The serratus posterior inferior inserts onto the outer surfaces of ribs 9-12 via distinct costal tendinous slips, depressing the lower ribs during forced expiration. These tendinous insertions are palpable on the posterior lateral thorax.
The serratus posterior inferior costal tendon slips are the insertion points disrupted in lower thoracic rib avulsion injuries. The muscle is identified during paraspinal approaches to the lower thoracic spine as the superficial layer requiring retraction. Trigger points in these costal tendon slips refer pain to the lower back in a pattern mimicking renal colic.
Traction avulsion of the costal tendon slips in explosive trunk rotation producing posterior lower thoracic pain and visible rib periosteal disruption on CT, managed conservatively with rib strapping.
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