The serratus anterior muscle spans the upper eight or nine ribs. This muscle helps you rotate or move your scapula (shoulder blade) forward and up. Sometimes it’s referred to as the “boxer’s muscle,” since it’s responsible for the movement of the scapula when a person throws a punch.
Serratus anterior pain can be caused by several different medical conditions and lifestyle factors.
The most common causes of muscle pain include:
- minor injuries
Serratus anterior pain is common in sports with repetitive motions, such as swimming, tennis, or weightlifting (especially with heavy weights).
This pain may also result from serratus anterior myofascial pain syndrome (SAMPS). SAMPS can be difficult to diagnose and is often done so by exclusion — meaning your doctor has ruled out other sources of pain. It often manifests as chest pain, but can also cause arm or hand pain. It’s a rare myofascial pain syndrome.
Various medical conditions can also lead to serratus anterior pain or symptoms similar to it. These include:
- slipped or broken rib
- pleurisy (inflammation or infection of the lung and chest tissues)
- ankylosing spondylitis, a type of arthritis that affects the spine
Issues with the serratus anterior most often results in pain in the chest, back, or arm. These issues can also make it difficult to lift your arm overhead or have a normal range of motion with the arm and shoulder. You may experience:
- arm or finger pain
- difficulty with deep breathing
- pain in the chest or breasts
- shoulder blade pain
Most muscle pain doesn’t warrant a doctor’s visit. However, you should call your doctor immediately if you experience:
- difficulty breathing
- a high fever with a stiff neck
- a tick bite or bull’s-eye rash
- muscle pain after starting a new medication or increasing the dosage of an existing medication
- worsening pain in the back or chest that doesn’t improve with rest
- pain that interferes with your sleep or daily activities
These could be signs of something more serious and should be evaluated as soon as possible.
Serratus anterior pain can sometimes radiate to other parts of the body, so it’s not always clear where the pain is originating — which is why a doctor’s evaluation and diagnosis can be important in these instances.
If the pain is severe, your doctor may order imaging tests like an MRI scan or X-ray for muscle pain.
If the cause of the serratus anterior pain isn’t evident, your doctor might want to rule out other conditions, such as the ones mentioned above. This might result in additional testing or referrals to other specialists.
If you experience muscle pain during an activity, this is typically indicative of a pulled muscle. A modified version of RICE is recommended in such cases:
- Rest. Take it easy with your daily activities and try to rest the muscle as much as possible.
- Ice. Apply a towel-wrapped ice pack to the sore part of the muscle for 20 minutes at a time, several times a day.
- Compression. You may find it difficult to apply compression to the serratus anterior. You can try wearing tighter shirts or wrapping the area with bandages to help reduce swelling.
- Elevation. This isn’t applicable to the serratus anterior.
Sometimes nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin (Bufferin) or ibuprofen (Motrin IB or Advil) can be helpful in reducing swelling and easing pain. Check with your doctor to make sure these types of medications are safe for you.
You can also use warm compresses and massages to loosen your muscles, or try these exercises.
If at-home treatments don’t work, talk with your doctor. Depending on the extent of your injuries and what your doctor finds during the examination, they may prescribe:
- oral steroids
- muscle relaxers
- stronger pain medication
- joint injections
Serratus anterior pain can be uncomfortable, but it typically resolves on its own without significant treatment.
Remember that stretching before and after activities can help reduce the risk of injury — especially with the muscles we don’t usually think about, like the serratus anterior.
If you think you’re experiencing serratus anterior pain and it doesn’t resolve in a several days, call your doctor to rule out anything serious.