{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T18:13:46Z","timestamp":1782756826722,"version":"3.54.5"},"reference-count":56,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T00:00:00Z","timestamp":1749081600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Importance<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>This case report presents a detailed account of a single patient\u2019s clinical experience\u2014including the adverse event, its management, and outcome\u2014supplemented by expert commentary from a clinician specializing in DN.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>The setting of this case report was an outpatient physical therapy clinic.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>A 24-year-old woman undergoing physical therapy for chronic neck and shoulder pain.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Intervention(s) or Exposure(s)<\/jats:title>\n                  <jats:p>The physical therapist administered DN to the left intrascapular muscles using a rib bracketing technique to treat trigger points.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main Outcome(s) and Measure(s)<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The patient experienced an unusually sharp pain during needle insertion. Over the following 2\u00a0days, 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\u00a0weeks but achieved complete recovery by 1\u00a0month, returning to activities like hiking and skiing.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Relevance<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ptj\/pzaf078","type":"journal-article","created":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T08:19:46Z","timestamp":1749111586000},"source":"Crossref","is-referenced-by-count":2,"title":["Pneumothorax After Dry Needling of Intrascapular Muscles Using a Rib Bracketing Technique: Insights From the Clinician, Patient, and Clinical Expert"],"prefix":"10.1093","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1427-2424","authenticated-orcid":false,"given":"Paul E","family":"Mintken","sequence":"first","affiliation":[{"name":"Doctor of Physical Therapy Program, Graduate College of Health Sciences, Hawaii Pacific University , Honolulu, HI 96813 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blair","family":"Denman","sequence":"additional","affiliation":[{"name":"Physical Therapy Program, Physical Medicine and Rehabilitation Department, University of Colorado Anschutz Medical Campus , Aurora, CO 80045 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6415-029X","authenticated-orcid":false,"given":"Jan","family":"Dommerholt","sequence":"additional","affiliation":[{"name":"University of Social Welfare and Rehabilitation Sciences, Neuromusculoskeletal Rehabilitation Research Center , Tehran ,","place":["Iran"]},{"name":"Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences , Tehran ,","place":["Iran"]},{"name":"Bethesda Physiocare, Inc., Bethesda, MD 20814-2777 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,6,5]]},"reference":[{"issue":"3","key":"2025082003564667800_ref1","doi-asserted-by":"publisher","first-page":"133","DOI":"10.2519\/jospt.2017.7096","article-title":"The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: a systematic review and meta-analysis","volume":"47","author":"Gattie","year":"2017","journal-title":"J Orthop Sports Phys Ther"},{"issue":"6","key":"2025082003564667800_ref2","doi-asserted-by":"publisher","first-page":"3122","DOI":"10.3390\/app12063122","article-title":"Periosteal needling to the cervical articular pillars as an adjunct intervention for treatment of chronic neck pain and headache: a case report","volume":"12","author":"Perreault","year":"2022","journal-title":"Appl Sci"},{"issue":"8","key":"2025082003564667800_ref3","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1007\/s11916-013-0348-5","article-title":"Physiologic effects of dry needling","volume":"17","author":"Cagnie","year":"2013","journal-title":"Curr Pain Headache Rep"},{"issue":"4","key":"2025082003564667800_ref4","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1179\/106698111X13129729552065","article-title":"Dry needling\u2014peripheral and central considerations","volume":"19","author":"Dommerholt","year":"2011","journal-title":"Journal of Manual and Manipulative Therapy"},{"key":"2025082003564667800_ref5","doi-asserted-by":"publisher","DOI":"10.2147\/JPR.S154728","article-title":"Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm","volume":"12","author":"Fernandez-de-Las-Penas","journal-title":"J Pain Res"},{"issue":"3","key":"2025082003564667800_ref6","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12031205","article-title":"Clinical effectiveness of dry needling in patients with musculoskeletal pain-An umbrella review","volume":"12","author":"Chys","journal-title":"J Clin Med"},{"key":"2025082003564667800_ref7"},{"key":"2025082003564667800_ref8"},{"key":"2025082003564667800_ref9","volume-title":"Hum Resouces Res Organ"},{"issue":"3","key":"2025082003564667800_ref10","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1179\/2042618613Y.0000000044","article-title":"Adverse events following dry needling: a prospective survey of chartered physiotherapists","volume":"22","author":"Brady","year":"2014","journal-title":"J Manual Manipul Ther"},{"issue":"1","key":"2025082003564667800_ref11","doi-asserted-by":"publisher","first-page":"103","DOI":"10.26603\/ijspt20200103","article-title":"Adverse events associated with therapeutic dry needling","volume":"15","author":"Boyce","year":"2020","journal-title":"Int J Sports Phys Ther"},{"issue":"2","key":"2025082003564667800_ref12","doi-asserted-by":"publisher","first-page":"00156","DOI":"10.1183\/23120541.00156-2024","article-title":"Pneumothorax as a complication of dry needling technique","volume":"10","author":"Bontinck","year":"2024","journal-title":"ERJ Open Res"},{"key":"2025082003564667800_ref13","volume-title":"Trigger Point Dry Needling; 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