A 35-year-old woman felt a sharp pain beneath her shoulder blade during a dry needling session for muscle pain. Her pneumothorax, or partially collapsed lung, was not confirmed until she went to an emergency department three days later.
Her case, published in Cureus in December 2024, is one of a string of reports showing that needles aimed at muscle, skin or breast tissue can occasionally pierce the thin lining around the lung and let air leak into the chest. What stands out across these reports is timing: the telltale symptoms do not always appear on the treatment table.
The issue drew fresh attention this year after doctors in Doha, Qatar, described a pneumothorax caused by a needle accidentally dropped onto a woman's chest during a breast cyst drainage. That air pocket measured 1.5 centimeters and shrank to 0.8 centimeters without a chest tube.
Pain on the Table, Diagnosis Days Later
Dry needling, in which practitioners insert thin needles into tight muscle knots, accounts for several recent reports. The Cureus authors noted that symptoms may begin immediately or be delayed, particularly in younger patients.
A 2025 case report in the journal Physical Therapy described a woman who felt unusually sharp pain as a needle entered the muscles between her shoulder blades. Over the next two days, she developed shortness of breath, chest pain, a dry cough, and chest discomfort. An X-ray showed a moderate pneumothorax, which was treated with a chest tube and one night in the hospital. The authors raised concerns about a technique that brackets needles between the ribs in that region and concluded that early recognition and prompt treatment can lead to full recovery.
The risk reached a national audience in December 2025, when Pittsburgh Steelers linebacker T.J. Watt had surgery to stabilize and repair a partially collapsed lung after a dry needling session at the team's facility, NBC News reported. The outlet noted that the Cleveland Clinic considers dry needling generally safe and describes a collapsed lung as an extremely rare serious side effect when needling is done over the chest.
Not everyone agrees on just how rare. A 2024 report in ERJ Open Research described four women, ages 28 to 35, seen at one emergency department with pneumothorax after dry needling between September 2022 and December 2023. The authors argued that the complication is not extremely rare and should be part of consent discussions.
From Trigger Points to Breast Biopsies
Other needle procedures carry the same possibility. In Izmir, Turkey, a 19-year-old woman developed breathing trouble and sweating within about two hours of needle electromyography, a nerve and muscle test, and imaging showed small pneumothoraces on both sides. They resolved after five days. A plastic surgery team in Turku, Finland, linked a pneumothorax after breast reduction surgery to local anesthetic injections and recommended angling needles more shallowly.
In a trigger point injection case published last year, a 38-year-old man with chronic back pain and chronic obstructive pulmonary disease developed right-sided chest pain and breathlessness several hours after his injections. Imaging revealed a pneumothorax and a metal needle retained inside his chest cavity. Surgeons removed it with a minimally invasive procedure, and he went home the same day.
An older breast case shows how a delayed presentation can escalate. A 54-year-old woman arrived at an emergency department 32 hours after a breast needle aspiration with one-sided chest pain and breathlessness. She had a tension pneumothorax, a dangerous buildup of pressure in the chest, that required emergency needle decompression, and she later needed an operation after bleeding into the chest. Other doctors argued in a published letter that the bleeding was more likely caused by the emergency decompression than by the aspiration itself.
Rare, but Not Unheard Of
None of this means routine needle procedures are dangerous for most people. An Italian study of more than 200,000 breast fine-needle aspirations recorded pneumothorax in about 1 in 10,000 cases, though the researchers acknowledged that mild cases may have been missed. Other breast series have reported rates as high as 1 in 417.
A German prospective study of 229,230 acupuncture patients recorded just two pneumothoraces. One needed hospital treatment, and the other needed only observation.
Case reports have clear limits. They describe what happened to individual patients, not how often it happens, and they cannot show which techniques or settings carry the most risk.
What to Watch for After a Needle Near the Chest
The practical message is awareness, not avoidance. After procedures involving needles around the chest, upper back, shoulders or breast, warning signs include sudden, sharp chest pain on one side that worsens with breathing, new shortness of breath and a persistent dry cough.
Those symptoms can emerge hours or even days later. Anyone who develops them should seek medical care and mention the recent procedure, since that history changes what doctors look for first. Severe breathlessness, a racing heart, or feeling faint warrant emergency care.
People considering dry needling, trigger point injections, or similar treatments can ask their practitioner about training, needle technique near the ribs, and which warning signs to watch for afterward.
Key Questions Answered
Which needle procedures have been linked to pneumothorax?
Published cases involve dry needling, trigger point injections, needle electromyography, local anesthetic injections during breast surgery, breast needle aspiration, and acupuncture.
Can symptoms start after leaving the clinic?
Yes. Reports describe symptoms beginning hours later, and one dry needling patient was diagnosed three days after her session.
How common is this complication?
It is rare. An Italian study of more than 200,000 breast aspirations found about 1 case per 10,000, and a German study of 229,230 acupuncture patients recorded two.
What symptoms should people watch for?
Sudden one-sided chest pain that worsens with breathing, new shortness of breath, or a persistent dry cough after a needle procedure near the chest.
What should someone do if symptoms develop?
Seek medical care, mention the recent procedure, and get emergency help for severe breathlessness, a racing heart or feeling faint.
