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200
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Anatomy

Upper Limb

Question 78 of 239

A 49 year old man presents to the Emergency Department after an alleged assault by multiple assailants. During examination he displays signs of serratus anterior weakness. The serratus anterior muscle acts to produce which of the following:

Answer:

The serratus anterior pulls the scapula forward over the thoracic wall and facilitates scapular rotation. It also keeps the costal surface of the scapula closely opposed to the thoracic wall.

Serratus Anterior Muscle

Anatomy / Upper Limb / Pectoral Region

Last Updated: 16th November 2020

Table: Function and Innervation of the Serratus Anterior Muscle

Muscle Serratus Anterior
Origin Lateral surfaces of ribs 1 – 8/9 and deep fascia overlying the related intercostal spaces
Distal Attachment Costal surface of medial border of scapula
Function Protraction and rotation of scapula; keeps medial border and inferior angle of scapula opposed to thoracic wall
Innervation Long thoracic nerve

Origin

The serratus anterior muscle originates as a number of muscular slips from the lateral surfaces of ribs 1 - 8/9 and the intervening deep fascia overlying the related intercostal spaces.

Insertion

The muscle forms a flattened sheet, which passes posteriorly around the thoracic wall to insert primarily on the costal surface of the medial border of the scapula.

Function

The serratus anterior pulls the scapula forward over the thoracic wall and facilitates scapular rotation. It also keeps the costal surface of the scapula closely opposed to the thoracic wall.

Innervation

The serratus anterior is innervated by the long thoracic nerve, which is derived from the roots of the brachial plexus, passes through the axilla along the medial and passes vertically down the serratus anterior muscle on its external surface, just deep to skin and superficial fascia.

Modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons

Serratus Anterior Muscle. (Image modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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