Posted on Authorea 21 Nov 2020 | The copyright holder is the author/funder. All rights reserved. No reuse without permission. | https://doi.org/10.22541/au.160596918.86927318/v1 | This a preprint and has not been peer reviewed. Data may be preliminary. Affiliations Jes´us Guodemar-P´erez PhD; PT, Rodr´ıguez Valera-Calero Antonio Juan risk the decrease to features Authors anthropometric on needling based dry depth during pleura pneumothorax and of major rhomboid of model Prediction Title Page pneumothorax Title induced of identified risk in study the ultrasonography, avoiding This with for election assessed Conclusion: to length as needle recommended pleura. depth, the is pleura the in needling. and mm clinicians through dry assist rhomboid 19 during passing could both of findings of rhomboid predict length Our risk the can maximum subjects. the circumference of a healthy thorax decreasing variance inserting and the major general, BMI rhomboid of In gender, of 51.5% that limit. limit explained depth deep circumference both (p<0.001) the thorax rhomboid-to-pleura in pleura reach skin-to-rhomboid, and variance of and the BMI, 69.7% matrix circumference to Sex, and correlation significantly thorax (p<0.001) contributing A BMI, (p<0.001). variables weight, ultrasound distances circumference. those height, with chest skin-to-pleura detect greater was assessed and y showed to study as breathing Men used depth, (BMI), diagnostic were Results: rhomboid index analyses A and mass locations. and regression pleura inspiration Methods: body linear maximum both weight, multiple in height, for a needling. sides depth age, model and dry (both sex, prediction pleura measurements during 236 on a and pneumothorax of of based muscle total of accuracy imaging, a major the risk involving rhomboid calculate male) the puncture % to the avoid pleura (52.5 expiration), predict to of subjects adverse can healthy risk subjects 59 serious features the healthy on minor, anthropometric reducing conducted of considered if for sample investigate instructions be a To safety can in and needling Objective: excluded, dry be needed. to cannot are associated pneumothorax events induced adverse including common events mostly Although Background: Abstract 2020 21, November 3 2 1 Guodemar-P´erez C´esar Fern´andez-de-las-Pe˜nas Valera-Calero Antonio Juan pneumothorax needling of on dry risk based during the depth decrease pleura to and features major anthropometric rhomboid of model Prediction e unCro University Carlos Juan Rey Jos´e Cela Camilo Universidad University Cela Jose Camilo 1 D C´esar Fern´andez-de-las-Pe˜nasMD; 1 1,2 1 T h addt;ErqeCendra-Martel Enrique Candidate; PhD PT, niu Cendra-Mart´ın Enrique , 1 3 T PhD PT, rcaMar´ıa Gallego-Sendarrubias Gracia , 4,5 T h,DS;Gai Mar´ıa Gallego-Sendarrubias Gracia DMSc; PhD, PT, 1 2 Tom´as Fern´andez-Rodr´ıguez, 1 n Jes´us and , 3 T Tom´as Fern´andez-PT; 1 , 1 Posted on Authorea 21 Nov 2020 | The copyright holder is the author/funder. All rights reserved. No reuse without permission. | https://doi.org/10.22541/au.160596918.86927318/v1 | This a preprint and has not been peer reviewed. Data may be preliminary. hsi h rtcluaigteacrc fapeito oe nldn utpeatrpmti features anthropometric multiple including model prediction a of accuracy the calculating index first the mass the However, body is higher This proposed. and add? thickness been article muscle have this larger needling does with dry What subjects before in 0.04%, ribs accuracy [?] the poor is of reported procedures authors palpation needling including dry strategies during Different events adverse excluded significant be of cannot rate it risk estimated the topic? Although this about for known election already length What’s needle with the needling. assessed in dry as clinicians during depth, Keywords: assist pneumothorax pleura induced could and of rhomboid findings risk deep both Our the the predict avoiding reach subjects. can to healthy pleura circumference recommended pleura. in of thorax the is ultrasonography, through 69.7% and mm passing and 19 BMI of of risk (p<0.001) gender, the length rhomboid that decreasing maximum the major a rhomboid of inserting BMI, of variance general, limit Sex, the In (p<0.001). limit. of depth 51.5% distances (p<0.001) explained skin-to-pleura A circumference contributing y variables circumference. thorax those rhomboid-to-pleura chest and locations. detect skin-to-rhomboid, and to both breathing and used in (BMI), were circumference variance analyses index the regression mass ultrasound to linear with body multiple assessed significantly of weight, to as a risk depth, expiration), height, and rhomboid and the matrix age, and inspiration avoid correlation pleura sex, maximum both to in on for sides based subjects model (both prediction imaging, healthy measurements a of 236 of accuracy of sample the total calculate a a for involving in male) instructions depth % safety needling. pleura (52.5 dry and and muscle during excluded, needed. pneumothorax major are be rhomboid puncture cannot the pleura predict pneumothorax of risk induced the including reducing events adverse serious Background: Abstract account: word Abstract account: Word 841 766 653 (+34) number: Phone Email: SPAIN. Madrid, Madrid, 28051 2-4 62, Suertes las de Avenida Calero; Valera Antonio Juan Spain. * Alcorc´on, Madrid, Carlos, Juan Rey Terap´eutico, Universidad Ejercicio y 5 Alcorc´on, Spain Carlos, Juan Rey 4 3 2 1 eateto hsclTeay cuainlTeay eaiiainadPyia eiie Universidad Medicine, Physical and Rehabilitation Therapy, Occupational Therapy, Physical of Department ´ tdaIsiuinle oeca lıiaeIvsiaio nFsoeai:TrpaMna,Punci´on Seca Manual, Terapia Fisioterapia: Investigaci´on Cl´ınica en e Docencia, en C´atedra Institucional Spain Madrid, Alcorc´on, Spain Practice, Carlos, Professional Juan Private Rey Universidad Spain Ca˜nada, Doctorado, Madrid, la de de Internacional Villanueva Jos´eEscuela Cela, Camilo Universidad Therapy, Physical of Department drs o ern euss/crepnigauthor corresponding / requests reprint for Address [email protected] hmodMsl;DyNeln;Utaon mgn;Pemtoa;Ciia eiinRules Decision Clinical Pneumothorax; Imaging; Ultrasound Needling; Dry Muscle; Rhomboid lhuhmsl omnavreeet soitdt r edigcnb osdrdminor, considered be can needling dry to associated events adverse common mostly Although 2 words 429 2 5 words 255 Methods: Results: igotcsuywscnutdo 9hatysubjects healthy 59 on conducted was study diagnostic A Objective: 2 e hwdgetrhih,wih,BI thorax BMI, weight, height, greater showed Men oivsiaei nhooercfaue can features anthropometric if investigate To Conclusion: hssuyidentified study This Posted on Authorea 21 Nov 2020 | The copyright holder is the author/funder. All rights reserved. No reuse without permission. | https://doi.org/10.22541/au.160596918.86927318/v1 | This a preprint and has not been peer reviewed. Data may be preliminary. n eraerltv ikdrn naiepoeue.Csmne lhv ugse apto fteribs the subjects of in index palpation accuracy mass suggested poor body have higher reported al and authors safety thickness these et patient’s muscle however, ensure due Cushman larger pneumothorax; to needed prevent with proposed procedures. is could been invasive prevention needling have and dry during strategies safety before different risk correct fact, relative In a decrease musculature, complication. and rhomboid this after the of pneumothorax severity of events described iatrogenic the location adverse to are describing the anatomical muscles serious into reports the thoracic insertion most to case posterior needle the Due several into improper of needling fact, an from dry one In resulting of is and technique. application Pneumothorax cage the the rib during events. or space thorax adverse the pleural significant needling for dry when 0.04% occurring [?] of rate l eetyrpre,a sesdwt lrsudiaig entikeso h ao hmodmuscle et rhomboid Folli major length. the needle of thickness correct mean the a ensure imaging, to ultrasound needling with dry assessed before as or reported, during recently evaluation al. ultrasound of use the after to pain have and associated events events treatment adverse adverse during several pain common safety, bleeding, most bruising, intervention the include that safe and reported a minor been considered as has treatment be declared It can is needling literature. dry needling the in dry years described last that been the fact in the literature crucial Despite potential the a is targeting safety in muscle the its attention into improving needle increasing filament technique, solid invasive received trapezius a management of has middle the insertion and for the the applied of MTrP interventions consists to therapeutic needling common Dry deeper most MTrPs. the of and are needling ribs) dry spine and the scapular therapy Manual the to of superficial margin medial (immediately the serratus on between muscle. angle line posterosuperior the inferior into originates the the inserts muscle and and to major vertebrae root rhomboid T2-T5 of The spine scapular processes dorsal scapular scapula. spinous the the the the by and of innervated ligament motion spine supraspinous and thoracic the rhomboid positioning the from the in the to located In contributes muscle in which quadrangular MTrPs nerve a muscle. is active major rhomboid of rhomboid the The 10.2% is of pain prevalence spine a thoracic disorders rhomboid show of pain radiculopathy development spinal cervical in the musculature prevalent with for highly patients muscle be relevant fact, to one found that been which stretch, patient suggest those have the palpation, are points MTrPs of (e.g., latent trigger symptoms stimulation whereas Myofascial the patient, on the reproduce painful of not symptoms is does disturbances the hyper- which pain autonomic reproduces a or referred muscle referral as motor pain skeletal induces defined which and a is those pain, MTrP syndrome of are referred A pain band elicits (MTrPs). myofascial needling), taut or points is a contraction, trigger pain in myofascial chronic of spot with presence irritable individuals the by in characterized observed (MPS), impairment muscular to frequent features One anthropometric at on needling needled based dry be depth during could Introduction pneumothorax pleura pleura of the and risk and major lower the mm rhomboid the decrease 16.2 since of to puncture model mm pleura 11.6 Prediction accidental from an ranges depth avoid limit of to lower mm 25mm 19.6-27.7 major than rhomboid longer of major no limit needles rhomboid clinician? use the the should of for Clinicians variance message the ‘take-home’ of the 51.5% is depth explained What pleura circumference of 69.7% thorax and and limit index, deep mass body Sex, 4 8,9 . 3 eetees eiu des vnscno eecue,Baye al. et Brady excluded, be cannot events adverse serious Nevertheless, . nadto,u o7%o ainswt hrccpi loehbtatv TP nthe in MTrPs active exhibit also pain thoracic with patients of 75% to up addition, In . 7 . 3 11 scnlso ftersuy hyrecommended they study, their of conclusion As . 1 . 10 . 6 ic r edigi an is needling dry Since . 8 aea siae risk estimated an gave 5 tle superficial lies It . 2 1 iose al. et Simons . cieMTrPs Active . 1 Posted on Authorea 21 Nov 2020 | The copyright holder is the author/funder. All rights reserved. No reuse without permission. | https://doi.org/10.22541/au.160596918.86927318/v1 | This a preprint and has not been peer reviewed. Data may be preliminary. rcdmdal otesiospoeso h hrccsie h rndcrwsteeoepae nthe in placed therefore was transducer The was projection spine. horizontal thoracic a the Second, of ( points calculated. process these manual was spinous by between points identified the was middle-distance these scapula to flexed. the between of elbows medially distance angle and inferior traced al. half the 90o et and the Folli of process by and spinous abduction described the palpation, Firstly, in as reliable. procedure arms highly the their be following to with selected was prone point in standing assessment were in The participants expiration imaging, and ultrasound inspiration For maximum abduction at arms calculated of also 90o was with (measured circumference process) position thorax xiphoid Further, BMI. the and at weight height, horizontally gender, age, included participants. data 35 Anthropometric a of the determined total cut-off in we a maximum predictors moment), giving potential the respiratory measurements, seven given Procedure and 70 included required least circumference originally be at thorax we of would BMI, Since size weight, results subjects sample model. height, the 50 final recommended gender, of of the is overestimation (age, size in variables, avoiding model sample included predictor for a five predictors and five than estimation, range models of more size a prediction study, no sample for prognostic with this size a predictor, on sample as potential this proper per Considering obtain subjects features appropriate. to 15 anthropometric as to on considered based 10 were measurements model study,from prediction 96 the a least in conducting at inclusion study of their previous consent. to a informed Prior on written University. Based a Carlos signed approved Juan such (e.g., and was Rey distance condition read study of participants skin-to-pleura This medical Committee all normal sclerosis). Ethics other multiple a Institutional or any compromising the sclerosis, history by condition and lateral prior under amyotrophic neuromuscular gravis, have pneumothorax; been and other myasthenia have analgesics); or 18 sarcopenia, or year; or between fracture complications, previous relaxants be tumor, the respiratory muscle to pain as surgery, had thoracic (e.g., thoracic they reported tone they participate, muscle of if between to affecting excluded announcements eligible treatment were flyer be pharmacological Participants To local old. using years (Spain). by 65 Madrid conducted in was 2020 volunteers October-November healthy of recruitment Consecutive checklist and study guidelines (STARD) This Studies Accuracy circumference. Participants Diagnostic thorax of and Reporting measured gender, anthropometric the (BMI), distance on for index based skin-to-pleura Standards mass thickness the the body rhomboid followed for weight, major height, model measuring age, prediction for including a location features reliable calculate a to in study ultrasonography accuracy with diagnostic a is This moment, respiratory Design weight, Study healthy rhomboid height, of the into age, sample needling on a dry Methods of based in application model the imaging, during prediction ultrasound assist predict a could can with appropriate gender musculature. features that assessed and the anthropometric is BMI if as determining circumference, evaluate hypothesis thorax depth, hence, to Our was pleura and, study to muscle, and this subjects. of clinicians muscle major aim help rhomboid the major could Therefore, and rhomboid gender) needle. pleura moment, the the of respiratory more of length circumference, including depth procedure thorax similar the age, A determine BMI<23). 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Data may be preliminary. h at06 fvrac p00) hrfr,tecmie oe xlie 15 fvrac o predicting for variance of 51.5% explained model combined circumference the depth. thorax Therefore, and rhomboid (p<0.001), (p<0.05). the 8.7% variance additional of an 0.6% contributed features last gender the anthropometric (p<0.001), variance combined, the of When 42.2% depth. pleura (p<0.05). of variance 4 variance (p<0.001), Table of of 13.3% 69.7% additional 0.5% of an total last contributed a gender the explained (p<0.001), circumference variance In thorax the of analysis. and 55.9% regression age. with the not contributed from BMI gender, excluded multicollinearity was and height no BMI, 3 therefore, with Table variables perimeter); and height, and anthropometric BMI, weight, BMI the height, perimeter, with among weight, height with existed perimeter, (except also correlated age, correlations was moment, significant respiratory depth addition, with Rhomboid correlated was gender. depth Pleura features. perimeter showed depth thorax 2 rhomboid for Table but perimeter, expiration (p<0.001), thorax and depth inspiration pleura BMI, (p>0.05). differences and between weight, differences (p<0.001) side-to-side found no height, distance No were pleura age, Differences to p<0.001). rhomboid higher (all, feature. (p<0.001), any exhibited distance in rhomboid-to-pleura men found and general, were depth, In on pleura measurements. 236 depth, sides side. of rhomboid both total and com- a assessing moment, analyzed respiratory After we to ratory expiration, due included. and excluded were inspiration was maximum 1 males) one both (52.5% announcements, in the subjects subject each to asymptomatic responding Fifty-nine volunteers 60 plications. of total a From regression the into entry variable. for additional Results R value each in of F changes association critical adjusted the the The determine of p<0.05. to to criterion as significantly set contributed significance was that The variables equation those determination. determine the depth to between conducted pleura analyses were variance models shared To regression and calculated. depth. 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(normal Statistical Mac data the for with USA) conducted NY, was was analysis expiration. imaging Data maximum ultrasound and using of inspiration experience limit maximum of moments, lowest Analysis years two 10 ( Statistical and at than MHz analysis rhomboid, (Gyeonggi- more main 8 3-12 with major the Ecube clinician E8-PB-L3-12T for of Alpinion same calculated transducer equipment limit the ultrasound by linear lowest an performed a the using trials with by to calculated Korea) skin were do, pleura, pleura to to rhomboid skin major distances following The rvdsscoeorpi n nhooercdt ftettlsml,addvddb edr respi- gender, by divided and sample, total the of data anthropometric and sociodemographic provides hw h irrhclrgeso nlsscnutdfrrobi ao et.BIcnrbtdthe contributed BMI depth. major rhomboid for conducted analysis regression hierarchical the shows ecie h irrhclrgeso nlsscnutdi hssuyfrdtriigper depth. pleura determining for study this in conducted analysis regression hierarchical the describes umrzsPasnscreaincecet frobi n luadphwt anthropometric with depth pleura and rhomboid of coefficients correlation Pearson’s summarizes 18 hs ttsial infiatvrals(<.5 eeicue nastep- a in included were (p<0.05) variables significant statistically Those . 5 2 eerpre tpb tpi h ersinmodel regression the in step by step reported were i.2 Fig. .Tema ftrerepeated three of mean The ). Table Posted on Authorea 21 Nov 2020 | The copyright holder is the author/funder. All rights reserved. No reuse without permission. | https://doi.org/10.22541/au.160596918.86927318/v1 | This a preprint and has not been peer reviewed. Data may be preliminary. sasse ihutaon,i elh ujcs M,gne,adtoa icmeec eetemost for the relevant were most depth, the circumference pleura moment thorax respiratory of and and variance weight, gender, the gender, BMI, of BMI, and 69.7% subjects. depth, explain healthy pleura can for in features features ultrasound, relevant anthropometric with some assessed that as is conditions. found neuromuscular segments no study between different with This subjects therefore, differences only healthy MTrP; depth we in the just Second, assessing of applied research Conclusion location be depth. Further can exact pleura model the and this depths. Larger be Finally, rhomboid different not this differences. needed. of have demographic could First, values several could which normative with recognized. point, locations determine subjects, measurement be at to healthy one should needled of needed assessed limitations be sample are a potential could sizes on pleura results, sample based the promising was lower and shown model the mm results, has prediction since 16.2 current study to puncture the this mm pleura on 11.6 accidental Although Based from an avoid ranges depth. thorax pleura. to limit of and the lower mm 25mm BMI of 19.6-27.7 major than use, the puncture rhomboid longer can ribs, accidental of no Clinicians the an limit needles of variance. regression of identification use of hierarchical manual risk should 70% the to the clinicians the inability from decrease almost and results to explained equipment the circumference which ultrasound are of depth, study absence pleura current in determine the to dry from predicted, during used findings pneumothorax accurately analysis relevant of be (explaining most risk cannot the depth the decrease limit muscle Perhaps to deep rhomboid useful rhomboid potentially for be if than could Even depth models needling. pleura both respectively). considered of for variance, combination be model of the should explained 52.7% which more and activation, a 69.7% revealed superior data posterior Our serratus procedures. of and invasive role intercostal of the application the although during controversial Nevertheless, to is moment. breathing due inspiration respiratory the the maximum expiration of to between Since in differences association due superior limit. show of model posterior lower not lack regression did serratus rhomboid the depth the with its explaining respiratory in associated muscle, expiration; ventilatory included Although not and a or not was not were moment gender models. is they respiratory major prediction BMI, depth, Thus, rhomboid both where pleura significance. with in consistent, poor associated predictors their were were relevant depth age most and the pleura the moment in and were gender rhomboid of circumference relevance determining thorax the variables height, explain identified (i.e., would The scores differences anthropometric gender more These higher therefore, show and, women. model. men fat than prediction differences that BMI) of gender supporting and proportion observed weight, measures, we the higher This age, analysis, anthropometric selecting with descriptive depth. This the for associated the pleura all in considered and is Interestingly, depth). for rhomboid weight be distance. both rib higher to in tissues of variance since underlying parameter of skin-to- finding SD first percentage expected great 1 were the a study an - that explaining our is BMI, with mean support in the features the identified would is several gender) length and results but needle and Current depth imaging, perimeter, first muscle ultrasound (e.g., considered. the rhomboid depth use not in is rhomboid-pleura cannot of consist al. with clinicians it SD (which correlation et if margins 1 location, moderate Seol acceptable safety + this be providing mean features. in could and anthropometric the insertion recommendation BMI multiple between the needle on including range optimal based model a the recommendations prediction length assessing a needle study of provided first accuracy pneumothorax. the potential determin- the a by not asymp- calculating and acupuncture puncture in is or pleura needling depth accidental this dry an pleura of Although avoid and to use length the rhomboid needle in predict appropriate clinicians most to help the able could ing findings were These features subjects. anthropometric tomatic that found study This Discussion 6 19 h aeymri sgetrdrn maximum during greater is margin safety the , 13 Posted on Authorea 21 Nov 2020 | The copyright holder is the author/funder. All rights reserved. No reuse without permission. | https://doi.org/10.22541/au.160596918.86927318/v1 | This a preprint and has not been peer reviewed. Data may be preliminary. References Interest: length of needle Conflicts appropriate pneumothorax. of an risk selecting the for decreasing clinicians Funding: and assist major could rhomboid findings of Our insertion during depth. limit lower rhomboid Cler d ,Saln C rtoR,MrisJ,SmaoR,Prer F eiblt n accu- and Reliability VF. Parreira RF, Sampaio JA, A Martins interventions: RR, therapy Britto physical CC, for Starling rules S, Vda prediction Caldeira Clinical 17. SZ. George MD, Bishop JM, Beneciuk 16. JA, Cleland Cimadevilla-Fern´andez-Pola de-Jes´us-Franco E, F, L, Laguna-Rastrojo Rennie JA, D, major Valera-Calero Moher JG, rhomboid 15. Lijmer during L, Irwig insertion PP, Glasziou needle CA, of Gatsonis DE, depth Bruns Appropriate JB, Reitsma SH. PM, Jang Bossuyt, DH, 14. Yoon H, Cho SJ, Seol 13. Fern´andez-de-Las-Pe˜nas Enhancing E, M. Soldini Barbero F, C, needle Mena safe S, Ballerini of A, verification Schneebeli Ultrasound A, M. Folli Teramoto M, 12. Ludlow L, Scholl Vernon M, Henrie D, Cushman 11. pneumotho- iatrogenic with case A S. Ozkaya P, Ekaterina A, Dirican EB, Menekse I, Turkmen T, Uzar 10. ByeD ep ,Cmbl ,Fen ,ZltaE mt ,e l des vnsascae with aossciated events Adverse al. need- et G, dry Smith E, point Zylstra trigger S, Fuehne following C, Campbell events H, Adverse Wempe D, C. Boyce Doody 9. J, Dommerholt J, thoracic McEvoy of management S, the Brady for 8. needling Dry J. Dommerholt M, Fern´andez-de-las-Pe˜nas Layton 7. C, Clinical-Based and Evidence An scapulae, Fern´andez-de-las-Pe˜nas Needling, levator J, Dry Point Dommerholt the Trigger of C. 6. properties Morphometric Kurto˘glu Z. D, Uzmansel B, G. Beger U, Plaza-Manzano Dinc O, JA, Beger Cleland 5. C, patients in Fernandez-de-las-Penas frequent M, more be Maestre-Lerga might points R, trigger Ortega-Santiago myofascial Active 4. M. Uludag U, Akarirmak H, points Sari trigger 3. myofascial of Prevalence M. Third Barbero manual. C, point Fernandez-de-las-Penas trigger R, The Clijsen A, dysfunction. Chiarotto and pain 2. Myofascial L. Simons JG, Travell DG, Simons 1. ayo itmtyi elh dls rsPeml 07SpOt3()592.Egih Portuguese. English, Sep-Oct;33(5):519-26. 2007 Pneumol. Bras J adults. healthy in cirtometry of 10.2522/ptj.20080239 racy doi: 114-124. 89: 2009; Ther Phys. review. systematic 10.3390/dia- doi: 284. (5): 10 2020; Diagnostics needling. dry gnostics10050284 for applications Potential accuracy features: diagnostic metric anthropo- reporting on for based depth items muscle essential soleus Fern´andez-de-Las-Pe˜nas of of 10.1136/bmj.h5527 model list Arias-Bur´ıa Prediction doi: C, updated JL. h5527. 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Manip Man J 449-455. pain. spine (4): 2019] 40 Kingdom, 2018; United Elsevier: Anat. edition. 2nd Radiol Approach. Surg fetuses. upper human in with minor 10.1007/s00276-018-2002-8 patients rhomboid doi: in 10.1093/pm/pnz020 and points doi: major, trigger (7):1379-1386. rhomboid from 20 2019; pain Med referred Pain and pain. spine 237-44 sensitivity thoracic (2): pain 48 pressure 2012; Widespread Med. Rehabil Phys J 316-37. Eur 97: radiculopathy. 2016; cervical Rehabil with Med Phys Arch meta-analysis. and review systematic doi.org/10.1016/j.apmr.2015.09.021 A disorders: spinal in 2019 Kluwer., Wolters PA: Philadelphia, edition. ercie ofnigfrti research this for funding no received We None 7 Posted on Authorea 21 Nov 2020 | The copyright holder is the author/funder. All rights reserved. No reuse without permission. | https://doi.org/10.22541/au.160596918.86927318/v1 | This a preprint and has not been peer reviewed. Data may be preliminary. risk-of-pneumothorax-during-dry-needling of-rhomboid-major-and-pleura-depth-based-on-anthropometric-features-to-decrease-the- Tables.pdf rhomboid- file B) Hosted skin-to-rhomboid, A) distances of of skin-to-pleura Measurement process C) (C) Spinous intercostalis; and 4) and to-pleura, scapula; superior posterior the serratus of major, border medial assessment the 2. the in Figure during 2 placement and Probe 1 (B) between vertebra; distance the Middle 3) scapula; the 1. Figure Figures of Legend Vlnk A atsM eklL otnJ,Fui J ertspseirmsls ntm,clinical anatomy, muscles: posterior Serratus LJ. Fourie 614–619 JD, 44: Fortin 2003; L, J Weikel Med M, Singap Baltes analysis. JA, Correlational Vilensky 104: 19. Biostatistics Y.H. Chan, 18. eeac,adfnto.Ci nt 01 4() 3-1 o:10.1002/ca.1039 doi: 237-41. (4): 14 2001; Anat. 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