Safety and anatomical accuracy of dry needling procedures in musculoskeletal system: a systematic review of cadaveric studies.

Introduction: In recent years, invasive physiotherapy techniques have seen a significant rise in use for the treatment of musculoskeletal pain. However, there is currently no standardization in the anatomical landmarks, needle length, and insertion angles applied across different muscles, which is critical for ensuring both safety and reliability, especially in non-ultrasound-guided interventions.

Objective: To analyze the results of studies evaluating invasive puncture techniques performed on cadaveric specimens and to assess their methodological quality.

Methods: A systematic review was conducted according to PRISMA guidelines. A comprehensive search was performed in the MEDLINE, Scopus, Web of Science, CINAHL, and SPORTDiscus databases, including all records up to 23 December 2024. Studies were included if they assessed the anatomical safety and procedural accuracy of invasive physiotherapy techniques on cadavers. The quality of reporting was assessed using the QUACS scale, and risk of bias was evaluated with the JBI Critical Appraisal Checklist for Systematic Reviews.

Results: Twenty-one cadaveric observational studies were included. All studies demonstrated anatomically safe approaches, with no reported injury to adjacent neural or vascular structures. However, there was variability in methodological quality and consistency in reporting across studies. The mean QUACS score across the included studies was 8.95 out of 13, corresponding to an average methodological quality of 68.84% (30.76% to 92.30%).

Conclusion: The current evidence supports the anatomical safety of invasive physiotherapy techniques applied to cadavers. Nevertheless, the development and implementation of standardized, reproducible protocols are necessary to improve the consistency, safety, and clinical applicability of these interventions, particularly when performed without ultrasound guidance.