The medial (vertebral) border is the long inner edge of the shoulder blade that runs roughly parallel to the spine, from the superior angle down to the inferior angle. Levator scapulae, rhomboid minor and rhomboid major attach along its back surface, and serratus anterior attaches along its front (rib-side) surface. These muscles hold the scapula against the chest wall and control its movement.
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| Landmarks |
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| Ossification | Formed from the primary centre of the scapular body; a secondary ossification centre for the medial border appears around puberty and fuses by about 20-25 years. |
The medial border is the edge that lifts away from the chest in scapular winging. In long thoracic nerve palsy with serratus anterior weakness, the whole medial border and inferior angle lift backward and toward the midline, while in trapezius palsy (spinal accessory nerve injury) the scapula tends to sit lower and drift outward. Observing the medial border during wall push-ups and arm raising is a standard part of shoulder examination. Rhomboid and middle trapezius trigger points along this border are common causes of pain between the shoulder blades.
Ask the person to place the back of the hand on the lower back; the medial border lifts away from the chest wall and can be felt clearly. Run your fingers down along it from the superior angle to the inferior angle. With the arm relaxed, it normally lies about 5-7 cm from the spinous processes.
Lifting of the medial border away from the chest wall, most often from long thoracic nerve injury and serratus anterior weakness.
Aching pain between the shoulder blades from overloaded rhomboids and middle trapezius along the medial border, common with prolonged desk work.
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