Shoulder Orthopaedic Test: Serratus Anterior Strength Test or ( Punch out test )

The Serratus Anterior Strength Test, also known as the Push Out Test, is a clinical maneuver used to examine the strength and function of the serratus anterior muscle, as well as to identify scapular winging.

Here is how the Serratus Anterior Strength Test is performed:

1. The patient is seated or standing with their arms raised to shoulder level, elbows flexed to 90 degrees, and their hands positioned against a wall or a stable surface.
2. The examiner stands behind the patient and observes the scapulae for any winging or abnormal movement.
3. The patient is then instructed to push against the wall or surface with their hands, while the examiner applies resistance to the movement.
4. During the pushing motion, the examiner observes the scapulae for any winging or abnormal movement.
5. The test is repeated with the patient's arms positioned in different directions to assess the strength and function of the serratus anterior muscle from different angles.

If the serratus anterior muscle is weak or not functioning properly, the scapula may wing out or move abnormally during the pushing motion, indicating a potential injury or dysfunction of the muscle.

References:

1. Kibler WB, Sciascia AD. Serratus anterior muscle evaluation. In: Burkhart SS, Morgan CD, Kibler WB, eds. Shoulder Surgery: Principles and Procedures. Philadelphia, PA: Lippincott Williams & Wilkins; 2018:413-424.
2. Norkin CC, White DJ. Measurement of Joint Motion: A Guide to Goniometry. 5th ed. Philadelphia, PA: F.A. Davis Company; 2016.
3. Wilk KE, Macrina LC, Fleisig GS, et al. Deficits in glenohumeral passive range of motion increase risk of shoulder injury in professional baseball pitchers: a prospective study. Am J Sports Med. 2015;43(10):2379-2385.
4. Uhl TL, Kibler WB, Gecewich B, Tripp BL. Evaluation of clinical assessment methods for scapular dyskinesis. Arthroscopy. 2009;25(11):1240-1248.