(Kiosk 2) The Cutting Effect: The Role of the Serratus Anterior in Rock Climbing

Case Diagnosis: Serratus anterior myofascial pain leading to scapular dyskinesis

Case Description or Program Description: A 42 year-old male, avid rock climber, with no significant past medical history presented with non-traumatic, chronic right-sided thoracic pain.

Setting: Outpatient clinic

Assessment/Results: Exam reveals full right shoulder range of motion with pain within 110-180 degrees of abduction, improved with scapular assist. MRI of the right shoulder and chest wall reveals mild rotator cuff tendinosis. He completed multiple courses of PT for scapular stability without improvement. Right scapulothoracic corticosteroid injection provided pain relief temporarily. Patient was noted with tenderness to palpation over the right serratus anterior and underwent an ultrasound-guided serratus anterior trigger point injection to restore scapular kinematics. On follow up, he reported significant (80%) improvement after injection.

Discussion (relevance): Given the patient’s degree of relief from the serratus anterior trigger point injection, it is speculated that the serratus anterior muscle spasm led to scapular dyskinesis. It is unusual that the more typically affected paraspinals, trapezius, levator scapulae and rhomboids were all unaffected in this patient. The serratus anterior and the lower trapezius must be at their optional length-tension relationship for efficient upward rotation of the scapula. With the intense demand that climbing puts on the soft tissues supporting the scapula, it has high potential to result in imbalance in soft tissue length, leading to scapular dyskinesis.

Conclusions: This case highlights the difficulty in identifying the source of scapular dyskinesis. The motion of the scapula is highly complex and influenced by muscle and joint forces which arise from the thoracic surface, as well as the acromioclavicular and glenohumeral joints. It is important to thoroughly evaluate the serratus anterior in these athletes presenting with thoracic pain.