Standing, sitting, or supine
For women, a gown over the non-examined side with the examined area exposed or a halter top is recommended.
For men, removal of the shirt is requested.
Anterior to the patient.
(The standing patient may need some stabilization. The examiner can provide stabilization by placing the lateral aspect of the closest foot next to the lateral border of the patientís closest foot.)
May I place my fingers on the front of your ribs? (or point to the demonstrated area).
Raise your arm to shoulder level and bend your elbow (or demonstrate). Rest your elbow in my
hand. Now gently push your elbow forward. Hold this position and do not let me move you.
Position the patient in 900 of shoulder flexion and 900 or more of elbow flexion. Rest the patientís distal arm in your hand. Palpate the area of the serratus anterior muscle belly on the side of one of the lower ribs. Ask the patient to push his/her elbow forward. Make sure that the patient is protracting the scapula and not just leaning forward with the upper body weight. Guide the amount of resistance by asking the patient to hold while you alternately push posteriorly on the patientís elbow with your hand and then support his/her elbow/distal arm to let the muscle relax.
VH - Serratus anterior.