SCAPULAR ABDUCTION AND

UPWARD ROTATION:
SERRATUS ANTERIOR

Prof. Dr: Amr. A. Abo-Gazia

SERRATUS ANTERIOR

Range of Motion
 Serratus anterior
• 1) Origin:
• Outer surfaces and superior borders of upper
eight or nine ribs.
• 2) Insertion:
• Costal surface of medial border of scapula.
• 3) Nerve Supply:
• Long thoracic nerve C5, C6, C7, C8.
 Action:
• - With the origin fixed, it abducts the scapula,
rotates it so the glenoid cavity faces cranially and holds
the medial border of the scapula firmly against the
thorax.
• - In addition the lower fibers may depress the
scapula and the upper fibers may elevate it slightly.
• - Starting from a position with the humerus fixed in
flexion and the hands against a wall, the serratus acts
to displace the thorax posteriorly as the effort is made
to push the body away from the wall.
 NOTE
A strong element of this type of action in which
the serratus moves the thorax in relation to the
fixed scapula comes into play in a properly
executed push up.
• Also with fixed insertion by the Rhomboids,
the serratus may act in forced inspiration.
•
 Range of Motion:
• In general the abduction displacement of the
scapula is approximately equivalent to the space
of 3 to 4 fingers.
• This range of motion may be limited by:
• - Tension of trapezoid ligament (limits forward
rotation of scapula upon clavicle).
• - Tension of trapezius and Rhomboids major
and minor.
 SCAPULAR ABDUCTION AND
UPWARD ROTATION

Grade "3"
Fair Strength 

Grade "4, 5"

Good and Normal Strength 

Grade "2"
Poor Strength 

Grade "1, 0"

Trace and Zero Strength 
 SCAPULAR ELEVATION

Range of Motion

• Trapezius (upper fibers) .

* Levator scapulae
 Trapezius (upper fibers)
• 1) Origin:
• - External occipital protuberance
• - Medial 1/3 of superior nuchal line
• - Ligamentum nuchae
• - Spinous process of seventh cervical vertebra
• 2) Insertion:
• - Lateral 1/3 of clavicle
• - Acromion process of scapula
• 3) Nerve Supply:
• Accessory and ventral ramus: C2, C3, C4.
• Action:

• - The trapezius upper fibers elevate the scapula.

• - With the insertion fixed and acting: unilaterally, the

upper fibers extend laterally flex and rotate the head
and joints of the cervical vertebrae so that the face
turn toward the opposite side.

• - With the insertions fixed and acting: bilaterally the

upper trapezium extends the head and neck.

•
 Levator Scapulae:
• 1) Origin:
• Transverse processes of first four cervical
vertebrae.
• 2) Insertion:
• Medial border of scapula between superior angle and
root of spine.
• 3) Nerve Supply:
Dorsal Scapular Nerve: C3 C4 C5
• Action:
• - With the origin fixed, elevates the scapula and
assists in rotation, so that the glenoid cavity faces
caudally.
• - With the insertion fixed and acting
unilaterally, it rotates and flexed the cervical
vertebrae to the same side
• - Acting bilaterally, the levator scapulae may
assist in extension of the cervical spine.
 Accessory Muscles:
• Rhomboids major and minor
 Range of motion:
• With full range of motion the shoulder is brought upper
with a distance of approximately 3 fingers separating it with
the ear inferior lobe.

• This range of motion may be limited by the following

factors:

• - Tension of costoclavicular ligament

• - Tension of muscles depressing the scapula and clavicle:

Pectoralis minor, subclavius and trapezius (lower fibers).
 SCAPULAR ELEVATION

Grade "3"
Fair Strength 

Grade "4, 5"

Good and Normal Strength 

Grade "2"
Poor Strength 

Grade "1, 0"

Trace and Zero Strength 
 SCAPULAR ADDUCTION
Trapezius (middle fibers)

Trapezius (middle fibers)

 Trapezius (middle fibers)
• 1) Origin:
• Spinous processes of first through fifth
thoracic vertebrae.
• 2) Insertion:
• Superior lip of spine of scapula.
• 3) Nerve Supply:
• Accessory ventral ramus: C2, C3, C4.
• Action:
• - The trapezius middle fibers are mainly
responsible for the scapula adduction.
• - They also maintain a stabilization role
during the scapula downward rotation.
• Accessory Muscles:
• a. Trapezius upper and lower fibers.
• b. Rhomboid major and minor.
•
 Range of Motion:
• From the abduction position to the adduction position, the scapula
travels a distance equivalent to the space formed by 3 to 4 fingers.

• This range of motion may be limited by the following factors:

• Tension of the coronoid ligament (limits backward rotation of

scapula upon clavicle).

• Tension of Pectoralis major and minor and serratus anterior

muscles.

. Contact of vertebral border of scapula with spinal musculature.

 SCAPULAR ADDUCTION

Grade "3"
Fair Strength 

Grade "4, 5"

Good and Normal Strength 

Grade "2"
Poor Strength 

Grade "1, 0"

Trace and Zero Strength 

Note 
SCAPULAR DEPRESSION AND
ADDUCTION:
TRAPEZIUS (LOWER FIBERS)
SCAPULAR DEPRESSION AND ADDUCTION:
TRAPEZIUS (LOWER FIBERS)
 Trapezius (lower fibers)
• 1) Origin:
• Spinous processes of sixth through twelfth thoracic vertebrae.
• 2) Insertion:
• Apex of spine of scapula
• 3) Nerve supply:
• Accessory and ventral ramus: C2, C3, C4.
• 4) Action:
• - The trapezius lower fibres mainly depress the scapula.
• - They also provide stabilization when the upper and middle
fibers are working.
• Accessory Muscle
• Trapezius middle fibers
 Range of Motion
• The distance covered by the depressed scapula is
similar to the adduction motion as both motion are
closely related together. It can also be compare to
elevation motion as it is the opposite motion.
• This range may be limited by the following factors:
• - Tension of interclavicular ligament and articular
disc of sternoclavicular joint.
• - Tension of trapezius (upper fibers) levator scapulae
and sternocleidomastoid (clavicular head) muscles.
 SCAPULAR DEPRESSION AND ADDUCTION

Grade "3 + 2"

Fair and Poor Strength 

Grade "4, 5"

Good and Normal Strength 

Grade "4, 5"

"Alternate" 
If deltoideus are weak

Grade "1, 0"

Trace and Zero Strength 
 SCAPULAR ADDUCTION AND
DOWNWARD ROTATION: RHOMBOIDS

1. Rhomboid major
2. Rhomboid minor
• Rhomboids Major and Minor
• 1) Origin:
• * Major:
• - Spinous processes of second through fifth thoracic
vertebrae.
• * Minor:
• - Ligamentum nuchae.
• - Spinous processes of seventh cervical and first
thoracic vertebrae.
• 2) Insertion:
• - Major: By fibrous attachment to medial border of
scapula between the spine and inferior angle.
• - Minor: Medial border at root of spine of scapula.
•
• 3) Nerve supply:
• Dorsal scapular nerve: C4, C5.
• 4) Action:
• Adduct and elevate the scapula, and rotate
it so that the glenoid cavity faces caudally.
•
• Accessory Muscle
• Trapezius (adductor)
 Range of Motion
• The range of motion is similar in distance as
for the adduction of scapula.
• This range may be limited by the same factors
as for the motion of scapular adduction.
•
 SCAPULAR ADDUCTION AND
DOWNWARD ROTATION

Grade "3"
Fair Strength 

Grade "4, 5"

Good and Normal Strength 

Grade "2"
Poor Strength 

Grade "1, 0"

Trace and Zero Strength 
Effect of weakness of the scapula adductor depressor
and downward rotator muscles:

• - Weakness of these muscles will cause the scapula to abduct

and the inferior angle to rotate outward.

• - The strength of adduction and extension of the humerus is

diminished by the loss of the Rhomboids fixation of the scapula.

• - Ordinary function of the arm is affected less by loss of

Rhomboids than by loss of either Trapezius or Serratus Anterior
Muscles.
 Effect of Contracture of these Muscles

• The scapula is drawn into a position of

adduction and elevation.
• Contracture tends to accompany paralysis or
weakness of Serratus Anterior Muscle because
the Rhomboids are direct opponents of the
Serratus
•Thank You