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The periscapular muscles are a group of muscles that are located near the scapula, or shoulder blade. These muscles are responsible for the movement and stabilization of the scapula, which is a large, flat bone that forms the shoulder girdle. The scapula has a unique structure, with minimal bony stabilization, and is almost completely stabilized by muscles. The periscapular muscles include the serratus anterior, trapezius, levator scapulae, rhomboid major, rhomboid minor, and pectoralis minor. These muscles work together to control the movement and position of the scapula, allowing for smooth and efficient shoulder function. Understanding the anatomy and function of the periscapular muscles is crucial for evaluating and treating shoulder injuries and pathologies, such as scapular dyskinesis and shoulder impingement.
| Characteristics | Values |
|---|---|
| Definition | Periscapular muscles are the muscles that are attached to the scapula (shoulder blade) and control its movement and stability. |
| Number of periscapular muscles | Six |
| Names of periscapular muscles | Serratus anterior, trapezius, levator scapulae, rhomboid major, rhomboid minor, and pectoralis minor |
| Most vital periscapular muscles | Serratus anterior and trapezius |
| Function of periscapular muscles | Scapular retraction, elevation, and posterior tilting |
| Role of periscapular muscles | Stabilizing, supporting, and facilitating smooth motion of the scapula on the chest wall, ensuring efficient shoulder function |
| Innervation | Cranial nerve 11, spinal accessory nerve, and dorsal scapular nerve (C5) |
| Blood supply | Network of periosteal vessels that originate from muscular insertions |
| Related medical conditions | Shoulder impingement, scapulothoracic abnormal motion (STAM), scapular dyskinesis, shoulder pain, and shoulder injuries |
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What You'll Learn
- The trapezius is the most superficial periscapular muscle
- The scapula is a floating bone almost entirely stabilised by muscles
- Serratus anterior muscle function is key to shoulder impingement rehabilitation
- The scapula must be dynamically stabilised during arm use
- The rhomboids are divided into major and minor portions
The trapezius is the most superficial periscapular muscle
The trapezius muscle is the most superficial periscapular muscle. It is a large, triangular, paired muscle located on the posterior aspect of the neck and thorax. The trapezius muscle has many attachment points, extending from the skull and vertebral column to the shoulder girdle. It is commonly regarded as having superior, middle, and lower components, inserting on the acromion and lateral scapular spine, superior scapular spine, and inferomedial scapular spine, respectively. The superior portion attaches to the skull and neck, extending the head at the neck. The middle portion attaches to the upper part of the spinous processes of C7-T12, adducting the two scapulae. The inferior portion, or the lower part of C7-T12, depresses the scapula.
The trapezius muscle is involved in movements of the shoulder girdle and is, therefore, functionally considered a muscle of the upper limb rather than the back. It is responsible for scapular stabilization and motion, including scapular retraction, elevation, and posterior tilting. The upper fibres of the trapezius can elevate and upwardly rotate the scapula and extend the neck. The middle fibres adduct the scapula, and the lower fibres depress it and aid the upper fibres in upward rotation. These motions allow for the scapula to rotate against the levator scapulae and the rhomboid muscles. The trapezius muscle also works with the serratus anterior muscle to allow us to raise our arms above our heads.
The trapezius muscle is one of the broadest and most superficial muscles of the upper back and trunk. It covers the upper back of the shoulders and neck and is often used as a landmark when dissecting a cadaver. The trapezius muscle is also used for active movements such as side bending, rotation of the head, elevating and depressing the shoulders, and internally rotating the arm. It is one of the two large muscles in the upper back, commonly referred to as "traps" or "trap muscles". These muscles help maintain posture and move the upper back, neck, and head.
The trapezius muscle receives its innervation from the spinal accessory nerve (CN XI) and the anterior rami of the C3 and C4 spinal nerves. The arterial supply to the trapezius varies depending on the level of the muscle. The descending (upper) part of the trapezius is supplied by transverse muscular branches arising from the occipital artery, while the transverse (middle) part is supplied by the superficial cervical artery or its branch. The ascending (lower) part is supplied by muscular branches of the dorsal scapular artery, which arises from the subclavian artery.
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The scapula is a floating bone almost entirely stabilised by muscles
The scapula, or shoulder blade, is a flat, triangular bone that sits on the thoracic wall or thoracic cage. It connects the upper limb to the trunk by articulating with the humerus at the glenohumeral joint and with the clavicle at the acromioclavicular joint. The scapula has two surfaces, three borders, three angles, and three processes. The bone is stabilised by the muscles that attach to it.
The scapula has various bony projections for the attachment of muscles, ligaments, and other soft-tissue structures. The intrinsic muscles of the scapula include the muscles of the rotator cuff (subscapularis, supraspinatus, infraspinatus, and teres minor). These muscles attach to the surface of the scapula and are responsible for the internal and external rotation of the shoulder joint, along with humeral abduction. The subscapularis muscle attaches to the anterior surface of the scapula, also known as the subscapular fossa. The supraspinatus and infraspinatus muscles originate in the medial two-thirds of the supraspinous and infraspinous fossas, which are the two concavities divided by the scapular spine. The infraspinatus and teres minor muscles also attach to the dorsal surface of the scapula, separated by fibrous septa. The supraspinatus attaches to the superior portion of the posterior side, also known as the supraspinous fossa. The levator scapulae attaches at the superior angle of the scapula, while the teres major attaches at the inferior angle. The rhomboids major and minor attach to the medial border of the scapula, and the serratus anterior attaches to the medial margin.
The extrinsic muscles of the scapula include the biceps, triceps, and deltoid muscles. They attach to the coracoid process and supraglenoid tubercle of the scapula, the infraglenoid tubercle of the scapula, and the spine of the scapula. These muscles are responsible for several actions of the glenohumeral joint. The coracoid process is also the site of attachment for the pectoralis minor, coracobrachialis, and the short head of the biceps brachii. The long head of the triceps brachii attaches to the infraglenoid tubercle. The trapezius is inserted into the upper border of the crest of the spine and into the medial border of the acromion. The serratus anterior is inserted along the medial border of the costal surface.
The third group of muscles attached to the scapula is mainly responsible for its stabilisation and rotation. These include the trapezius, serratus anterior, levator scapulae, and rhomboid muscles. The trapezius is the most superficial periscapular muscle and serves a primary role in scapular stabilisation and motion. The upper and lower trapezius muscles are synergists for upward rotation of the scapula. The rhomboids are divided into major and minor portions. The rhomboid minor originates from the spinous processes of C7 and T1 and inserts at the medial scapular border at the base of the spine. The rhomboid major originates from T2 through T5 and inserts along the posterior aspect of the medial border from the base of the spine caudally to the inferior angle. The serratus anterior originates from the anterolateral aspect of the first through ninth ribs.
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Serratus anterior muscle function is key to shoulder impingement rehabilitation
The periscapular muscles are a group of muscles that surround the scapula, or shoulder blade. The scapula is a large, flat bone that serves as a critical site of muscle attachment. It is unique in that, with the exception of its connection to the clavicle, it is a floating bone almost completely stabilised by muscles. The periscapular muscles include the trapezius, rhomboids, and serratus anterior.
The serratus anterior 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. It wraps around the rib cage, passing beneath the scapula, and inserts along the medial border of the scapula. Its main function is to protract and upwardly rotate the scapula, which is essential for reaching forward and overhead arm movements. It also acts as a scapular stabiliser, keeping the shoulder blades against the rib cage during rest and movement.
When the serratus anterior is weak or inhibited, the scapula does not move smoothly along the thorax, resulting in scapular winging, where the shoulder blade abnormally moves away from the thorax during arm movements. This altered movement pattern can lead to overuse injuries such as shoulder impingement and rotator cuff tendinopathy. Therefore, ensuring proper activation and control of the serratus anterior is key to preventing and rehabilitating shoulder impingement.
To assess serratus anterior function, tests such as the Serratus Anterior Strength Test, Shoulder Abduction Test, and Push-Up Test can be performed. If weakness or dysfunction is identified, specific exercises such as the Wall Slide and those outlined by Elite Health & Performance can be incorporated into a rehabilitation program to improve serratus anterior activation and scapular kinematics, thereby reducing shoulder impingement symptoms.
By focusing on serratus anterior muscle function through targeted exercises, individuals can improve their scapular stabilisation and movement patterns, optimising shoulder girdle performance and health while reducing the risk of shoulder impingement and associated pain.
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The scapula must be dynamically stabilised during arm use
The scapula is a sturdy, flat, triangular bone that forms a critical site of muscle attachment. It is unique because, except for its connection to the clavicle, it is a floating bone almost entirely stabilised by muscles. The scapula provides attachment to several groups of muscles, including the intrinsic and extrinsic muscles. The intrinsic muscles of the scapula include the rotator cuff muscles, teres major, subscapularis, teres minor, and infraspinatus. These muscles attach to the scapular surface and assist with abduction and external and internal rotation of the glenohumeral joint. The extrinsic muscles include the triceps, biceps, and deltoid.
The periscapular muscles are primarily responsible for scapular stabilization and motion. The trapezius, the most superficial periscapular muscle, originates in the occiput and the ligamentum nuchae in the cervical spine and inserts on the acromion and lateral scapular spine. The upper and lower trapezius muscles are associated with scapular retraction, elevation, and posterior tilting. The serratus anterior, levator scapulae, rhomboids, and serratus anterior are also involved in scapular movement and stabilization.
The scapulohumeral rhythm is a combination of motions of the scapula, clavicle, and humerus that work together to achieve full elevation of the arm. The scapula must upwardly rotate, posteriorly tilt, and externally rotate, while the clavicle retracts, elevates, and posteriorly rolls. Any disturbance in this rhythm can decrease scapulothoracic movement and impact the shoulder complex function.
Therefore, the scapula must be dynamically stabilised during arm use to maintain optimal shoulder function. Dynamic muscle function is crucial in stabilising the scapula and facilitating its purposeful movement. Weakness of the scapular stabilisers can lead to abnormal stresses on the anterior capsular structures of the shoulder and increased compression on the rotator cuff. Coordinated scapulothoracic motion is essential for full and pain-free movement of the shoulder complex.
To address scapular dysfunction, clinicians can employ a rehabilitation program that includes exercises such as the genie stretch, dynamic hug, and bear crawl to restore the balance of musculature for normal static scapular position and dynamic motion.
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The rhomboids are divided into major and minor portions
The rhomboids are a group of muscles that play a crucial role in upper limb movement and stability of the shoulder girdle and scapula. They are divided into two functionally similar muscles: the rhomboid major and the rhomboid minor. These muscles work together with the serratus anterior, trapezius, and levator scapulae to anchor the scapula and prevent "winging".
The rhomboid minor is a small, cylindrical muscle that originates from the ligamentum nuchae and the spinous processes of the C7 and T1 vertebrae. It inserts at the medial border of the scapula, near the base of the spine. The rhomboid major, on the other hand, is a quadrangular or broad quadrilateral muscle located inferior to the rhomboid minor. It arises from the spinous processes of the T2 to T5 vertebrae and attaches to the medial border of the scapula, below the spine.
Both the rhomboid major and minor receive their vascular supply primarily through the dorsal scapular artery (DSA), a branch of the subclavian artery. The DSA provides the necessary oxygen and nutrients for the muscles' function. The motor function of the rhomboids is controlled by the dorsal scapular nerve (DSN), which originates from the ventral ramus of the spinal nerve root C5. This innervation is crucial for the coordinated action required for scapula stability and control.
The rhomboids are important in scapular retraction and downward rotation, countering the upward rotation caused by the trapezius muscle. They are enmeshed within the thoracolumbar fascia, which integrates their mechanical actions with the movements of the thoracic spine and rib cage. By working in conjunction with other muscles, such as the levator scapulae and trapezius, the rhomboids help regulate scapular elevation, stability, and rotation.
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Frequently asked questions
The periscapular muscles are a group of muscles that are responsible for controlling the motion and stability of the scapula against the thoracic wall. They facilitate smooth motion and ensure efficient shoulder function.
There are six periscapular muscles: the serratus anterior, trapezius, levator scapulae, rhomboid major, rhomboid minor, and pectoralis minor.
The trapezius is the most superficial periscapular muscle and plays a crucial role in scapular stabilization and motion.
The periscapular muscles enable the scapula to rotate upwardly, tilt posteriorly, and externally rotate, allowing a full range of motion for the arm. They also dynamically stabilize the scapula during arm use, maximizing the activation of muscles originating from the scapula.
The periscapular muscles, particularly the serratus anterior and trapezius, stabilize, support, and facilitate smooth motion of the scapula on the chest wall. This dynamic muscle function is essential for efficient shoulder function during athletic activities and overhead movements.
