Paralysis of the serratus anterior in a world class marksman

Abstract

The medical literature has produced a wide array of descriptive articles concerning paralysis of the serratus anterior; however, there has been no work on the role of sports in producing this condition. The functional anatomy, pathophysiology, and clinical evaluation are presented. A case study demonstrates the symptoms and progression of a typical patient with paralysis of the serratus anterior.

Anatomical Characteristics of the Upper Serratus Anterior: Cadaver Dissection

“…This scapular position has often been described as occurring with total serratus anterior paralysis, which identifies the unopposed levator scapulae as the cause. 27 Perhaps the unopposed upper serratus anterior is also at fault, particularly related to the anterior tilting posture. Treatment considerations may include attention to the unopposed upper serratus anterior.…”

“…The serratus anterior is considered by most authors to be the primary stabilizer of the scapulothoracic articulation and provides a solid base of support for upper-extremity function. 3,10,20,23,26,27 The serratus anterior anatomically divides the scapulothoracic articulation into 2 distinct spaces: the subscapularis space posterior to the serratus anterior and the serratus anterior space anterior to the serratus anterior. 20 The serratus anterior, historically called the serratus magnus most likely due to its significant expanse, originates from the anterior aspect of ribs 1 through 7 3,23 or ribs 1 through 10 3,26 and inserts along the medial scapular border extending from the superior to the inferior angle.…”