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Brachial Plexus Examination
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Janice He, Bassem Elhassan, Rohit Garg
The serratus anterior provides the most stability to the scapula in the beginning of shoulder flexion with the elbow in extended posture. This can be used to test the serratus strength. With the elbow extended, patient is asked to initiate shoulder forward flexion and the examiner provides resistance to this motion. If there is weakness of serratus anterior, then the examiner would notice the scapular blade winging off the thoracic wall (Figure 12.3(b)). Thirdly, the push up test is a classic manoeuvre that is described extensively however this might not be as practical for a patient with brachial plexus injury. This test uses the same principle as scapular protraction against resistance. The patient is asked to push up against the wall while the examiner inspects for scapular thoracic abnormal motion (STAM) (Figure 12.3(c)).
Arthroscopic resection of the superomedial scapula and scapulothoracic bursectomy
Published in Andreas B. Imhoff, Jonathan B. Ticker, Augustus D. Mazzocca, Andreas Voss, Atlas of Advanced Shoulder Arthroscopy, 2017
Numerous muscles participate in the scapulothoracic motion, and their origins on the scapula body separate off various spaces that are occupied by bursa. The levator scapulae and romboids originate from the axial spine and insert onto the medial border of the scapula. The serratus anterior originates from the chest wall and inserts on the undersurface of the entire medial edge of the scapula. The subscapularis muscle also originates from the undersurface of the scapula. Two spaces are created as a result of these two muscles—the scapulothoracic space or serratus anterior space and the subscapuarlis space.4 The scapulothoracic space is formed between the chest wall and the serratus anterior and is the location of the scapulothoracic or infraserratus bursa.4 This bursa is typically involved with snapping scapula syndrome and is removed during surgical bursectomy. The subscapularis space is formed between the subscapularis and the serratus anterior and is the location of the subscapularis or supraserratus bursa.4 This location is not typically involved with snapping scapula syndrome and should be avoided during surgery because it is not the location of the pathologic bursa and it is also the location of the neurovascular bundle (Figure 43.1).
The neurological examination
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Serratus anterior muscle (Figure 11.1a) Innervation: Long thoracic nerve (C5-C7).Function: Abduction of scapula.Physical examination: The patient pushes against resistance (e.g., the examiner’s hand or a wall). If the serratus anterior is paralyzed, winging of the scapula can be observed.
Feasibility and significance of stimulating interscapular muscles using transcutaneous functional electrical stimulation in able-bodied individuals
Published in The Journal of Spinal Cord Medicine, 2021
Naaz Kapadia, Bastien Moineau, Melissa Marquez-Chin, Matthew Myers, Kai Lon Fok, Kei Masani, Cesar Marquez-Chin, Milos R. Popovic
The motor points and electrode positioning for FES for the various muscles were as follows (Fig. 1(a,b)): Serratus Anterior (SA): Electrode between the latissimus dorsi and the pectoralis major, on the muscular bulk of the serratus between the 4th and 9th ribs.Upper Trapezius (UT): On the superior aspect of the shoulder blade, away from the supero-medial angle of the scapula to limit stimulation of the levator scapulae muscle.Lower Trapezius (LT): Medially and in line with the muscle fibers next to the spine of T8-T12 vertebrae below the inferior tip of the scapula, to limit stimulation of the rhomboids.Anterior and middle deltoid: on the bulk of the muscle, one proximal and one distal.
Scapula muscle exercises using the Neurac technique for a patient after radical dissection surgery: a case report
Published in Physiotherapy Theory and Practice, 2020
The patient’s pain level and SPADI scores were reduced, as well as increased shoulder ROM. These improvements in pain, SPADI scores, and shoulder ROM may be associated with an increase in the subacromial space (Ludewig and Cook, 2000; Roy, Moffet, Hébert, and Lirette, 2009). The upper trapezius is an agonist for scapula elevation and upward rotation (Bigliani, Perez-Sanz, and Wolfe, 1985; Wiater and Bigliani, 1999). The serratus anterior and lower trapezius muscles have a movement arm to induce torque on the scapula with upward rotation and posterior tilt (Ludewig and Cook, 2000; Roy, Moffet, Hébert, and Lirette, 2009), and function as a middle trapezius agonist during scapula retraction (Bigliani, Compito, Duralde, and Wolfe, 1996; Bigliani, Perez-Sanz, and Wolfe, 1985; Wiater and Bigliani, 1999). Increasing the strength of these muscles may lead to restored normal scapulohumeral rhythm and increased subacromial space during shoulder movements (Ludewig and Cook, 2000; McClure, Michener, and Karduna, 2006), which could contribute to improvements in shoulder pain, function, and ROM.
Free serratus anterior fascial flap combined with vascularized scapular bone for reconstruction of dorsal hand and finger defects
Published in Case Reports in Plastic Surgery and Hand Surgery, 2018
Takeshi Kitazawa, Masato Shiba, Kazuhiro Tsunekawa
The flap is harvested from the contralateral, uninjured side. The patient is placed in a semi-lateral position on the affected side with the uninvolved arm elevated and supported, and the injured hand is placed on the hand table. A lazy zigzag incision is made from the axillary fold to the level of the eighth or ninth rib and the lateral and anterior margins of the latissimus dorsi muscle are identified. The plane between the latissimus dorsi and serratus anterior muscles is developed to expose the vascular bundle and the long thoracic nerve running along the surface of the serratus anterior muscle. The areolar tissue must be kept with the serratus muscle, not with the latissimus muscle. Dissection of the thoracodorsal artery is continued in retrograde fashion to its origin at the subscapular bifurcation. The branch to the latissimus muscle is encountered and ligated, and the angular branch is dissected to the lateral border of the scapula, then preserved. After the vascular pedicle is mobilized to the required length, the serratus fascia and overlying areolar tissue of the required size are lifted off the muscle from ventrally to dorsally.