Mintken Paul E, Denman Blair, Dommerholt Jan
Doctor of Physical Therapy Program, Graduate College of Health Sciences, Hawaii Pacific University, Honolulu, HI 96813, United States.
Physical Therapy Program, Physical Medicine and Rehabilitation Department, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States.
Phys Ther. 2025 Aug 5;105(8). doi: 10.1093/ptj/pzaf078.
This case report emphasizes the importance of recognizing and preventing adverse events, specifically pneumothorax related to dry needling (DN), particularly when using rib bracketing techniques in the intrascapular region. It highlights the need for greater clinician awareness to enhance patient safety and minimize the risk of complications during DN interventions.
The objective of this case report was to describe the clinical presentation, progression, and outcome of a patient who developed a pneumothorax following DN, and to propose alternative methods for safer needling in the intrascapular musculature.
This case report presents a detailed account of a single patient's clinical experience-including the adverse event, its management, and outcome-supplemented by expert commentary from a clinician specializing in DN.
The setting of this case report was an outpatient physical therapy clinic.
A 24-year-old woman undergoing physical therapy for chronic neck and shoulder pain.
INTERVENTION(S) OR EXPOSURE(S): The physical therapist administered DN to the left intrascapular muscles using a rib bracketing technique to treat trigger points.
MAIN OUTCOME(S) AND MEASURE(S): The primary outcome was the development of a pneumothorax, identified through clinical symptoms and confirmed by radiographic imaging. Outcomes included hospitalization, symptom resolution, and return to physical activity.
The patient experienced an unusually sharp pain during needle insertion. Over the following 2 days, she developed dyspnea, thoracic pain, dry cough, and chest discomfort. A radiograph confirmed a moderate left-sided pneumothorax, which was treated with chest tube reinflation and one night of hospitalization. Post-discharge, the patient had residual symptoms for 2 weeks but achieved complete recovery by 1 month, returning to activities like hiking and skiing.
DN can result in serious complications such as pneumothorax. Early recognition and immediate treatment can lead to full recovery. This case raises concerns about the safety of the rib bracketing technique for DN in the thoracic intrascapular region.
Physical therapists should exercise caution when performing DN, especially in high-risk anatomical areas. Safer techniques should be considered, and vigilance is crucial to detect and manage adverse events promptly. Enhancing practitioner awareness can improve patient outcomes and safety during rehabilitation interventions.
本病例报告强调了识别和预防不良事件的重要性，特别是与干针疗法（DN）相关的气胸，尤其是在肩胛内区域使用肋骨包围技术时。它突出了临床医生提高认识的必要性，以增强患者安全性并在DN干预期间将并发症风险降至最低。
本病例报告的目的是描述一名在DN后发生气胸的患者的临床表现、病情发展和结果，并提出在肩胛内肌肉组织中进行更安全针刺的替代方法。
本病例报告详细描述了一名患者的临床经历，包括不良事件、其处理和结果，并辅以一位专门从事DN的临床医生的专家评论。
本病例报告的背景是一家门诊物理治疗诊所。
一名24岁女性，因慢性颈部和肩部疼痛正在接受物理治疗。
物理治疗师使用肋骨包围技术对左侧肩胛内肌肉进行干针治疗以治疗触发点。
主要结局是气胸的发生，通过临床症状识别并经影像学检查确认。结局包括住院治疗、症状缓解和恢复体育活动。
患者在针刺过程中经历了异常剧烈的疼痛。在接下来的2天里，她出现了呼吸困难、胸痛、干咳和胸部不适。X线片证实为中度左侧气胸，通过胸腔闭式引流和一晚住院治疗。出院后，患者有2周的残留症状，但在1个月时完全康复，恢复了徒步旅行和滑雪等活动。
DN可导致气胸等严重并发症。早期识别和立即治疗可实现完全康复。本病例引发了对肩胛内区域DN的肋骨包围技术安全性的担忧。
物理治疗师在进行DN时应谨慎，尤其是在高风险解剖区域。应考虑更安全的技术，警惕性对于及时发现和处理不良事件至关重要。提高从业者的认识可改善康复干预期间的患者结局和安全性。
