The rhomboid major inserts via a broad tendinous sheet onto the medial border of the scapula between the spine and the inferior angle, with fibres attaching to the fibrous edge of the infraspinous fossa. This insertion is the principal scapular retractor tendon of the posterior thorax.
Rhomboid major insertion tendinopathy produces medial scapular border pain reproduced by resisted scapular retraction. It is a common source of interscapular pain in desk workers and is associated with upper crossed syndrome. Dry needling and strengthening of the rhomboids in the retracted position are effective. The medial scapular insertion is at risk during thoracic surgery requiring scapular retraction.
Degenerative or traction change at the medial scapular border rhomboid insertion producing interscapular pain reproduced by resisted scapular retraction, associated with prolonged forward-head posture.
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