A Study of the Distances from the Skin to the Lung Apex from Magnetic Resonance Imaging (MRI)
Keywords:trapezius muscle, dry needling, magnetic resonance imaging, lung, myofascial pain syndrome
Objectives: To study distances from skin overlying upper trapezius muscle to lung apex for a safe trigger point release by needling technique.
Study design: Retrospective study
Setting: Phramongkutklao Hospital
Subjects: Fifty-seven participants who had magnetic resonance imaging (MRI) investigated from 1st July 2013 to 31st December 2015
Methods: MRIs were reviewed. The C7 spinous process (C7SP) was identified and a horizontal line was drawn for marking reference points, 1R and 1L which were 7 cm from C7SP to the right and the left shoulders respectively, and 2R and 2L which were laterally intersected with the skin. Distances from these points to the lung apex in vertical direction as 1RA, 1LA, 2RA and 2LA, in 30◦ medial direction as 1RB, 1LB, 2RB and 2LB, and in 30◦ lateral direction as 1RC, 1LC, 2RC and 2LC, were measured in cm.
Results: The shortest mean distances were from all reference points directing 30o medially: 1RB 5.31, 1LB 5.35, 2RB 4.68 and 2LB 4.67 cm; and the shortest minimum distance was 3.34 cm of 2RB. The mean distances of the vertical direction were longer than of the 30o medial direction; and the shortest minimum distance was the 1RA of 3.74 cm. The distance of the 30o lateral direction from all reference points could not be measured as the lines in this direction did not pass through the pleura.
Conclusion: The shortest distances from the points representing trigger points of upper trapezius in the vertical and the 30o medial directions were less than 4 cm. Therefore one should use a 30 mm long acupuncture needle for dry needling at trigger point of upper trapezius to reduce a risk of pneumothorax.
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