The Serratus Anterior Strength Test is commonly used to assess scapular control, serratus anterior function and shoulder movement quality during resisted upper limb tasks. This article explains the protocol, interpretation, limitations and practical recording guidance.

Introduction

The serratus anterior plays an important role in:

• scapular upward rotation
• scapular stability
• shoulder movement efficiency
• force transfer through the upper limb

Reduced serratus anterior function may contribute to:

• scapular winging
• altered shoulder mechanics
• shoulder fatigue
• reduced overhead performance
• shoulder loading intolerance

The Serratus Anterior Strength Test is one of several assessments used to evaluate scapular control and shoulder movement quality during resisted movement.

The test is commonly used alongside:

• scapular observation
• shoulder strength testing
• push-up assessments
• movement analysis
• shoulder ROM assessment
• overhead movement assessment

Although altered serratus anterior function may be associated with shoulder dysfunction in some populations, the test should not be interpreted as a stand-alone diagnostic assessment.

Quick Summary

• Primary purpose: Assess serratus anterior strength and scapular control
• Body region: Shoulder and scapular region
• Commonly associated with: Scapular winging and altered scapular mechanics
• Positive finding: Weakness, winging or reduced scapular control
• Negative finding: Stable scapular movement with appropriate control
• Clinical role: Supports movement assessment and shoulder evaluation
• Best interpreted with: Movement assessment and broader shoulder findings

What Is the Serratus Anterior Strength Test?

The Serratus Anterior Strength Test is a movement and strength assessment used to evaluate the serratus anterior muscle during resisted shoulder or scapular tasks.

The assessment is intended to:

• evaluate scapular stability
• assess shoulder girdle control
• identify movement compensations
• assess tolerance to resisted upper limb loading

The test may involve:

• resisted shoulder flexion
• scapular protraction
• wall-based loading
• push-up variations
• manual resistance testing

Why It Is Used

The Serratus Anterior Strength Test may help:

• assess scapular control
• identify winging patterns
• monitor movement quality
• assess shoulder stability during loading
• guide exercise selection
• monitor progress over time

The test may be particularly relevant in:

• overhead athletes
• throwing sports
• swimming
• gym-based training
• shoulder rehabilitation settings
• return-to-sport assessment

What It Measures

The test is intended to assess:

• serratus anterior strength
• scapular movement quality
• scapular stability
• shoulder girdle control
• resistance tolerance during upper limb loading

A positive finding may suggest altered scapular control or reduced serratus anterior contribution. However, the assessment does not independently diagnose shoulder pathology or nerve involvement.

Who It Is Useful For

The Serratus Anterior Strength Test may be useful for:

• exercise professionals
• strength and conditioning settings
• sports performance assessment
• allied health assessment environments
• overhead athlete monitoring
• movement assessment education

When to Use This Test

Consider using the Serratus Anterior Strength Test when a client reports:

• shoulder fatigue
• scapular winging
• difficulty with overhead tasks
• reduced shoulder stability
• shoulder discomfort during pressing
• altered shoulder mechanics

The assessment may become more meaningful when combined with:

• scapular observation
• ROM assessment
• shoulder strength testing
• overhead movement assessment
• pushing assessments

When Not to Use or When to Be Cautious

Use caution when:

• acute shoulder injury is suspected
• symptoms are highly irritable
• severe pain is present
• neurological symptoms are worsening
• recent surgery occurred

Stop testing if:

• pain becomes excessive
• neurological symptoms increase
• movement quality deteriorates significantly
• the client requests cessation

Equipment Required

• Open assessment space
• Wall or plinth if required
• Documentation system

No specialised equipment is required.

Step-by-Step Protocol / Practice

Setup

The client may stand, sit or assume a push-up position depending on the chosen variation.

Client Position

Common testing positions include:

• standing shoulder flexion
• wall push-up position
• quadruped position
• resisted scapular protraction

Examiner/Professional Position

Position beside the client to:

• apply resistance where required
• observe scapular movement
• monitor compensations
• compare sides

Testing Procedure

1. Position the shoulder and scapula appropriately.
2. Instruct the client to perform the required movement.
3. Apply resistance gradually if required.
4. Observe scapular movement and control.
5. Compare findings between sides.

Instructions

Ask the client to:

• move in a controlled manner
• maintain posture
• report pain or fatigue
• avoid compensatory movement where possible

Positive Finding

A positive finding may involve:

• scapular winging
• reduced movement control
• early fatigue
• asymmetrical scapular movement
• inability to maintain scapular position
• pain during loading

Negative Finding

A negative finding involves:

• stable scapular control
• symmetrical movement
• appropriate resistance tolerance
• absence of winging or major compensation

Positive and Negative Test Interpretation

Positive Test Interpretation

A positive Serratus Anterior Strength Test may increase suspicion of:

• reduced scapular control
• serratus anterior weakness
• altered shoulder mechanics
• reduced overhead loading tolerance

The finding may become more meaningful when combined with:

• observable scapular winging
• overhead movement dysfunction
• asymmetrical movement patterns
• fatigue-related compensation

However, the test does not independently confirm:

• nerve pathology
• structural shoulder pathology
• scapular dyskinesis diagnosis

Movement changes may also relate to:

• fatigue
• pain inhibition
• movement apprehension
• general shoulder weakness
• motor control variability

Negative Test Interpretation

A negative finding may suggest:

• adequate scapular control
• appropriate serratus anterior contribution
• stable movement during resisted tasks

However:

• shoulder symptoms may still exist
• movement quality may change under fatigue
• additional assessment may still be appropriate

Normative Data, Benchmarks or Reference Values

There are currently limited universally accepted normative values for isolated serratus anterior strength testing.

Practical comparison guidance may include:

• side-to-side comparison
• visible scapular symmetry
• fatigue tolerance
• movement quality during repeated loading
• ability to maintain scapular position during resisted movement

Where available, shoulder endurance and push-up performance measures may provide additional context.

Interpretation is generally strengthened when findings are:

• repeatable
• consistent across tasks
• aligned with symptom behaviour
• associated with functional movement limitations

Reliability and Validity

Research investigating scapular assessment suggests:

• visual scapular assessment may demonstrate variable reliability
• movement interpretation may vary between assessors
• standardised positioning improves consistency

Reliability may be influenced by:

• assessor experience
• fatigue levels
• movement speed
• resistance consistency
• observation angle

At the time of writing:

• strong MDC and SEM values specific to isolated serratus anterior testing remain limited

Sensitivity and Specificity

Sensitivity and specificity values are not commonly reported for serratus anterior strength testing because the assessment is not generally used as a stand-alone diagnostic test.

The assessment is more appropriately used to:

• evaluate movement quality
• monitor shoulder function
• assess scapular control
• support exercise and loading decisions

Common Errors and Limitations

Common errors include:

• excessive resistance
• inconsistent positioning
• poor scapular observation
• failure to compare sides
• overinterpreting isolated weakness

Key limitations include:

• limited standardised protocols
• variable visual assessment reliability
• overlap with broader shoulder dysfunction
• influence of fatigue and pain

Practical Applications

The Serratus Anterior Strength Test may help:

• assess scapular control
• guide exercise selection
• monitor overhead athletes
• assess movement quality
• track progress over time
• contribute to shoulder screening

The test is often most useful alongside:

• scapular observation
• push-up assessment
• shoulder strength testing
• ROM assessment
• functional overhead tasks

How to Record This in Measurz

Record:

• Test name: Serratus Anterior Strength Test
• Side tested
• Testing position used
• Presence of winging
• Strength findings
• Fatigue response
• Pain score
• Compensations observed
• Scapular movement quality
• Comparison side findings
• Related shoulder findings
• Retest date

Related Tests / Internal Links

Related shoulder and scapular assessments may include:

• Scapular Retraction Test
• Wall Push-Up Test
• Shoulder ROM Assessment
• Empty Can Test
• Push-Up Endurance Assessment

FAQs

What does the Serratus Anterior Strength Test assess?

The test assesses serratus anterior function, scapular control and shoulder movement quality during resisted tasks.

What is scapular winging?

Scapular winging refers to excessive prominence or altered movement of the scapula during shoulder movement or loading.

Does this test diagnose nerve injury?

No. The assessment may identify altered scapular control but does not independently diagnose nerve pathology.

Can fatigue affect the test?

Yes. Fatigue may significantly influence scapular control and movement quality during testing.

Should this test be used alone?

No. Scapular assessments are generally more useful when interpreted alongside broader shoulder and movement findings.

Key Takeaways

• The Serratus Anterior Strength Test assesses scapular control and shoulder movement quality.
• A positive finding may suggest altered scapular mechanics or reduced serratus anterior contribution.
• The test does not independently diagnose shoulder or nerve pathology.
• Fatigue, pain and movement variability may influence findings.
• The assessment is most useful alongside broader movement and shoulder evaluation.

References

Cook, C., & Hegedus, E. J. (2021). Orthopedic physical examination tests: An evidence-based approach (3rd ed.). Pearson.

Kibler, W. B., Ludewig, P. M., McClure, P. W., et al. (2013). Clinical implications of scapular dyskinesis in shoulder injury: The 2013 consensus statement from the ‘Scapular Summit’. British Journal of Sports Medicine, 47(14), 877–885. https://doi.org/10.1136/bjsports-2013-092425

Morrow, E. K., Morris, J. H., & Struyf, F. (2020). Clinical examination and physical assessment of shoulder pain. British Journal of Sports Medicine, 54(20), 1208–1215. https://doi.org/10.1136/bjsports-2019-101168

Struyf, F., Nijs, J., Mottram, S., et al. (2014). Clinical assessment of scapular positioning in musicians and athletes. Manual Therapy, 19(2), 108–115. https://doi.org/10.1016/j.math.2013.11.002