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Muscle deep-dives

Serratus Anterior trigger points: referred pain, palpation and release

A clinical deep-dive on Serratus Anterior: trigger point locations, the referred pain pattern they produce, palpation landmarks, activating factors and an evidence-based release protocol.

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Serratus Anterior trigger points: referred pain, palpation and release
Serratus anterior — trigger point on the lateral chest wall over the mid-axillary rib slips (marked X) refers pain to the lateral chest, down the inside of the arm to the ring and little finger, and to a focal spot at the inferior angle of the scapula; often mistaken for a 'side stitch', angina or C8 radiculopathy.

Why this muscle causes pain

Protracts and upwardly rotates the scapula; critical for overhead reach. Trigger points here are common in everyday and athletic populations and frequently contribute to the referred pain patterns described below.

Where the trigger points sit

Lateral chest wall over the upper ribs, under the arm.

The referred pain pattern

Lateral chest and lower scapular border, sometimes mimicking 'side stitch' or breathing pain.

How to find it by palpation

Palpate the muscle belly along its accessible course. Reproduction of the patient's familiar pain on palpation supports involvement.

What sets it off

Sprint running, push-ups, sustained reaching, scapular winging.

Self-care that actually helps

Wall slides, push-up plus, scapular control. Clinically: needling along the rib slips.

Symptoms this muscle produces

Clinically, this muscle turns up in the workup of mid-thoracic back pain, shortness of breath/stitch-in-the-side, side of chest pain, medial epicondylar pain, volar finger pain and volar forearm pain. Those are the complaints its referral zone overlaps, which is why a patient may present with any of them and never mention the muscle itself.

Muscles covered

Studies cited

Every claim in this article traces back to one of the sources below.

  1. Kietrys 2013 — Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysis. J Orthop Sports Phys Ther 2013;43(9):620-34 ↗
  2. Gattie 2017 — The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: a systematic review and meta-analysis. J Orthop Sports Phys Ther 2017;47(3):133-49 ↗
  3. Boyles 2015 — Effectiveness of trigger point dry needling for multiple body regions: a systematic review. J Man Manip Ther 2015;23(5):276-93 ↗
  4. Charles 2019 — A systematic review of manual therapy techniques, dry cupping and dry needling in the reduction of myofascial pain and myofascial trigger points. J Bodyw Mov Ther 2019;23(3):539-46 ↗
  5. Cagnie 2013 — Physiologic effects of dry needling. Curr Pain Headache Rep 2013;17(8):348 ↗
  6. Fernández-de-las-Peñas 2019 — Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm. J Pain Res 2019;12:1899-911 ↗
  7. Shah 2015 — Myofascial trigger points then and now: a historical and scientific perspective. PM R 2015;7(7):746-61 ↗
  8. Halle 2016 — Pertinent dry needling considerations for minimizing adverse effects. Int J Sports Phys Ther 2016;11(5):651-62 ↗
  9. Boyce 2020 — Adverse events associated with therapeutic dry needling. Int J Sports Phys Ther 2020;15(1):103-13 ↗
  10. Hong 1994 — Lidocaine injection versus dry needling to myofascial trigger point: the importance of the local twitch response. Am J Phys Med Rehabil 1994;73(4):256-63 ↗
  11. Simons & Travell — Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins, Baltimore ↗

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