Journal of Electromyography and Kinesiology 24 (2014) 221–227

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Journal of Electromyography and Kinesiology

journal homepage: www.elsevier.com/locate/jelekin

Assessing the validity of surface electromyography for recording muscle

activation patterns from serratus anterior
Lucien Hackett a, Darren Reed b,⇑, Mark Halaki a, Karen A. Ginn b
a
Discipline of Exercise and Sport Science, Faculty of Health Sciences, The University of Sydney, Australia
b
Discipline of Biomedical Science, Sydney Medical School, The University of Sydney, Australia

a r t i c l e i n f o a b s t r a c t

Article history: Purpose: No direct evidence exists to support the validity of using surface electrodes to record muscle
Received 27 June 2013 activity from serratus anterior, an important and commonly investigated shoulder muscle. The aims of
Received in revised form 10 January 2014 this study were to determine the validity of examining muscle activation patterns in serratus anterior
Accepted 17 January 2014
using surface electromyography and to determine whether intramuscular electromyography is represen-
tative of serratus anterior muscle activity.
Methods: Seven asymptomatic subjects performed dynamic and isometric shoulder flexion, extension,
Keywords:
Shoulder
abduction, adduction and dynamic bench press plus tests. Surface electrodes were placed over serratus
Serratus anterior anterior and around intramuscular electrodes in serratus anterior. Load was ramped during isometric
Muscle activation tests from 0% to 100% maximum load and dynamic tests were performed at 70% maximum load. EMG
Electromyography signals were normalised using five standard maximum voluntary contraction tests.
Results: Surface electrodes significantly underestimated serratus anterior muscle activity compared with
the intramuscular electrodes during dynamic flexion, dynamic abduction, isometric flexion, isometric
abduction and bench press plus tests. All other test conditions showed no significant differences includ-
ing the flexion normalisation test where maximum activation was recorded from both electrode types.
Low correlation between signals was recorded using surface and intramuscular electrodes during concen-
tric phases of dynamic abduction and flexion.
Conclusions: It is not valid to use surface electromyography to assess muscle activation levels in serratus
anterior during isometric exercises where the electrodes are not placed at the angle of testing and
dynamic exercises. Intramuscular electrodes are as representative of the serratus anterior muscle activity
as surface electrodes.
Ó 2014 Elsevier Ltd. All rights reserved.

1. Introduction
Electromyography (EMG) is the most reliable tool that research-
ers have to understand the complex activation patterns of muscles
during exercises and functional activities (Basmajian and De Luca,
1985). EMG can be recorded by intramuscular electrodes placed
into the belly of the muscle or surface electrodes placed on the
overlying skin.
Traditionally surface electrodes have been preferred for superfi-
cial muscles as they are non-invasive, easier to set up (Giroux and
Lamontagne, 1989) and sample from a larger cross-section of the
muscle than intramuscular electrodes (Basmajian and De Luca,
1985). However, surface electrodes may be susceptible to geometric
⇑ Corresponding author. Address: Discipline of Biomedical Science, Sydney
Medical School, Cumberland Campus C42, The University of Sydney, Lidcombe,
NSW 1825, Australia. Tel.: +61 2 9351 9144; fax: +61 2 9351 9715.
E-mail address: darren.reed@sydney.edu.au (D. Reed).
displacement away from the target muscle (Oberg et al., 1992) and
recording EMG signals from adjacent or underlying muscles, leading
to contamination of signals, known as crosstalk (Johnson et al., 2011;
Perry et al., 1981; Stokes et al., 2003).
Intramuscular electrodes are commonly used to record activity
from deep muscles inaccessible to surface electrodes, but may also
be the electrode of choice in some superficial muscles if cross talk
or geometric displacement is a potential problem. They record
activity from a smaller volume of muscle having more specificity
than surface electrodes and therefore, are not susceptible to cross-
talk (Basmajian and De Luca, 1985; Bouisset and Maton, 1972;
Giroux and Lamontagne, 1989). However, studies suggest that they
may not be representative of activity in the entire muscle (Giroux
and Lamontagne, 1989; Yemm, 1977).
The shoulder region, with the humerus and scapula both
moving through large ranges and multiple muscles with varying
morphology lying in close proximity to each other, presents chal-
lenges in using surface electrodes on superficial shoulder muscles.

http://dx.doi.org/10.1016/j.jelekin.2014.01.007
1050-6411/Ó 2014 Elsevier Ltd. All rights reserved.

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222 L. Hackett et al. / Journal of Electromyography and Kinesiology 24 (2014) 221–227
Previous research in the shoulder region has shown geometric dis-
placement (Oberg et al., 1992) and crosstalk from adjacent muscles
in isometric (Johnson et al., 2011; Waite et al., 2010) and dynamic
exercises (Jaggi et al., 2009) may lead to invalid recordings from
surface electrodes.
Serratus anterior is an important axioscapular muscle crucial to
normal shoulder function. This large, flat muscular sheet attaches
via individual digitations from the first 8 or 9 ribs to the medial
border of the scapula (Palastanga et al., 2012). It is a major protrac-
tor of the scapula and the lower fibres co-ordinate with trapezius
to upwardly rotate the scapula (Palastanga et al., 2012). EMG re-
search investigating serratus anterior activity has predominantly
used surface electromyography over the lower digitations of the
muscle where it is most accessible and superficial (Cools et al.,
2007; Decker et al., 1999; Ekstrom et al., 2003). However, glenohu-
meral joint movement results in the skin overlying the lower fibres
of serratus anterior experiencing large degrees of shift during
shoulder movement. There is also the possibility that surface elec-
trode recordings from serratus anterior may be contaminated by
potential cross-talk from adjacent muscles. To date, no studies
have assessed the validity of using surface electrodes to record
activity from serratus anterior. In addition, the issue of whether
recording serratus anterior activity using intramuscular electrodes
is representative of activity in the whole of this large muscle has
not been investigated and is still unknown. Therefore, the aims
of this experiment were to:
 Determine the validity of using surface electrodes to record
muscle activity from the lower fibres of serratus anterior during
dynamic and isometric contractions.
 In the test conditions where the validity of surface electrode
recordings were confirmed, to determine the representative-
ness of intramuscular electrodes compared to surface electrodes
for recording muscle activity from the lower fibres of serratus
anterior.
2. Methods
2.1. Subjects
Seven asymptomatic subjects (six male, one female, aged 19–
23) volunteered to participate in this investigation. To be eligible
to participate subjects must have had no pain in their dominant
shoulder in the previous two years and had never been treated
for shoulder pain. Prior to the experiment, shoulder strength and
range of motion tests were conducted by an experienced physio-
therapist to verify normal pain free functioning of the dominant
shoulder and subjects gave their informed consent. Ethics approval
was granted by The University of Sydney’s Human Research Ethics
Committee (approval number 04-2011/13610).
2.2. Instrumentation
Electromyographic data were collected simultaneously from
the lower fibres of serratus anterior using both surface and intra-
muscular electrodes. Intramuscular electrodes were manufactured
in the Shoulder Laboratory, Sydney Medical School, using the tech-
nique developed by Basmajian and De Luca (1985) and comprised
of two insulated wires of 0.14 mm diameter made of Teflon coated
stainless steel. The two wires were bent back to form barbs at
2 mm and 4 mm respectively from the terminal end. This terminal
end was de-insulated for a length of 1 mm for both wires. Using a
sterile technique, the wires were inserted via a hypodermic needle
acting as a cannula into the digitation of serratus anterior over rib 7
(Geiringer, 1994). Wires were looped to allow for adequate move-
ment, and then taped to the skin to prevent inadvertent removal.
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A pair of 3.2 mm diameter silver/sliver chloride surface elec-
trodes (Red Dot, 2258, 3M, Sydney, Australia) was used to detect
muscle activity from serratus anterior (Ekstrom et al., 2004). With
the subject side-lying and the arm in 60° abduction, the surface
electrodes for serratus anterior were placed at a distance of
approximately 25 mm apart over the seventh rib (Ekstrom et al.,
2005; Hardwick et al., 2006), in line with the muscle fibres and
around the intramuscular electrodes (Giroux and Lamontagne,
1989; Johnson et al., 2011). A large ground electrode (Universal
Electrosurgical Pad: Split, 9160F, 3M, Sydney, Australia) was placed
on the spine and acromion of the contralateral scapula. Resistances
were measured between surface electrodes (Dick Smith Electronics
Q-1450) and were <5 kX.
Both the intramuscular and surface electrodes were then con-
nected to amplifiers (Iso-DAM8-8 amplifiers, World Precision
Instruments, Sarasota, FL; gain = 100) via a junction box. Data
was recorded on a personal computer using SPIKE 2 software (Ver-
sion 4.0 Cambridge Electronics Design, Cambridge, UK) and a 16
channel analogue to digital converter (CED2701, CED Ltd., Cam-
bridge, UK) at a sample rate of 3125 Hz.
Maximum voluntary contractions (MVCs) were then performed
using five standardised shoulder normalisation tests (Boettcher
et al., 2008; Ginn et al., 2011) known to have a high likelihood of pro-
ducing maximum activity in serratus anterior. These normalisation
tests were performed in random order and consisted of manually
resisted shoulder flexion with the shoulder at 125° flexion, internal
rotation at 90° shoulder abduction, shoulder extension at 30° abduc-
tion, abduction with the shoulder abducted 90° and internally ro-
tated and self-resisted horizontal adduction at 90° shoulder flexion.
2.3. Test positions
Isometric and dynamic tests of shoulder flexion, extension,
abduction, adduction and a dynamic bench press plus exercise
(seated chest press to a point where the elbows are fully extended,
followed by shoulder protraction) were performed. These tests
were selected as they include tasks expected to elicit high serratus
anterior activity (flexion and abduction, bench press plus) (Decker
et al., 1999; Ludewig et al., 2004), as well as ones in which it would
be expected to be less active (extension, adduction). The order of
the isometric and dynamic tests was block randomised. During
the abduction, adduction, flexion and extension tests the subject
stood with their feet placed shoulder width apart and their contra-
lateral hand placed on the corresponding hip in order to prevent
unwanted trunk movement. For the flexion test, the contralateral
foot was brought two feet-lengths forward, and for the extension
test, the ipsilateral foot was brought two feet-lengths forward.
The bench press plus exercise was performed on gym equipment
(Hyper Extension Gym 50036, 150lbs).
Prior to testing and electrode placement, the maximum isomet-
ric load (100% load) for shoulder abduction, flexion, adduction, and
extension was measured using a load cell (XTRAN load cell S1W,
Applied Measurement Australia PTY LTD, Melbourne, Australia),
with resistance maintained for three seconds. Maximum tests were
repeated twice, with at least a 30 s rest in between each repetition.
The maximum load was used as the ramped isometric target load,
and to calculate the 70% maximum load used during dynamic test-
ing. The one repetition maximum (1RM) for the dynamic bench
press plus exercise was calculated by the Bryzcki equation, using
the number of repetitions a subject was able to perform sub-max-
imally to determine their 1RM (Bryzcki, 1995). The testing order of
these maximal load tests was randomised.
Dynamic tests included shoulder flexion, extension, abduction,
adduction and bench press plus. The bench press plus, was per-
formed seated and through range from 20° shoulder extension to
90° shoulder flexion, followed by full range scapular protraction
 L. Hackett et al. / Journal of Electromyography and Kinesiology 24 (2014) 221–227 223

A i) ii) F B i) ii)

F
C i) ii) D i) ii)

E i)

Fig. 1. Performance of flexion (A), extension (B), abduction (C), adduction (D), bench press plus (E) during both dynamic (i) and isometric (ii) conditions. Force transducer (F).

(Fig. 1E). The other four shoulder movements were performed
using a cable apparatus attached to a pulley (Fig. 1A–D). Abduction
was performed from 0° to 160°, adduction from 140° to 0°, flexion
from 30° extension to 160° flexion and extension from 140° flexion
to 30° extension. Load was set at 70% of maximum load during
these dynamic tests in order to produce a high level of muscle
activity while avoiding the level of fatigue that comes with pro-
longed maximal exercise.
Timing was monitored and standardised at three seconds dur-
ing the concentric phase and three seconds during the eccentric
phase of the exercises, with a one second pause between concen-
tric and eccentric phases. The same body and foot positioning as
described above was monitored in order to ensure correct scapulo-
humeral rhythm during the execution of each test without
compensatory trunk movement. A draw-wire was used (Micro-
epsilon, 94496, Ortenburg, Germany) to synchronise shoulder
movement with the EMG signals. Two repetitions of each dynamic
test were performed in random order, with a 30 s rest interval
between each repetition.
Ramped isometric tests for shoulder flexion, extension, abduc-
tion, and adduction were performed randomly with at least
2 min rest between each test to avoid the effects of fatigue.
Ramped exercises allowed for an examination of the effect of
different isometric loads ranging from 0% to 100% of maximum

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224 L. Hackett et al. / Journal of Electromyography and Kinesiology 24 (2014) 221–227
load. Posture and feet positioning was monitored and standardised
as in the dynamic tests. Using the load cell (XTRAN load cell S1W,
Applied Measurement Australia PTY LTD, Melbourne, Australia)
connected to an amplifier (DA100 BIOPAC Systems Inc, Goleta,
CA USA) connected to an analogue to digital converter (MP100,
BIOPAC Systems Inc, Goleta, CA, USA) and the AcqKnowledge
Software (Version 3.9.0, BIOPAC Systems Inc, Goleta, CA, USA), sub-
jects’ applied force and target force signals were displayed on a
laptop computer. The ramped target signal consisted of a four sec-
onds linear increase in force from zero to maximum, three seconds
at maximum, then four seconds linear decrease back to zero
(Fig. 2). Subjects were instructed to follow the target signal by
applying the appropriate force level.
Isometric tests were performed in standing using the same pul-
ley apparatus as for the majority of the dynamic shoulder tests. The
shoulder was positioned in 90° flexion in the sagittal plane for the
flexion and extension tests and in 90° abduction in the scapular
plane for the abduction and adduction tests. The isometric tests
were performed twice in random order, with a 30 s rest interval
between repetitions.
2.4. Data analysis
Data processing was performed in Matlab (version 7, The Math
Works, Natick, MA). EMG signals were high pass filtered at 10 Hz
(zero lag, 8th Order Butterworth), notch filtered at 50 Hz (zero
lag, 8th Order Butterworth), rectified then the linear envelope
calculated by low pass filtering at 3 Hz (zero lag, 8th Order Butter-
worth). The EMG signals were then normalised using the maxi-
mum value recorded for the muscle during the five normalisation
tests and expressed as (%MVC) separately for each of the surface
and indwelling electrodes.
The mean activation level from the lower fibres of serratus
anterior as measured by the mean linear envelope of the EMG re-
corded using each type of electrode across each trial of each iso-
metric test was calculated as well as across 1 s during each trial
of the five shoulder normalisation tests. The mean EMG levels
across the trials were calculated for each test. Differences in the
levels were examined using a 2 factor repeated measures analysis
of variance (ANOVA) with factors: test and electrode type (Statisti-
ca, version 7.0, Stat Soft Inc., Tulsa, OK).
The mean activation level from the lower fibres of serratus
anterior as measured by the mean linear envelope of the EMG re-
corded using each type of electrode across each of the concentric
and eccentric phases of movement, identified using the draw wire
sensor signal, were calculated for each trial of each dynamic test
Fig. 2. An example of the ramped target signal (smooth line) and matched force
applied by the subject (irregular line) as displayed on the computer screen during
the isometric exercises.
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and averaged across trials. Differences in the levels were examined
using a 3 factor repeated measures ANOVA with factors: test, phase
of movement and electrode type. Normality of the data was con-
firmed using probability plots. Tukey HSD post hoc analysis was
used when significant ANOVA results were obtained.
The signals were then time normalised to 101 points for each
testing cycle and Pearson’s correlation analysis was used to assess
the similarity in the pattern of change with load or range of
movement between signals obtained from the two types of
electrodes.
3. Results
Mean (±95% CI) lower serratus activity levels recorded from
both surface and intramuscular electrodes for each of the test con-
ditions examined are depicted in Fig. 3. During the different
ramped isometric tests, there was a significant difference between
activity recorded from different tests (F3,18 = 31.01, p < 0.05) and an
interaction between test and electrode type (F3,18 = 5.70, p < 0.05).
Tukey post hoc analysis indicated that the activity recorded using
the intramuscular electrodes was higher (p < 0.05) than that re-
corded using the surface electrodes during the ramped isometric
shoulder abduction and flexion tests with no difference (p > 0.05)
between the two electrode types during adduction and extension
tests. Serratus anterior mean activity levels from each electrode
type during abduction were similar (p = 1.0) to the levels recorded
during flexion and both were higher than that recorded during
shoulder adduction and extension (p < 0.05).
During the dynamic tests, there was a main effect of: electrode
type (F1,6 = 6.59, p < 0.05) with the intramuscular electrodes regis-
tering higher activity levels than surface electrodes; phase of
movement (F1,6 = 54.59, p < 0.01) with higher levels of activity re-
corded during the concentric phase of each test; and with different
tests producing different activity levels (F4,24 = 57.16, p < 0.01).
There was also a three way interaction between test, electrode type
and phase of movement (F4,24 = 4.97, p < 0.01). Tukey post hoc test
indicated that the activity recorded using the intramuscular elec-
trodes was higher (p < 0.05) than that recorded using the surface
electrodes during the concentric phase of both dynamic abduction
and flexion and during both the concentric and eccentric phases of
the bench press plus with no differences between the two types of
electrodes during any other tests or phases of movement (p > 0.05).
Lower serratus anterior mean activity levels recorded with each
electrode type during dynamic shoulder abduction, flexion and
bench press were similar and higher than that recorded during dy-
namic adduction and extension (p < 0.05).
During the isometric shoulder normalisation tests, there were
significant main effects in: electrode type (F1,6 = 9.59, p < 0.05)
with the intramuscular electrodes recording higher activity levels
than the surface electrodes; differences between tests
(F4,24 = 77.69, p < 0.01); and an interaction between test and elec-
trode type (F4,24 = 5.61, p < 0.05). Tukey post hoc analysis indicated
that activity in the lower fibres of serratus anterior recorded using
the intramuscular electrodes was higher (p < 0.05) than that re-
corded using the surface electrodes during shoulder abduction at
90° in internal rotation and horizontal adduction with no differ-
ence (p > 0.05) between the two electrode types during flexion at
125°, extension at 30° abduction and internal rotation. The mean
activity levels from each electrode type during abduction at 90°
in internal rotation were similar (p > 0.05) to the levels during
horizontal adduction and both were higher (p < 0.05) than during
shoulder internal rotation and extension normalisation tests.
Lower serratus anterior activity levels during flexion were similar
(p = 0.64) to those recorded during abduction and higher than dur-
ing all other normalisation tests (p < 0.05) when recorded by the
 L. Hackett et al. / Journal of Electromyography and Kinesiology 24 (2014) 221–227 225

100

serratus anterior activation

intramuscular
90
surface
80

level (% MVC)
70
60
50
40
30
20
10
0

rotation
abduction

adduction
flexion

concentric

eccentric

eccentric

concentric

eccentric

concentric

eccentric

concentric

eccentric

abduction

flexion

horizontal
adduction

extension

internal
extension

concentric
abduction flexion adduction extension bench press
plus
ramped isometric tests dynamic tests shoulder normalization tests

Fig. 3. Mean normalised serratus anterior activity levels (±95% CI) recorded from surface (grey) and intramuscular electrodes (black) electrodes during the tests investigated.
*
indicates significantly different mean activation levels between electrode types (p < 0.05).

intramuscular electrodes. Lower serratus anterior activity levels subjects between lower serratus anterior activity recorded with
recorded by the surface electrodes were higher during flexion intramuscular and surface electrodes during both the isometric
(p < 0.05) than all other normalisation tests. All other normalisa- ramped and dynamic tests were low (r 6 0.41) for the concentric
tion tests produced activity at an average of <10%MVC and no sig- phases of the dynamic abduction and flexion but high (r P 0.68)
nificant differences were found in serratus anterior activity levels otherwise.
recorded using intramuscular and surface electrodes (p > 0.05).
The mean (±95% CI) time normalised activity levels in the lower
fibres of serratus anterior as recorded from each electrode type for 4. Discussion
each of the ramped isometric and dynamic test conditions exam-
ined that produced mean activity levels >10% are depicted in The results of this study provide no evidence to indicate that
Fig. 4. The mean (±95% CI) Pearson’s correlation coefficients across crosstalk is contaminating the signals recorded from the surface

120 a c r = 0.41 ± 0.46 r = 0.75 ± 0.35

activation level (% MVC)

100 r = 0.88 ± 0.05

serratus anterior

80

60

40

20

0
r = 0.31 ± 0.45 r = 0.80 ± 0.30
120 b d
activation level (% MVC)

100 r = 0.85 ± 0.09

serratus anterior

80

60

40

20

0
0 20 40 60 80 100
time (% cycle)
e r = 0.68 ± 0.18 r = 0.88 ± 0.07
120
activation level (% MVC)

100
serratus anterior

80

60

40

20

0
0 20 40 60 80 100
time (% cycle)

Fig. 4. Mean time normalised pattern of normalised serratus anterior activation as recorded from intramuscular (black) and surface (grey) electrodes with 95% CI (dashed
lines) versus time (% cycle) for (a) isometric ramp abduction, (b) isometric ramp flexion, (c) dynamic abduction, (d) dynamic flexion, and (e) bench press. The average (±95%
confidence intervals) across subjects and trials of the correlation coefficient between the recordings from intramuscular and surface electrodes is reported.

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226 L. Hackett et al. / Journal of Electromyography and Kinesiology 24 (2014) 221–227
electrodes over the lower fibres of serratus anterior. During all the
adduction and extension tasks examined, similarly low serratus
anterior activity was recorded from both the intramuscular and
surface electrodes (Johnson et al., 2011; Waite et al., 2010). This
indicates that the surface electrodes were not picking up activity
from adjacent muscles.
However, this study has demonstrated significantly different
activity in the lower fibres of serratus anterior recorded using sur-
face electrodes and intramuscular electrodes during both dynamic
and isometric shoulder tasks when serratus anterior would be ex-
pected to be active (Fig. 3). During shoulder flexion, abduction,
bench press and horizontal adduction across all loads examined
significantly lower serratus anterior activity levels were recorded
from the surface electrodes compared with the intramuscular elec-
trodes. This consistent under-reporting of serratus anterior activity
by surface electromyography indicates that activity in the lower fi-
bres of serratus anterior can only be measured validly with the use
of intramuscular electromyography.
A likely explanation of the significantly lower serratus anterior
activity levels recorded using surface electromyography is geomet-
ric displacement. As the shoulder moved through range, the skin
over the lower fibres of serratus anterior may have moved to a dif-
ferent position in relation to the muscle. This may have resulted in
the surface electrodes being displaced to a position with greater
fatty tissue and/or away from the innervation zone of the muscle,
or off serratus anterior completely and into the intercostal space.
The low correlation (Fig. 4) between the recruitment patterns of
the lower fibres of serratus anterior recorded during the concentric
phases of the dynamic shoulder flexion and abduction tasks exam-
ined would also indicate that the two recording electrode types de-
tected significantly different patterns of activation and would
support these explanations.
Geometric displacement could also explain the significantly
lower activity in the lower fibres of serratus anterior recorded by
the surface electrodes during the shoulder isometric tasks per-
formed at 90° elevation (flexion, abduction and horizontal flexion).
The surface electrodes were attached with the subject’s arm ab-
ducted to 60°. Moving the arm to 90° flexion or abduction may
have again displaced the surface electrodes away from the rib to
which serratus anterior is attached and over the superior intercos-
tal space. This was consistent with dynamic exercises where the
greatest difference between the electrode types occurred at
approximately 90° elevation (middle of the concentric range at
25% cycle, Fig. 4). However, during the isometric normalisation
test performed at 125° flexion, there was no difference in the activ-
ity recorded from surface and intramuscular electrodes. During
this test the surface electrodes may have displaced further superi-
orly from the intercostal space to be positioned over the rib above
and therefore, over the digitation of serratus anterior attaching to
this rib, and hence recorded similar activity to the intramuscular
electrode. Based upon these findings, surface electrodes may val-
idly record activity from the lower fibres of serratus anterior dur-
ing isometric tasks if the surface electrodes are applied with the
shoulder joint in the same angle at which isometric testing will
be performed, therefore minimising potential electrode movement.
The current study only compared serratus anterior muscle
activity recorded using surface and intramuscular electrodes from
the muscle attachment over rib 7. However, because the only
superficial parts of serratus anterior accessible for surface elec-
trode placements are over the slips attaching to the ribs, it is likely
that geometric displacement would also affect the validity of sur-
face electrode recordings from other rib locations. This will require
further study to determine the applicability of the current results
to parts of serratus anterior attaching to other ribs.
The similar activation levels recorded between electrode types
during the flexion shoulder normalisation test, where maximum
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activity from the lower fibres of serratus anterior was most com-
monly recorded, suggests that intramuscular electromyography is
at least as representative of muscle activity in lower serratus ante-
rior as surface electromyography. With intramuscular electrodes
recording greater lower serratus anterior activity than surface elec-
trodes during abduction, flexion and bench press tests and similar
levels in all other test conditions, it could be argued that they are in
fact more representative than surface electrodes. This finding is
consistent with other studies suggesting that intramuscular elec-
tromyography is representative of whole muscle activity in the
shoulder region (Bogey et al., 2000; Bouisset and Maton, 1972;
Johnson et al., 2011).
While the results of the current study indicate that intramuscu-
lar electrodes are at least as representative of lower serratus ante-
rior activity as surface electrodes, it is possible that neither
electrode type was detecting activity from the entire muscle. In
this experiment electrodes were placed over/into the part of serra-
tus anterior associated with the 7th rib i.e. over the lower portion
of serratus anterior. Future research will need to investigate both
upper and lower sections of serratus anterior to determine if
recording from only lower portions validly represents activity in
the whole of this muscle.
In conclusion, this study demonstrates that it is not valid to use
surface electrodes placed over the digitation of serratus anterior at-
tached to rib 7 to record muscle activity from the lower fibres of
serratus anterior during dynamic exercises where serratus anterior
would be expected to be active and isometric exercises where the
electrodes are not placed at the shoulder angle to be tested. Addi-
tionally, intramuscular electrodes have been shown to be at least
as representative of activity in the lower fibres of serratus anterior
as surface electrodes. These results indicate that intramuscular
electrodes should be used to investigate lower serratus anterior
activation patterns during functional activities.
Funding
No funding was obtained for this study.
Conflict of interest
None declared.
Photography
All subjects photographed provided their consent by ticking
applicable box in consent form.
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Discipline of Biomedical Science, Sydney Medical School,
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The University of Sydney and a musculoskeletal physio-
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therapist in part time private practice. She is involved in
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for shoulder dysfunction; the aetiology of frozen
shoulder; perceptual changes associated with chronic
shoulder pain; and studies evaluating the validity of
Lucien Hackett is a medical student at the University
physical examination techniques at the shoulder.
of Sydney. He graduated with first class honours in
Exercise and Sport Science from the Faculty of Health
Sciences, University of Sydney in 2012. He has specific
interests in the areas of anatomy and sports medicine.

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