of this manuscript. The authors are also grateful to authors/ publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

References:

  1. StandringS. (Ed). Gray's Anatomy: The Anatomical Basis of Clinical Practice 40th ed. New York: Churchill Livingstone.2008;2729-31.
  2. Satoh  JI.  The serratus   posterior  superior  in  certain  catarrhine  monkeys and  man,  in particular  the  structure    of  the   muscular    digitations    and  their   nerve   supply.   Okajimas Folia  Anat  Jpn. 1969; 46:65-122.
  3. Sinclair DC. Muscles and fasciae, In: Romanes GJ (ed) Cunningham’s textbook of anatomy. 12th eds. Oxford: Oxford University Press, 1981; 352.
  4. Satoh  J I.  The   serratus   posterior    inferior   in monkey and man,   in particular the structure of the   digitations    of this muscle    and   their    nerve   supply.    Okajimas    Folia   Anat   jpn. 1970; 47:19-61.
  5. Vilensky JA, Baltes M, Weikel L, Fortin JD, Fourie LJ. Serratus posterior muscles: anatomy, clinical relevance, and function. Clin Anat. 2001 ;14(4):237-41.
  6. Hollinshead WH,Rosse Ceds). In: Textbook of anatomy. 4th ed. Philadelphia.1985;309-310
  7. Moore   KL,  Dalley  AF  II. Clinically oriented  anatomy.   4th ed.  Baltimore: Lippincott     Williams and Wilkins. 1999; 80.
  8. Snell   RS. Clinical anatomy    for  medical   students.  Baltimore: Lippincott   Williams and Wilkins. 2000; 58.
  9. Fourie   LJ. The    scapulocostal     syndrome.    S  Afr  Med   J  1991; 79:721-724.
  10. Loukas M, Louis RG Jr, Wartmann CT, Tubbs RS, Gupta AA, Apaydin N, Jordan R. An anatomic investigation of the serratus posterior superior and serratus posterior inferior muscles. Surg Radiol Anat. 2008;30(2):119-23.

Research Incentive Schemes

Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


Best Article Award

A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma COLAKOGLU entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by Arpita M. et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
Late to bed everyday? You may die early, get depression
Egg a day tied to lower risk of heart disease
88 Percent Of Delhi Population Has Vitamin D Deficiency: ASSOCHAM Report

List of Awardees

Awardees of COVID-19 Research

Woman Researcher Award

A Study by Neha Garg et al. entitled "Optimization of the Response to nCOVID-19 Pandemic in Pregnant Women – An Urgent Appeal in Indian Scenario" published in Vol 12 issue 09

A Study by Sana Parveen and Shraddha Jain entitled "Pathophysiologic Enigma of COVID-19 Pandemic with Clinical Correlates" published in Vol 12 issue 13

A Study by Rashmi Jain et al. entitled "Current Consensus Review Article on Drugs and Biologics against nCOVID-19 – A Systematic Review" published in Vol 12 issue 09

Emerging Researcher Award

A Study by Madhan Jeyaraman et al. entitled "Vitamin-D: An Immune Shield Against nCOVID-19" published in Vol 12 issue 09

Study by Dheeraj Kumar Chopra et al. entitled "Lipid-Based Solid Dispersions of Azilsartan Medoxomil with Improved Oral Bioavailability: In Vitro and In Vivo Evaluation" published in Vol 12 issue 19


RSS feed

Indexed and Abstracted in


Antiplagiarism Policy: IJCRR strongly condemn and discourage practice of plagiarism. All received manuscripts have to pass through "Plagiarism Detection Software" test before forwarding for peer review. We consider "Plagiarism is a crime"

IJCRR Code of Conduct: We at IJCRR voluntarily adopt policies on Code of Conduct, and Code of Ethics given by OASPA and COPE. To know about IJCRRs Code of Conduct, Code of Ethics, Artical Retraction policy, Digital Preservation Policy, and Journals Licence policy click here

Disclaimer: International Journal of Current Research and Review (JICRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal.



Company name

International Journal of Current Research and Review (JICRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

Contact

148, IMSR Building, Ayurvedic Layout,
        Near NIT Complex, Sakkardara,
        Nagpur-24, Maharashtra State, India

editor@ijcrr.com

editor.ijcrr@gmail.com


Copyright © 2021 IJCRR. Specialized online journals by ubijournal .Website by Ubitech solutions