Ann Rehabil Med.  2014 Feb;38(1):72-76. 10.5535/arm.2014.38.1.72.

Appropriate Depth of Needle Insertion During Rhomboid Major Trigger Point Block

• Seol SJ
• Cho H
• Yoon DH
• Jang SH

• KMID: 2266543
• DOI: http://doi.org/10.5535/arm.2014.38.1.72

Abstract

OBJECTIVE
To investigate an appropriate depth of needle insertion during trigger point injection into the rhomboid major muscle.
METHODS
Sixty-two patients who visited our department with shoulder or upper back pain participated in this study. The distance between the skin and the rhomboid major muscle (SM) and the distance between the skin and rib (SB) were measured using ultrasonography. The subjects were divided into 3 groups according to BMI: BMI less than 23 kg/m2 (underweight or normal group); 23 kg/m2 or more to less than 25 kg/m2 (overweight group); and 25 kg/m2 or more (obese group). The mean+/-standard deviation (SD) of SM and SB of each group were calculated. A range between mean+1 SD of SM and the mean-1 SD of SB was defined as a safe margin.
RESULTS
The underweight or normal group's SM, SB, and the safe margin were 1.2+/-0.2, 2.1+/-0.4, and 1.4 to 1.7 cm, respectively. The overweight group's SM and SB were 1.4+/-0.2 and 2.4+/-0.9 cm, respectively. The safe margin could not be calculated for this group. The obese group's SM, SB, and the safe margin were 1.8+/-0.3, 2.7+/-0.5, and 2.1 to 2.2 cm, respectively.
CONCLUSION
This study will help us to set the standard depth of safe needle insertion into the rhomboid major muscle in an effective manner without causing any complications.

Keyword

Pneumothorax; Trigger point injection; Rhomboid major muscle

MeSH Terms

Back Pain
Humans
Muscles
Needles*
Overweight
Pneumothorax
Ribs
Shoulder
Skin
Superficial Back Muscles*
Thinness
Trigger Points*
Ultrasonography

Figure

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  Fig. 1 Patient's posture during measurement.

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  Fig. 2 Placement of probe during measurement: A, the spine of scapula; B, the medial border of scapula; and C, location of probe.

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  Fig. 3 Transverse view of ultrasonographic image of the rhomboid major muscle at a point 1 cm medial to the midpoint of the medial border of the scapula. SM, distance from the skin to the rhomboid major muscle; SB, the distance from the skin to the rib.

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