The rhomboid major is the larger of the two rhomboids, retracting the scapula and rotating the glenoid inferiorly. Weakness of the rhomboids (and serratus anterior imbalance) produces medial scapular winging — the medial border lifts from the thorax during horizontal push-up or forward reaching. This is distinguished from serratus anterior palsy (lateral winging with long thoracic nerve injury) by the pattern of winging.
| Origin | Spinous processes of T2-T5 |
|---|---|
| Insertion | Medial border of the scapula between the root of the spine and the inferior angle (the larger, more caudal rhomboid) |
| Nerve Supply | Dorsal scapular nerve (C4, C5) |
| Blood Supply | Dorsal scapular artery |
| Actions | Retracts the scapula (adduction toward the spine); Rotates the glenoid inferiorly; Elevates the medial scapular border slightly |
|---|
Rhomboid myofascial pain produces medial scapular border pain with a characteristic deep aching that does not resolve with positional change. Trigger points in the rhomboid major refer along the medial scapular border. The combination of weak rhomboids and overactive pectoralis minor produces the classic forward head-rounded shoulder posture of office workers.
The rhomboid major is palpable under the trapezius at the medial scapular border between the scapular spine and inferior angle, becoming firm during resisted scapular retraction.
Medial scapular border pain from rhomboid major trigger points managed with dry needling and scapular retraction strengthening.
