Enhancing Trigger Point Dry Needling Safety by Ultrasound Skin-to-Rib Measurement: An inter-Rater Reliability Study

Abstract

Dry needling (DN) is a minimally invasive treatment technique widely used by physical therapists to treat myofascial trigger points (MTrP). Even if its safety has been commonly declared and the majority of adverse events are considered mild, serious adverse events cannot be excluded and DN treatments of several trunk muscles can potentially result in pneumothorax. Ultrasound imaging (US) skin-to-rib measurement could ensure the safety of this treatment procedure. Therefore, the aim of this study was to determine the inter-rater reliability of depth measurement of different trunk muscles (i.e., rhomboid, lower trapezius, iliocostalis, and pectoralis major) between an expert and two novice physiotherapists. Skin-to-rib distance of 26 asymptomatic and normal weights subjects was consecutively, independently, and randomly measured for each muscle by the three examiners (1 expert and 2 novice physical therapists) with a handheld US wireless probe. Intraclass correlation coefficient (ICC3,k) and standard error of measurement (SEM) were used to assess inter-rater reliability. Inter-rater reliability of skin-to-rib measurements between the three examiners was good to excellent or excellent for every muscle, with an ICC3,k ranging from 0.92 and 0.98 (95% CI 0.86–0.99). The SEM never exceeded 10% of the skin-to-rib distance. In conclusion, skin-to-rib US measurements of the trunk muscles can be reliably performed by novice physical therapists using a handheld US device. These measures could be used as an innovative and reliable technique to improve the safety of some potential dangerous DN treatments.

Effectiveness of Dry Needling for Myofascial Trigger Points Associated with Neck Pain Symptoms: An Updated Systematic Review and Meta-Analysis

“…Although dry needling could be considered a safe treatment if properly applied, potential risks associated with its application on each body area where it is applied should be taken into account. In fact, recent studies have proposed different positions [ 63 ] or the use of echography [ 64 ] for improving the safety of dry needling application.…”

Prediction model of rhomboid major and pleura depth based on anthropometric features to decrease the risk of pneumothorax during dry needling

“…18 For ultrasound imaging, participants were in prone with their arms in the abduction of 90° and elbows flexed. The assessment point was selected following the procedure as described by Folli et al 13 which has been found to be highly reliable. Firstly, the spinous process and the inferior angle of the scapula was identified by manual palpation, and the half distance between these points was calculated.…”

“…As a conclusion of their study, they recommended the use of ultrasound evaluation during or before dry needling to ensure the correct needle length. Folli et al recently reported, as assessed with ultrasound imaging, a mean thickness of the major rhomboid muscle of 16.3 mm (males muscle thickness: 25.4 mm; women muscle thickness: 20.4 mm) 13 . However, they routinely use of ultrasound in clinical practice is not always possible because of its high economic costs.…”

A new ultrasound-guided percutaneous electrolysis and exercise treatment in patellar tendinopathy: three case reports

“…Moreover, there is literature that also strongly recommends its use not only as an evaluation tool due to its low cost, safety and portability, but also because of the possibility of obtaining quantitative measurements of tissue texture (thickness, cross-sectional areas or perimeters) and as a guide for invasive interventions such as dry needling or percutaneous electrolysis in anatomical regions of high risk due to space conflict [10][11][12].…”