Dry Needling the Rhomboids Safely: Lessons from a Recent Pneumothorax Case

Dry Needling the Rhomboids: What a Recent Case Teaches Us About Safety

Dry needling is an effective clinical tool for treating myofascial pain, trigger points, and movement dysfunction. But like any skilled intervention, it requires anatomical precision and clinical judgment—especially when needling near the thoracic cavity.

In June 2025, the journal Physical Therapy published a case report of a pneumothorax following dry needling of the rhomboids and middle trapezius using a rib bracketing technique.
You can view the abstract here.

At Vertex PT Specialists in Columbia, SC, we treat scapular, shoulder, and neck pain daily—and we take safety seriously. That’s why we wanted to break down what went wrong in this case, and how to needle the intrascapular region more safely and effectively.

Watch the full video breakdown by Dr. Brandon Vaughn here:

What Happened in the Case?

The patient was a 24-year-old woman being treated for chronic shoulder and neck pain. The treating physical therapist used a rib bracketing technique to needle the left rhomboid and middle trapezius with 0.20 mm × 20 mm needles. She reported a sharp, abnormal pain during one insertion.

Two days later, she developed shortness of breath, chest pain, and a dry cough. A chest radiograph confirmed a moderate pneumothorax, and she required an ER visit, chest tube placement, and overnight hospitalization. Thankfully, she made a full recovery—but the event was entirely avoidable.

What Went Wrong?

Based on the case report and expert commentary, here’s where the technique likely failed:

1. High-Risk Technique in a Hard-to-Palpate Region

Rib bracketing in the intrascapular region is difficult due to narrow anatomy and variable rib depth. Studies show clinicians are only ~66–73% accurate at palpating ribs between the scapula and spine. That margin of error matters when working near the lungs.

2. Needle Was Too Thin

The therapist used a 0.20 mm needle—so thin it may have glided between ribs or provided poor tactile feedback. In high-risk zones, thicker needles (0.30–0.32 mm) are preferred because they allow the clinician to feel bony resistance and avoid over-penetration.

3. No Adjustment for Patient Anatomy

The patient had a low BMI, meaning her skin-to-pleura distance was minimal. Even a 20 mm needle may have been too long. In our clinic, most patients reach the rib around 10–15 mm, depending on build.

4. Missed Warning Signs

The sharp pain reported during insertion was not typical and should have prompted a reassessment. Ignoring those signs can lead to serious consequences.

How We Do It Differently at Vertex PT

At Vertex PT Specialists, we regularly treat patients with scapular pain, postural dysfunction, and shoulder instability—and dry needling is one of the tools we use. But we take every precaution to ensure safety, including:

Here’s how we reduce risk while still delivering results:

• We don’t avoid rib bracketing just because a patient has low BMI. Instead, we make sure the technique is executed by clinicians with advanced palpation skills and experience. The issue in this case wasn’t the patient’s body type—it was poor execution.
• We choose needle size and depth based on actual tissue feel. Most patients reach rib contact between 10–15 mm. Using a needle that’s too thin or going too deep without feedback is what leads to complications.
• We use alternative techniques—when needed. If rib palpation is uncertain, we’ll switch to pincer grip or bolster methods. Safety comes first.
• We stay sharp—even with experience. Complacency is dangerous. This isn’t about memorizing depths from a weekend course; it’s about reading the body in front of you.
• We educate patients. We explain what to expect during treatment and encourage them to speak up if anything feels off.

Dry Needling in Columbia, SC—With Safety in Mind

If you’re dealing with upper back, scapular, or shoulder pain and considering dry needling, it’s essential to work with clinicians who understand both the anatomy and the risks involved. At Vertex PT Specialists, we provide expert dry needling at our clinics in Cayce–West Columbia, Downtown Columbia, and Irmo, SC. We also offer outpatient home health dry needling across Lexington and Richland counties—bringing skilled care directly to your doorstep.

Whether you’re recovering from injury, managing chronic pain, or aiming to move better, our therapists prioritize clinical precision and evidence-based treatment in every session.