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  • Writer's pictureRobin R Varghese, PT.

Serratus Anterior Myofascial Pain Syndrome

Serratus Anterior Muscle



  • The serratus anterior (SA) is a fan-shaped muscle that originates on the superolateral surfaces of the first to eighth or ninth ribs at the lateral wall of the thorax and inserts along the superior angle, medial border, and inferior angle of the scapula. Its main part lies deep under the scapula and the pectoral muscles.

  • It is supplied by the Long Thoracic nerve

  • The muscle acts as the prime muscle in protraction and upward rotation of scapula and also stabilizes scapula at rest as well as during movement.

  • When the shoulder blade is in fixed position the accessory inspiratory muscles

  • The serratus anterior is also known as the “boxer’s muscle,” as it is largely responsible for the protraction of the scapula which occurs when throwing a punch.



SAMPS (Serratus Anterior Myofascial Pain Syndrome)

  • Serratus anterior myofascial pain syndrome is a condition that is characterized by pain and discomfort in the serratus anterior muscle, which is located on the side of the ribcage.

  • SAMPS is a frequently forgotten cause of chest pain and should only be suspected when alternative diagnosis of chest pain is ruled out.

  • It is a rare cause of anterior chest pain. It leads to pain in Serratus Anterior muscle. It can also cause weakness of affected extremity and restrict mobility.

  • This syndrome is sometimes confused with chronic mechanical neck pain, glenohumeral instability, and shoulder impingement syndrome.

Causes

  • Trauma, Posture, Vitamin deficiencies, joint disease, tension, stress and overuse.

  • It is is common in sports with repetitive motions, e.g. swimming, tennis, or weightlifting (especially with heavy weights).

  • May also be suspected in post-mastectomy patients, conditions like post herpetic neuralgia, thoracic vertebral fractures and athletic shoulder injuries

The symptoms include:

  • Difficulty with deep breathing

  • Sensitivity

  • Tightness

  • Pain in the chest or breasts

  • Shoulder blade pain

  • Deep, aching pain in a muscle

  • Pain that persists or worsens

  • A tender knot in a muscle

  • Difficulty in sleeping due to pain


Key points of SAMPS

Pain location

5th to 7th ribs

Pain type

Deep, constant or intermittent

​Referred to

​Anterior chest, Medial aspect of arm, the medial border of the scapula and palmar aspect of ring and 5th fingers, mimicking radiculopathy.

​Diagnosis

​Passive stretching (It is also very Important to rule out non muscular cause of chest pain)

​Treatment

​Physical therapy measures like Myofascial Release Techniques or MFR including Trigger Point Release or TPR, NSAIDs, and Trigger point injections.

Physiotherapy Treatment of Serratus Anterior Myofascial pain syndrome

Physiotherapy can be an effective treatment approach for Serratus anterior myofascial pain syndrome. The following are some of the physiotherapy treatment options that may be used:

  • RICE : Rest (to provide recovery time), Ice (to relieve pain and inflammation), Compression (to reduce further inflammation) and Elevation(to relieve swelling, improve circulation to aid flushing of pain substance)

  • Soft tissue mobilization: This technique involves manual manipulation of the affected muscle tissue to relieve tension and promote healing.

  • Stretching exercises: Gentle stretching of the serratus anterior muscle and surrounding muscles can help improve range of motion and reduce pain.

  • Strengthening exercises: Specific exercises designed to strengthen the serratus anterior muscle can help improve its function and reduce the risk of further injury.

  • Postural re-education: Poor posture can contribute to the development of Serratus anterior myofascial pain syndrome. A physiotherapist can teach you, proper body mechanics, to prevent further injury.

  • Modalities: Heat therapy, ice therapy, and electrical stimulation may also be used to relieve pain and promote healing.

  • Education: A physiotherapist can educate you on how to modify your daily activities to avoid aggravating the condition and to prevent recurrence.

Researches

  • SAMPS occurs with deep respiratory distress while running, repetitive coughing due to respiratory disease, lifting heavy loads, and other psychological stresses.

  • The cause of SAMPS is hyperactivated SA muscle contractions Pathological findings indicate an increase in the release of acetylcholine by the neuromuscular junction under relaxing conditions. Elevated and prolonged acetylcholine release generates persistent depolarization of the muscle fiber, which causes sarcomere shortening and involuntary muscle contraction.

  • Breast cancer is the second most common diagnosed type of cancer in women. Chronic neuropathic pain after mastectomy occurs frequently and is a serious health problem. In our previous single-center, prospective, randomized controlled clinical study, we demonstrated that the combination of serratus anterior plane block (SAM) and pectoral nerve block type I (PECS I) with general anaesthesia reduced acute postoperative pain.

  • Herpes Zoster reactivation causes inflammatory and haemorrhagic reaction in the posterior roots of spinal nerves and sensitive ganglia. Pharmacological therapy is often ineffective; intrathecal steroid injections and nerve blocks may be tried. Serratus anterior plane block (SAPB) could provide effective analgesia.

  • Early recognition of myofascial pain syndromes spares patients the long, tedious road of recovery.

At Valley Healing Hands, We provide the best Physical Therapy treatment for SAMPS or Serratus Anterior Myofascial Pain Syndrome. Depending on the severity and underlying cause of the condition, our physiotherapist who are highly qualified will plan an individualized treatment routine; customized to your specific needs. Our patients are highly satisfied with out services. You can learn about what they have to say about us here and get connected to us here. Our patients love us and you too will!!!



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