Abstract
Background: Although mostly common adverse events associated to
dry needling can be considered minor, serious adverse events including
induced pneumothorax cannot be excluded, and safety instructions for
reducing the risk of pleura puncture are needed. Objective: To
investigate if anthropometric features can predict the rhomboid major
muscle and pleura depth in a sample of healthy subjects to avoid the
risk of pneumothorax during dry needling. Methods: A diagnostic
study was conducted on 59 healthy subjects (52.5 % male) involving a
total of 236 measurements (both sides in maximum inspiration and
expiration), to calculate the accuracy of a prediction model for both
pleura and rhomboid depth, as assessed with ultrasound imaging, based on
sex, age, height, weight, body mass index (BMI), breathing and chest
circumference. A correlation matrix and a multiple linear regression
analyses were used to detect those variables contributing significantly
to the variance in both locations. Results: Men showed greater
height, weight, BMI, thorax circumference and skin-to-rhomboid,
rhomboid-to-pleura y skin-to-pleura distances (p<0.001). Sex,
BMI, and thorax circumference explained 51.5% of the variance of the
rhomboid (p<0.001) and 69.7% of pleura (p<0.001)
depth limit. In general, inserting a maximum length of 19 mm is
recommended to reach the deep limit of rhomboid major decreasing the
risk of passing through the pleura. Conclusion: This study
identified that gender, BMI and thorax circumference can predict both
rhomboid and pleura depth, as assessed with ultrasonography, in healthy
subjects. Our findings could assist clinicians in the needle length
election for avoiding the risk of induced pneumothorax during dry
needling.
Keywords: Rhomboid Muscle; Dry Needling; Ultrasound Imaging;
Pneumothorax; Clinical Decision Rules
What’s already known about this topic?
Although the estimated risk rate of significant adverse events during
dry needling procedures is ≤ 0.04%, it cannot be excluded
Different strategies including palpation of the ribs before dry
needling have been proposed. However, the authors reported poor
accuracy in subjects with larger muscle thickness and higher body mass
index