Pneumothorax complication of deep dry needling demonstration

Pneumothorax is a well-recognised but rare adverse event related to acupuncture or deep dry needling (DDN) over the thorax.1 ,2 This report of a pneumothorax resulting from DDN is unusual for a number of reasons: both the practitioner and the subject were doctors and both have contributed to this report; the practitioner was very experienced in DDN and had not knowingly caused such an event in the previous 45 years of practice and teaching DDN; the incident was captured on video and is presented online with this report (see online supplementary video). We hope that by reporting this event and review of the video recording we can suggest ways to reduce the risk of reoccurrence of such adverse events of DDN. The setting was a hands-on workshop teaching the technique of DDN for the treatment of myofascial pain syndromes. The workshop used the format of lecture, demonstration on a volunteer, and then practice by the group in groups of two or three individuals at an examination couch. Safety procedures were emphasised for each muscle considered. The safety precautions included identification of landmarks each time one prepared to needle the subject and an awareness of the local anatomy and of possible complications. During the introduction to the demonstrations the complication of pneumothorax was discussed. Symptoms were described and the advice to go to the emergency department for a chest X-ray was given. The muscle to be demonstrated was the iliocostalis muscle, one of the erector spinae muscles. RR-M volunteered to be the subject. The lecturer emphasised the danger of pneumothorax and spoke of the technique of ‘blocking’ the rib by placing a finger …