Understanding the Serratus Anterior Strength Test (Punch out test) Assessment
To assess the strength and function of the **Serratus Anterior muscle** and check for early signs of long thoracic nerve injury.
Watch How It's Done
How do I start?
Patient is standing, facing a wall, with the arm flexed to 90°.
What happens?
The patient is instructed to **push (punch)** their arm forward against the wall, maximally protracting the scapula.
In Plain English
What Does a Positive Result Mean?
**Medial winging of the scapula** (the medial border lifts off the rib cage) during the push, indicating Serratus Anterior weakness or injury to the long thoracic nerve.
Helpful Tip:
Should be compared to the opposite side. This test is a critical indicator of scapular stability.
Safety First
This guide is to help you understand what happens in a clinic. Do not try to diagnose yourself. If you have severe pain, swelling, or cannot put weight on your leg, please visit an urgent care center or your doctor immediately.
Other shoulder Tests
Adson's Test
To assess for Thoracic Outlet Syndrome (TOS) due to compression of the neurovascular bundle by the anterior and middle scalene muscles.
Anterior Drawer Test Of The Shoulder
To assess for anterior glenohumeral joint laxity and instability and the integrity of the anterior capsular structures.
Arm Squeeze Test
This is a new clinical test that may be useful to distinguish between Cervical radiculopathy from other shoulders related pathology. The anatomic reasoning behind this test is that because the musculocutaneous nerve (cervical root from C5 to C7), the radial nerve (from C5 to T1), the ulnar nerve (from C7 to T1), and the median nerve (from C5 to T1) are relatively superficial in the middle third of the arm and easy to elicit a painful provocation response by squeezing the arm. A moderate compression of skin, subcutis, and muscle by squeezing the middle third of the upper arm (brachial biceps and triceps area) on the side with shoulder pain elicits an intense reaction of local pain only in patients with cervical nerve root compression from C5 to T1, not when the pain arises from the shoulder.
Bear Hug Test
To assess for a tear or significant weakness in the **subscapularis tendon** (subscapularis strength).