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.
Objective: A correct examination is essential during a differential diagnosis of neck pain patients. Therefore, the objective of this study was to provide an update on the properties considered most important by PTs when conducting accessory and physiological movement tests during the cervical spine physical examination. Methods: A total of 84 private physiotherapy centres participated in this online cross-sectional survey including 415 active physiotherapists and members of one autonomous Spanish Physiotherapists School. The main outcome measures were the frequency and the importance of mobility and pain responses assessed during cervical spine examination and the most commonly utilized reference to make a judgement. Results: Pain responses are most frequently used by physiotherapists at a rate of 79.8% and also rated as important by 42.65% respondents mobility aspects such as quality of end-feel (17.3%), quantity of translation (16.4%) and quality of resistance (13.3%) during passive accessory intervertebral movement tests. During passive and active physiological movement tests, the most frequent properties assessed were the quality of motion path (80,5% and 84.3% respectively) and quantity of angle bending (81,7% and 77.6% respectively). Pain responses are used as reference by 54.7% to make a clinical judgement during passive accessory intervertebral movement tests. Conclusion: Physical therapists face validity in relation to passive accessory intervertebral movement test for assessing spinal segmental motion aspects has been decreasing with more attention devoted to pain responses. The current skepticism regarding the motion properties assessed with these tests is associated with utility aspects such as validity, sensitivity, accuracy and specificity.