The Upper Extremity 383
Rhomboids
The rhomboid (rhomboid, diamond shaped) muscles are paired muscles that lie beneath the trapezius
muscle (figure 7.9). They derive their name from the fact that they are shaped like a rhombus (G. rhom-
bos). They are often divided into the thinner and weaker upper portion called the rhomboid minor and
the thicker and stronger lower portion called the rhomboid major. The rhomboids run down and outward
from the spine to the medial border of the scapulae. Their line of pull is similar to that of the trapezius
except that their attachment is onto the medial border of the scapula. Hence, when the rhomboids
contract they produce downward rather than upward rotation of the scapula. They can also elevate and
adduct the scapula. Since downward rotation of the scapula accompanies shoulder adduction or exten-
sion, the rhomboids are used when these motions are performed forcefully or against resistance.
Palpation: Have a partner stand with the back of his or her right hand against the low back, and place
your fingers under the lower portion of the medial border of the right scapula. Then have your partner
lift his or her right hand backward (away from the back), and you will feel the rhomboids contract to
produce the necessary downward rotation of the scapula.
Attachments and Primary Actions of Rhomboids
Muscle Proximal attachment(s) Distal attachment(s) Primary action(s)
Rhomboids
(ROM-boidz)
C6 or C7 to T4 or T5
spinous processes
Medial border of scapula from
spine to inferior angle
Scapular elevation
Scapular adduction
Scapular downward rotation
Attachments and Primary Actions of Serratus Anterior
Muscle Proximal attachment(s) Distal attachment(s) Primary action(s)
Serratus anterior
(ser-A-tus an-TEER-ee-or)
Lateral, outer aspect of
lower 8 to 9 ribs
Inferior angle and medial
border of scapula
Scapular abduction
Scapular upward rotation
Scapular depression (lower fibers)
Serratus Anterior
The serratus anterior (serratus, saw) is named for
its serrated, or saw-toothed, anterior margin and
can be seen on the anterolateral rib cage below the
armpit. It actually runs from the lower eight or nine
ribs under the scapula to attach onto the inferior
angle and the entire length of the medial margin of
the scapula (figure 7.10). Part of the anterior portion
of this muscle is covered by the pectoralis major,
and posteriorly it is covered by the scapula. The
lowest four or five slips interdigitate with fibers of the
external oblique abdominal muscles. The serratus
anterior effectively attaches the medial scapula to
the front of the thorax. The line of pull makes it an
effective abductor of the scapula. The lower fibers
of the serratus anterior and the trapezius also form
a force couple for upward rotation of the scapula
(figure 7.11), used when one lifts the arms to the
side (shoulder abduction) and to the front (shoulder
flexion). In addition, the lower fibers of the serratus
anterior can assist with scapular depression.
Functionally, the serratus anterior has been
shown to be active in pushing movements,
FIGURE 7.10 Anterior scapular muscles: serratus
anterior and pectoralis minor (left shoulder, deep view).