Rhomboids

Original Editor - Naomi O'Reilly

Lead Editors - Naomi O'Reilly, Lucinda hampton, Ilona Malkauskaite, Kim Jackson, WikiSysop, Joao Costa and Kai A. Sigel  

Description

The Rhomboids are two muscles - Rhomboid Major & Rhomboid Minor. The two rhomboids lie deep to trapezius to form parallel bands that pass inferolaterally from the vertebrae to the medial border of the scapula. Rhomboid Major is thin and flat and twice as wide as the thicker Rhomboid Minor which lies superior to it.

The rhomboids are important in upper limb movement and stability of both the shoulder girdle and scapula. Both rhomboids receive innervation from the dorsal scapular nerve and supplied by the dorsal scapular artery. Variants in rhomboid musculature have been found but are very rare. Winged scapula and rhomboid palsy are clinical pathologies associated with the rhomboids.

Image: Rhomboid major muscle (highlighted in green) - posterior view

Anatomy

Origin & Insertion

The rhomboids consist of two separate muscles; the major and minor muscles which are found immediately deep to the trapezius.

1. The rhomboid minor is a cylindrical muscle that originates at the ligamentum nuchae and C7 and T1 vertebra. It inserts at the scapula's medial border near the base of the spine of the scapula.
2. The rhomboid major is quadrangular muscle located inferior to the rhomboid minor. The origin of the rhomboid muscles is from the spinous processes of the T2-T5 vertebra and inserts on the medial border of the scapula, just inferior to the rhomboid minor.

Image 2: Rhomboideus minor and rhornboideus major of right side: outline and attachment-areas.

	Origin Proximal Attachment	Insertion Distal Attachment
Rhomboid Major	Spinous Processes T2-T5	Medial Border of Scapula from Level of Spine to Inferior Angle
Rhomboid Minor	Nuchal Ligament Spinous Processes C7 & T1	Triangular Area Medial End of Scapular Spine

The 30 second video below in on the Rhomboids anatomy.

Rhomboid Major

Nerve Supply

The motor function of the rhomboid muscles is controlled by the dorsal scapular nerve (DSN). The DSN originates from the ventral ramus of the spinal nerve root C5, and courses posterior inferiorly through the middle scalene muscles and between the posterior scalene, levator scapulae (to which it also provides innervation), and the serratus posterior superior. It continues deep to the brachial plexus to innervate both the rhomboid minor and major muscles at their anterior border

Function

The rhomboid major and minor are a group of deep intrinsic shoulder muscles that together with the sternocleidomastoid, trapezius, pectoralis muscles, latissimus dorsi, and serratus anterior, form the shoulder girdle. This group of muscles is important for movement of the upper extremity and stabilization of the shoulder through articulation with the trunk.

Image 4: Posterior view of muscles connecting the upper extremity to the vertebral column. A Trapezius B  Teres  Major C Teres Minor D Latissimus Dorsi E Levator Scapulae F Rhomboid Major

Functionally, the rhomboid muscles retract, elevate and rotate the scapula. They also protract the medial border of the scapula, keeping it in position at the posterior thoracic wall.

The serratus anterior, trapezius and rhomboid major and minor work with the rhomboids to anchor the scapula and prevent winging. The serratus anterior is the antagonist muscle group to the rhomboids. The rhomboids also work in conjunction with the levator scapulae to elevate and retract the scapula

• Dysfunction, weakness or loss of nerve function to the rhomboids causes winging of the medial border of the scapula and inferior scapular angle rotation.
• The rhomboids are also vital to actions such as pulling and have been shown to play a large role in throwing and overhead arm movement.

Image 5: Rhomboid muscles animation

Physiotherapy

Assessment

The etiology of rhomboid injuries are usually posture related eg in correct shoulder placement when playing sports, carrying heavy objects, thoracic hyperkyphosis, forward head posture, upper crossed syndrome. Those who do not exercise regularly find that muscles like the rhomboid muscle become weak and more susceptible to strains and tears.

Palpation

Palpated together. The rhomboids are covered by trapezius so you need to relax trapezius by placing hand in small of back. Palpate along vertebral border by placing fingers under it. Have patient lift hand off back (with resistance if needed) and the rhomboids push fingers out.

Strength Testing

See Manual Muscle Testing: Scapular Retraction/ Adduction

The 30 second video shows testing the rhomboids.

Trigger Point Referral Pattern

The trigger point referral pattern of the Rhomboids is not as widely distributed but local to the muscles. The pain generally extends from the edge of the shoulder blades to the spine. Since the Rhomboids on both sides are almost always affected, this is a primary source of mid back tightness or aching between the shoulder blades.

Treatment

Take a look at the videos for examples of treatment techniques.

Massage & Myofascial Release

Exercise Prescription

Stretching

Foam Rolling

Taping