• Physical Therapy Korea
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• v.18 no.1
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• pp.1-8
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• 2011

Push-up plus has been advocated for increasing the activity of the serratus anterior muscle, the most critical scapular stabilizer. However, no previous study has reported the possibility of compensatory motion on the part of the pectoralis major, which could substitute for the action of the serratus anterior during push-up plus. The aim of the current study was to investigate the immediate effect of electromyography (EMG) biofeedback of the pectoralis major muscle on the pectoralis major, upper trapezius, and serratus anterior muscles during push-up plus. Fourteen healthy young subjects voluntarily participated in this study; each subject performed push-up plus from the quadruped position, in two conditions (i.e., with or without visual and auditory biofeedback). Surface EMG was used to measure pectoralis major, serratus anterior, and upper trapezius activity. A paired t-test was used to determine any statistically significant difference between the two conditions. Additionally, effect size was calculated to quantify the magnitude of EMG biofeedback in each muscle. Visual and auditory feedback reduced pectoralis major muscle activity significantly (p=.000) and increased the serratus anterior muscle activity significantly (p=.002), but did not induce a significant difference in upper trapezius muscle activity (p=.881). Thus, it is concluded that the visual and auditory feedback of pectoralis major muscle activity can be used to facilitate serratus anterior muscle activity during push-up plus.

• Journal of the Korean Society of Physical Medicine
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• v.8 no.3
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• pp.369-378
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• 2013

PURPOSE: The purpose of present study was to ascertain how the activity of the serratus anterior muscle, the upper trapezius muscle and the pectoral major muscle was affected while the upper arm was being flexed at 70, 90 and 110 degrees respectively in a closed kinetic chain exercise (wall push up plus) and an open kinetic chain exercise (static hug). METHODS: Sixteen healthy young men subjects participated in the study. Surface electromyography (EMG) data were collected from the dominant-side muscles during a closed kinetic chain exercise and an open kinetic chain exercise. The activity of each muscle was measured quantitatively, and by the use of the two-way repeated ANOVA, the data were compared with each other according to exercises and shoulder flexion angles. RESULTS: Results indicated that the closed kinetic chain exercise did not interact with the open kinetic chain exercise (p>.05). In both the closed kinetic chain exercise and the open kinetic chain exercise, the activity of the serratus anterior muscle became different significantly according to angles (p<.05). Its activity increased in order of 70, 90 and 110 degrees (p<.05). In both exercises and all angles, muscle activity was significantly higher in the serratus anterior muscle than in the upper trapezius muscle and the pectoral major muscle (p<.05). CONCLUSION: The above results show that there is a need to selectively control the exercise stress of the serratus anterior muscle in the case of the patients with the shoulder impingement syndrome characterized by the winged scapula, insufficient scapular protraction and upward rotation.

• PNF and Movement
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• v.16 no.1
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• pp.33-42
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• 2018

Purpose: The aim of this study was to investigate the effects of trapezius and serratus anterior strengthening exercise on the shoulder pain and muscle activation of patients with spinal cord injury and functional shoulder impingement syndrome. Methods: The study consisted of 10 patients with spinal cord injury who were hospitalized in Rehabilitation Hospital U, Uijeongbu, South Korea. The exercise was implemented three times a week for 10 weeks. In each session, the subjects performed one of a total of five types of exercise at mid-level intensity. The shoulder pain and disability index (SPADI) was used to evaluate the patients before and after the intervention. The muscle activation of the upper trapezius, middle trapezius, lower trapezius, and anterior serratus muscle was assessed by surface electromyography (EMG) at the beginning of the experiment and 10 weeks later. Wilcoxon's singed-rank test was conducted to determine differences in the pain index and muscle activation before and after the exercise. The level of statistical significance was set at ${\alpha}=0.05$. Results: SPADI scores significantly decreased after the exercise (p<0.05). In comparisons of muscle activation, there was a significant improvement in the upper trapezius at $60^{\circ}$ shoulder joint flexion (p<0.05). There was no significant improvement at $90^{\circ}$ shoulder joint flexion. The middle trapezius showed a significant improvement at $120^{\circ}$ shoulder joint flexion (p<0.05). Conclusion: Trapezius and serratus anterior strengthening exercise reduced pain in spinal cord injury patients with functional shoulder impingement syndrome. The decreased muscle activation of upper trapezius and increased muscle activation of the anterior serratus muscle at $60^{\circ}$ shoulder joint flexion point to positive effects of the exercise on supraduction of the scapula.

• Physical Therapy Korea
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• v.17 no.4
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• pp.8-15
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• 2010

This study was designed to investigate the effect of different hand positions on scapulothorcic muscle activities during push-up plus exercises. Fourteen healthy males performed push-up plus exercises under three conditions (neutral, $90^{\circ}$ internally rotated, and $90^{\circ}$ externally rotated hand positions), during which the activities of the serratus anterior, pectoralis major, and upper trapezius muscles were recorded using surface electromyography. The statistical significance at three different hand positions was tested by repeated one-way ANOVA. The mean activities of the serratus anterior increased and the mean activities of the pectoralis major decreased in the order of neutral hand position, internally rotated hand position, and externally rotated hand position. There was a significant difference during push-up plus between neutral and externally rotated hand positions as well as in the serratus anterior/pectoralis major activity ratio (p<.0.5). However, no significant differences were found in the activity of the upper trapezius muscle or the serratus anterior/upper trapezius activity ratio. We suggest that the push-up plus exercise performed in the externally rotated hand position could a beneficial strategy for selective strengthening of the serratus anterior muscle, while minimizing the activity of the pectoralis major muscle.

• Archives of Plastic Surgery
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• v.48 no.3
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• pp.282-286
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• 2021

Recent reports have described several cases of double muscle transfers to restore natural, symmetrical smiles in patients with long-standing facial paralysis. However, these complex procedures sometimes result in cheek bulkiness owing to the double muscle transfer. We present the case of a 67-year-old woman with long-standing facial paralysis, who underwent two-stage facial reanimation using two superficial subslips of the serratus anterior muscle innervated by the masseteric and contralateral facial nerves via a sural nerve graft. Each muscle subslip was transferred to the upper lip and oral commissures, which were oriented in different directions. Furthermore, a horizontal fascia lata graft was added at the lower lip to prevent deformities such as lower lip elongation and deviation. Voluntary contraction was noted at roughly 4 months, and a spontaneous smile without biting was noted 8 months postoperatively. At 18 months after surgery, the patient demonstrated a spontaneous symmetrical smile with adequate excursion of the lower lip, upper lip, and oral commissure, without cheek bulkiness. Dual-innervated muscle transfer using two multivector superficial subslips of the serratus anterior muscle may be a good option for long-standing facial paralysis, as it can achieve a symmetrical smile that can be performed voluntarily and spontaneously.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.9 no.2
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• pp.69-77
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• 2003

Objective: The purpose of this study is to describe the effect of the serratus anterior muscle exercise in a patient with winging of the scapular. Background and Purpose: The patient was a 33-year-old man with an 3 years history of the left deltoid region. He had not responded to previous treatments of rest, TENS and medicine. Materials and Methods: After Surgical operation of the shoulder, the patient was treated for 6 months in 144 visits. treatment consisted of push-up with plus in the standing position with his hands against the wall and unique push-up with quadruped position at mat. Also, Sling exercise therapy was utilized to control scapular stabilization and reduce stress on the scapulohumeral joint. Result: Following 104 physical therapy visits, the patient was able to full range of motion of the shoulder without shrug motion. Conclusion and Discussion: Scapular winging and serratus anterior muscle function are important consider in the rehabilitation of the shoulder dysfunction. Therefore, specific exercise program for people with the winging scapular should be considered.

• Archives of Reconstructive Microsurgery
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• v.4 no.1
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• pp.33-42
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• 1995

Frequently, a single muscle flap is not enough to cover a large compound defects after extensive trauma or ablation of tumor. For a extensive defects, several kinds of flaps are available for various needs of reconstruction. The combined latissimus dorsi and serratus anterior flaps provide the largest possible soft tissue coverage. Two flaps composed of latissimus dorsi and serratus anterior muscles are consistently nourished through the subscapular-thoracodorsal vessels and their many branches, and thus the two flaps can be isolated with one vascular pedicled free flap. We experienced 4 cases of reconstruction in closure of extensive compound defects using the combined latissimus dorsi and serratus anterior muscles with one vascular pedicled free flap. The advantages of using these flaps are : 1) its versatlity and excellent malleability 2) easy to dissection 3) long-stalked pedicle 4) the use of a vascularized rib 5) negligible motor dysfunction from the muscle removal.

• Physical Therapy Korea
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• v.24 no.4
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• pp.29-37
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• 2017

Background: The serratus anterior (SA) muscle is one of the important muscles in the upward rotation of the scapula when the arm is raised. Insufficient muscle activity of the SA can cause deformation of the shoulder rhythm resulting in shoulder pathology. Objects: This study intends to compare SA and upper trapezius (UT) activity during the conventional wall-slide and push-up plus exercises for SA muscle strengthening and the scapular upward rotation (SUR) exercise. Methods: A total of 30 subjects participated in this study, and we measured the muscle activity of the SA and UT muscles during the wall-slide, push-up plus and SUR exercises. The one-way repeated ANOVA was used to compare SA and UT muscle activities during the 3 exercises. Results: During the SUR exercise, SA muscle activity was 79.88% maximum voluntary isometric contraction (MVIC), which was significantly higher than its activity during the other 2 exercises. The UT muscle activity was 47.53 %MVIC during the SUR exercise, indicating a significantly higher UT muscle activity than during the other 2 exercises. Conclusion: These findings suggest that the SUR exercise can maximize SA muscle activity to strengthen the SA while keeping UT muscle activity at an appropriate level.

• The Journal of Korean Physical Therapy
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• v.23 no.2
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• pp.7-15
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• 2011

Purpose: We investigated the relationship between the muscle activity and kinematic variables of the upper extremity during a push-up task on stable and unstable surfaces. Methods: We recruited 15 healthy subjects. Subjects completed the push-up task on stable and unstable surfaces. Surface electromyograms were recorded from the serratus anterior, upper trapezius, latissimus dorsi, infraspinatus to monitor changes in muscle activity. Markers for kinematic changes of elbow flexion, shoulder extension, shoulder retraction and scapular adduction were attached at C7, the T7 spinous process, both acromions, the scapula superior and inferior angle, the humerus lateral epicondyle, and the ulnar styloid process. Correlation coefficients between muscle activity and kinematic variables were analyzed by SPSS for Windows, version 15.0. Results: On the unstable surface, elbow flexion and shoulder extension increased with increasing muscle activity of serratus anterior, upper trapezius and infraspinatus. On the stable surface, shoulder retraction decreased with increasing muscle activity of serratus anterior and infraspinatus. Scapular adduction decreased with all types of increasing muscle activity, regardless of the support surface. Conclusion: Correlations between muscle activity and kinematic variables were observed on stable and unstable surfaces during a push-up task, while correlations between right and left variables were not clear. These finding suggest that it may be used to develop a rehabilitation program which could be effective in improving shoulder function in patients with shoulder problems.

• PNF and Movement
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• v.11 no.1
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• pp.55-62
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• 2013

Purpose : This study was assessed muscle activity and onset time in trunk and upper extremity on functional reaching. Methods : The participant was 18 female(young 10, old 8). As functional reaching, we collection data by using EMG(MP150) on transverse abdominis, external oblique, erector spinae, deltoid middle and serratus anterior. Results : 1) In functional reaching, transverse abdominis, external oblique, erector spinae and deltoid middle muscle activity was augmented on old female(p>.05). Serratus anterior was augmented on young female(p>.05). 2) In functional reaching, transverse abdominis and erector spinae muscle onset time is significantly faster old female than young female(p<.05). External oblique and serratus anterior muscle onset time is faster old female than young female(p>.05). 3) As increase of age muscle activity of external oblique was more increased that we found .511 a coefficient correlation and onset time more faster on transverse abdominis and erector spinae were each -.492 and -.554 coefficient correlation. Conclusion : The muscle activity and onset time was difference in functional reaching according to ageing and task context. It is necessary concentration and attention to old female than young female. Therefore, these results suggest that importance of anticipatory postural control and selective strategy of postural control.