\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[T2A]{fontenc}
\usepackage[ngerman,polish,english]{babel}



\usepackage{float}






% Edit this header.tex file to include frontmatter definitions and global macros

% Add here any LaTeX packages you would like to load in all document blocks
% \usepackage{xspace}

% Add here any LaTeX macros you would like to load in all document blocks
% \def\example{This is an example macro.}

% -----

\iflatexml
% Add here any LaTeXML-specific commands

% -----

\else
% Add here any export style-specific LaTeX commands. These will only be loaded upon document export. 
% \paperfield{Subject domain of my document}
% \keywords{keyword1, keyword2}
% \corraddress{Author One PhD, Department, Institution, City, State or Province, Postal Code, Country}
% \fundinginfo{Funder One, Funder One Department, Grant/Award Number: 123456.}
\fi


\begin{document}

\title{Effects of local anesthetics (neural therapy) on pain and hand functions
in patients with De Quervain tenosynovitis: A prospective randomized
controlled study}



\author[1]{Hüma Bölük Şenlikci}%
\author[2]{Özden Sibel Odabaşı}%
\author[3]{Fatma Gülçin Ural Nazlıkul}%
\author[4]{Hüseyin Nazlıkul}%
\affil[1]{Affiliation not available}%
\affil[2]{Dr Nafiz Körez Sincan Devlet Hastanesi}%
\affil[3]{Yildirim Beyazit University Faculty of Medicine}%
\affil[4]{International federation of medical associations of neural therapy}%


\vspace{-1em}



  
  \date{May 24, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup





\selectlanguage{english}
\begin{abstract}
Objective: De Quervain tenosynovitis is the most common cause of lateral
wrist pain. The diagnosis can be made with the Finkelstein test when
pain is provoked with wrist ulnar deviation. Conservative treatment
including rest, non-steroidal anti-inflammatory medication and physical
therapy is applied first, then there may be a need for corticosteroid
injections, and in resistant cases, surgery. The aim of this study was
to evaluate the effectiveness of neural therapy (NT) on pain and hand
functions in patients with De Quervain tenosynovitis. Methods: A total
of 36 patients admitted between May 2019 and March 2020 were randomly
assigned to neural therapy (NT) and control groups. Hand rest and thumb
spica splint were applied to all the patients, and NT interventions to
the NT group only. A visual analog scale (VAS) and the Duru\selectlanguage{ngerman}öz Hand index
(DHI) were used to measure pain and functionality at baseline, then at 1
and 12 months after the end of the treatment. Results: The NT and
control groups both showed improvements in VAS and DHI scores at 1 and
12 months compared to baseline. The VAS scores were significantly lower
at both 1 and 12 months compared to baseline in the NT group. The DHI
scores were lower in the NT group at 1 month, and at 12 months there was
no significant difference between the two groups. No adverse effects
were seen in any patient. Conclusion: NT seems to be effective in
reducing pain and improving hand functions in patients with De Quervain
tenosynovitis.%
\end{abstract}\selectlanguage{ngerman}%



\sloppy


\textbf{Abstract}

\textbf{Objective:}

De Quervain tenosynovitis is the most common cause of lateral wrist
pain. The diagnosis can be made with the Finkelstein test when pain is
provoked with wrist ulnar deviation. Conservative treatment including
rest, non-steroidal anti-inflammatory medication and physical therapy is
applied first, then there may be a need for corticosteroid injections,
and in resistant cases, surgery. The aim of this study was to evaluate
the effectiveness of neural therapy (NT) on pain and hand functions in
patients with De Quervain tenosynovitis.

\textbf{Methods:} A total of 36 patients admitted between May 2019 and
March 2020 were randomly assigned to neural therapy (NT) and control
groups. Hand rest and thumb spica splint were applied to all the
patients, and NT interventions to the NT group only. A visual analog
scale (VAS) and the Duru\selectlanguage{ngerman}öz Hand index (DHI) were used to measure pain
and functionality at baseline, then at 1 and 12 months after the end of
the treatment.

\textbf{Results:} The NT and control groups both showed improvements in
VAS and DHI scores at 1 and 12 months compared to baseline. The VAS
scores were significantly lower at both 1 and 12 months compared to
baseline in the NT group. The DHI scores were lower in the NT group at 1
month, and at 12 months there was no significant difference between the
two groups. No adverse effects were seen in any patient.

\textbf{Conclusion:} NT seems to be effective in reducing pain and
improving hand functions in patients with De Quervain tenosynovitis.

\textbf{Key words:} Local anesthetics, De Quervain tenosynovitis, Wrist
pain

\textbf{Introduction}

De Quervain tenosynovitis is the most common cause of lateral wrist
pain. It occurs with stenosis of the abductor pollicis longus and
extensor pollicis brevis tendons in the first dorsal extensor
compartment of wrist. Thumb extension occurs with the contraction of
these muscles, which is why thumb extension and ulnar deviation
exacerbates pain. The prevalence of De Quervain tenosynovitis has been
reported to be 0.5\% in males and 1.3\% in females.\textsuperscript{1,2}
It is seen more commonly in middle-aged females and in the dominant
hand. In De Quervain tenosynovitis, fibrous tissue deposits cause
thickening of the tendon sheaths, but the cause of these fibrous tissue
deposits is unclear.

Diagnosis of De Quervain tenosynovitis is based on clinical examination.
The diagnosis can be made with the Finkelstein test, in which pain is
provoked with wrist ulnar deviation.\textsuperscript{3,4} Plain
radiography may be useful for differential diagnosis. Conservative
treatment of rest, non-steroidal anti-inflammatory drugs (NSAID), and
physical therapy is applied first, then there may be a need for
corticosteroid injections, and in resistant cases,
surgery.\textsuperscript{5} In some resistant cases, complementary and
alternative methods are preferred, as in other chronic musculoskeletal
diseases.\textsuperscript{6-9}

Neural therapy (NT) is a regulatory therapy using local anesthetics for
the management of chronic musculoskeletal pain. Neural therapy resolves
the underlying autonomic dysregulation by regulating the autonomic
nervous system. It occurs through the membrane stabilizing effect of
local anesthetic agents used during neural therapy. As a result of
autonomic regulation, tissue perfusion increases, pain mediators are
removed, and it provides an anti-inflammatory effect. Neural therapy
targets painful areas, segments of these areas and trigger points, so
includes local therapy (infiltration of trigger points) and segmental
therapy (infiltration of sympathetic ganglia, nerve roots, or peripheral
nerves).\textsuperscript{10,11}

To the best of our knowledge, the effect of neural therapy on patients
with De Quervain tenosynovitis has not been previously evaluated.
Therefore, the aim of this study was to highlight the short and
long-term effects of neural therapy on this condition.

\textbf{Material and methods}

Subjects

This prospective, randomized, controlled study included 41 patients
diagnosed with De Quervain tenosynovitis, which had been ongoing for
more than 4 weeks, and who were admitted to
\ldots{}\ldots{}\ldots{}\ldots{}\ldots{}\ldots{}\ldots{}\ldots{}\ldots{}\ldots{}\ldots{}\ldots{}\ldots{}\ldots{}\ldots{}between
May 2019 and March 2020. The patients were diagnosed clinically using
the Finkelstein test, in which the patient flexes the thumb and wraps
the fingers over thumb, then the physician stabilizes the forearm and
ulnarly deviates the wrist. The presence of pain over the abductor
pollicis longus and extensor pollicis brevis tendons is accepted as
positive test result. Patients were excluded from the study if they had
chronic widespread or local musculoskeletal pain due to rheumatological
diseases (i.e., fibromyalgia, rheumatoid arthritis), neurological
diseases (i.e., multiple sclerosis, cervical discopathy or plexopathy),
trauma or surgery to the related region (wrist, elbow or hand), or were
aged \textless{}18 years or \textgreater{}65 years. From the total 41
patients initially enrolled, 2 did not wish to participate in the study,
2 did not complete the treatment sessions and 1 patient did not attend
the evaluations at 1 month and 1 year after the end of the therapy.
Final evaluation was made of a total of 36 patients (NT group:18;
control group:18). Approval for the study was granted by the Ethics
Committee of
\ldots{}\ldots{}\ldots{}\ldots{}\ldots{}\ldots{}\ldots{}\ldots{}\ldots{}\ldots{}\ldots{}\ldots{}\ldots{}\ldots{}\ldots{}
Clinical Trials Registration was approved (NCT04384536). Informed
consent was obtained from all the study participants.

Evaluation

The study subjects were separated into neural therapy (NT) and control
groups using computer-based randomisation. Treatment of a thumb spica
splint and rest was given to both groups, and the NT group also received
neural therapy treatment. Injections of neural therapy treatment were
applied to all the patients in that group by the same physician. The
socio-demographic and clinical characteristics of the patients in both
groups were recorded, including age, gender, body mass index (BMI),
occupational status, the presence of repetitive trauma, dominant hand,
and duration of complaints. The patients were evaluated with a visual
analog scale (VAS) and the Duruöz Hand Index (DHI) at the beginning of
the study, then at 1 and 12 months after the end of the neural therapy.
In addition, the success of the treatment of both patient groups after
the treatment they received was questioned. Successful treatment was
defined as relief of the symptoms in such a way that the patients did
not need to consult for further intervention.

\textbf{Visual analog scale (VAS)}

A 10-cm VAS was used by patients for the self-assessment of pain
intensity associated with tenosynovitis. Patients were asked to score
the level of pain severity on a scale marked from 0-10, where 0= no pain
and 10= intolerable pain. \textsuperscript{12}

\textbf{Duruöz Hand Index (DHI)}

The DHI is a self-reporting scale for the evaluation of hand functions,
which was first developed in 1996 for patients with rheumatoid
arthritis. It consists of 18 items in 5 domains of kitchen tasks,
personal hygiene, dressing, office tasks, and others. Each item is
scored between 0-5, to give a total score of 0-90, with higher scores
indicating increased hand disability. \textsuperscript{13}

Intervention

In each session, 20 ml of local anesthetic (1:100 mixture of 10 mg/mL
procaine) was used. Local injection, C5-T8 segmental injections,
injection of the trigger points of the forearm muscles and stellate
ganglion injections were applied in each session, using a 27-gauge, 4-6
cm needle. The local injection was applied first in the first extensor
compartment at the point of maximal tenderness and was directed
proximally toward the radial styloid (3 mL of the mixture). Then the
forearm muscles were investigated by palpation to determine the trigger
points. If any trigger point was detected, approximately 5 mL lidocaine
was injected to that point. C5-T8 segmental injections were applied
intradermally to each spinous process and to 0.5-2 cm lateral of each
process on the affected side (approximately 0.25-0.5 ml per injection).
Finally, the stellate ganglion injection was applied using Fischer's
modified technique. The sternocleidomastoid muscle was palpated by the
physician between the middle part of the muscle and distal third of the
muscle, gently pulling the muscle laterally with the neurovascular
bundle. Following palpation of the anterior tubercle of the transverse
process of the sixth cervical vertebra, the cervical spine was extended
and rotated 45° to the opposite side. The needle entry point was 1 mm
below the tubercle, then the needle was directed first 45° caudally,
then 45° medially and then 45° dorsally for each injection. If the
aspiration was negative, 3mL procaine was
injected.\textsuperscript{14}(Figure 1,2,3)

The neural therapy procedure was applied twice a week for 2 weeks. All
the patients were evaluated at baseline, then at 1 and 12 months after
the end of the therapy sessions. This study was performed in accordance
with the Declaration of Helsinki.

Statistical analyses

Data obtained in the study were analyzed statistically using SPSS
version 24.0 software (IBM Corporation, Armonk, NY, USA). Continuous
variables were given as mean± standard deviation (SD) values and
categorical data as number (n) and percentage (\%). Conformity of the
continuous variables to normal distribution was assessed with the
Kolmogorov- Smirnov test. Normally distributed continuous variables were
compared with the t-test between the groups. Continuous variables
without normal distribution were compared with the Mann Whitney U-test
between groups. In-group analyses were evaluated using the repeated
measures ANOVA (Post hoc: LSD) test. The Chi-square test was applied to
categorical data. A value of p \textless{}0.05 was accepted as
statistically significant.

\textbf{Results}

The sociodemographic and clinical characteristics of the patients are
shown in Table 1. Age, gender, BMI values, occupational status, duration
of complaints, history of repetitive trauma, dominant hand, and the
treated hand were similar in both the NT and control groups
(p\textgreater{}0.05).

The VAS and DHI values are shown in Table 2. The pre-treatment VAS
scores were similar in both groups (7.88±1.18 vs 7.61±1.24). The VAS
scores of the first month follow-up (1.66±0.90 vs 4.22±1.47) and the
12th month follow-up (1.66±1.78 vs 3.83±2.09) in the NT group were
statistically significantly lower than those of the control group
(p\textless{}0.001 and p=0.002, respectively).

The DHI scores were higher in the NT group than in the control group at
baseline (40.55±13.11vs 26.83±13.16). The DHI scores of the first month
follow-up were found to be lower in the NT group than in the control
group (8.94±5.81 vs 16.61±10.27) (p=0.009). The DHI scores of the 12th
month follow-up were lower in the NT group than in the control group,
but the difference was not found to be significant (8.83±11.49 vs
12.66±7.89) (p=0.252).

In the NT group, the VAS scores of the first month (1.66±0.90) and 12th
month follow-up (1.66±1.78) were significantly lower than baseline
(7.88±1.18) (p\textless{}0.001), with no significant difference between
the first and 12th month of follow-up (p=1.00). In the control group,
the VAS scores of the first month (4.22±1.47) and 12th month follow-up
(3.83±2.09) were significanly lower than baseline (p\textless{}0.001)
with no significant difference determined between the first month and
12th month follow-up (p=0.360).

A similar significant relationship was found for DHI values. In the NT
group, the DHI scores were decreased at 1 month (8.94±5.81) and 12
months (8.83±11.49) compared to baseline (40.55±13.11)
(p\textless{}0.001), with no statistically significant difference
determined between the 1 and 12 month scores (p=0.965). In the control
group, the DHI scores of the baseline were significantly higher than the
DHI scores of the first month (16.61±10.27) and 12th month (12.66±7.89)
(p\textless{}0.001), with no statistically significant difference
determined between the 1 and 12 month scores (p=0.194) (Table 2, Figure
1-2)

The Finkelstein test was positive in all the patients at the first
evaluation. At the first month follow-up, no patients in the NT group
tested positive, but for half of the patients in the control group, the
test was positive. The difference between the two groups in respect of
the first month follow-up Finkelstein test positivity was found to be
statistically significant (p=0.001). At the 12th month follow-up
Finkelstein test positivity was 16.7\% in the NT group and 50\% in the
control group, but statistical significance was not demonstrated between
the two groups (Table 3).

Treatment success in the NT group was 88\% and 83\% at the first and
12th month follow-up examinations, respectively. In the control group,
the treatment success rate was 55\% and 44\%, respectively.

\textbf{Discussion}

This prospective randomized controlled study included 36 patients
diagnosed with De Quervain tenosynovitis. Patients were evaluated with
VAS and DHI at baseline then at 1 and 12 months after the end of the
treatment. Hand functions seemed to be improved at the first and 12th
month follow-up examinations in both groups. The 12th month follow-up
VAS scores were lower in the NT group than in the control group
therefore, and there was no significant difference in hand functions
between the two groups in long-term follow-up. In the NT group, no
patient had Finkelstein test positivity at the first month follow-up,
and the positivity rate at 12 months was 16.7\%.

Pain is the most common problem in accomplishing daily living activities
for patients with De Quervain tenosynovitis. The primary goal of
treatment of tenosynovitis is pain relief and regaining hand functions.

The effectiveness of treatment in De Quervain tenosynovitis has been
previously evaluated in many studies. In a retrospective study of 222
hands, which investigated the effectiveness of corticosteroid injection,
treatment success was achieved in the first 2 injections in 73\% of
patients in total. In 26\% of patients, corticosteroid injection
treatment failed or there was a need for surgery.\textsuperscript{2}

In another study, Lane et al. reported 76\% treatment success in a study
population treated with corticosteroid injection and there was need for
surgery in 4\% of the patients.\textsuperscript{15} In the current
study, the treatment success rate in the short and long-term follow-up
after treatment was \textgreater{}80\% in the neural therapy group.

When viewed in terms of adverse effect profile, in previous studies that
have paid particular attention to the side-effects of corticosteroid
injections, the authors have reported difficulty in maintaining blood
glucose regulation for a few days after the injection, especially in
patients with diabetes mellitus. \textsuperscript{16}

Another study investigating the effectiveness of corticosteroid
injections reported adverse effects such as skin atrophy and
hypopigmentation at a high rate of up to 60\% even in ultrasound-guided
injections. \textsuperscript{17} Therefore, it has been emphasized that
corticosteroid injection should not be considered as completely free of
adverse effects. In the current study, no adverse effects were detected
in any patient in the neural therapy group\textbf{.}

In a study in which the long-term treatment efficacy for De Quervain
tenosynovitis was evaluated, 13.7\% of the patients required repeated
injections during the mean follow-up period of 54 months, 5.9\% had a
partial response, and 2\% had no response. \textsuperscript{18} In the
current study, the treatment success rate in the NT group at 12 months
was 83\%.

Acupuncture is a rarely used treatment modality for De Quervain
tenosynovitis and few studies have been conducted on this subject. In a
study which evaluated the short-term effectiveness of corticosteroid
injection versus acupuncture treatment, there was reported to be no
superiority of one method over the other in the short term in respect of
pain. \textsuperscript{6} However, some authors have stated that
acupuncture should not be recommended as a priority treatment in De
Quervain tenosynovitis. \textsuperscript{19} Comprehensive long-term
results investigating the effect of acupuncture on hand functions and
pain are not available.

Recent studies have shown that De Quervain tenosynovitis is not just
stenosing of the tendons but also has a tissue inflammation
aspect.\textsuperscript{20} Local anesthetics have anti-inflammatory
effects in addition to nerve blocking and membrane stabilizer
effects.\textsuperscript{21} Therefore, local injection of procaine can
provide an anti-inflammatory effect and reduce edema, resulting in
reduced stenosis in the fibro-osseous canal. This could explain the
decrease in pain and functional improvement in the current study.

To the best of our knowledge no previous study in the literature has
evaluated the

efficacy of local anesthetics in the treatment of De Quervain
tenosynovitis, but another issue that should be noted is that local
anesthetics have been added to the injection solution with
corticosteroids in many studies, because as stated above, local
anesthetics also have anti-inflammatory
activity.\textsuperscript{4,6,18,22} Therefore, corticosteroids alone
may not be responsible for all the pain relief and functional
improvement demonstrated in these studies.

Trigger points are described as palpable and hypersensitive spots in
muscles, which may lead to the referred pain.
\textsuperscript{23,24}Trigger point injection contributed to the
treatment in the current study to eliminate the effect caused by
referred pain. Nazl\selectlanguage{polish}ı\selectlanguage{english}kul et al. reported that local anesthetic injection
to trigger points of the piriformis muscle decreased pain and improved
function in patients with low back pain. \textsuperscript{25}

In the human body, the sympathetic system has an effect on pain, by
affecting tissue perfusion. Decreased perfusion causes hypertonus of the
muscles and hyperalgesia. Neural therapy can regulate the autonomic
nervous system and restore decreased blood flow to tissue by blocking
the pathological signals of the sympathetic
system.\textsuperscript{26}In addition it has also been shown that the
sympathetic nervous system has a pathological memory responsible for
musculoskeletal pain.\textsuperscript{10,27} This pathological memory,
also known as neuronal signature, is considered to start when
pro-inflammatory cytokines released from sympathetic nerve endings cause
nociceptive stimulation due to tissue damage. The sympathetic
efferent-nociceptive afferent connection, which occurs as a short
circuit over time, may result in central sensitization. If this system
is activated with continuous stimulation at the spinal cord and brain
level, neuroplasticity develops and pathological pain memory occurs.

This is the most important mechanism of neural therapy approaches.
However, the pathophysiology of chronic pain still remains unclear. It
is known that chronic nociceptive stimulation leads to overactivation of
central sensory transmission and causes central sensitization.
Nociceptive transmission at spinal-supraspinal levels and sympathetic
activity in a wide dynamic range of neurons can be stopped by membrane
stabilization that is achieved by local anesthetic
injection.\textsuperscript{26,28} The pain-free condition seen in the
long-term follow up of the patients who underwent neural therapy may
have been caused by the effect of local anesthetics to erase the
pathological memory in these sympathetic system neurons and prevent
nociceptive transmission at spinal-supraspinal levels. Similarly, this
mechanism seems to be effective in Finkelstein test negativity in
long-term follow-up.

Stellate ganglion injection may alleviate the pain by breaking this
vicious circle.\textsuperscript{29,30,31} The decrease in pain and
improvement in hand function may have been achieved by these mechanisms
in the NT group patients.

Procaine was used as the local anesthetic in this study. The
anti-inflammatory and autonomic nervous system regulatory effect of
procaine can be considered responsible for the decrease in pain and
improvements in functionality. No adverse effects were seen in any
patient.

There were some limitations to this study, primarily the low number of
patients. Further studies with a greater number of patients will provide
more valuable results. Another limitation of the current study was the
non-blinded method, so it can be suggested that further studies should
be performed double blinded.

\textbf{Conclusion}

De Quervain tenosynovitis is a condition that can be treated
non-surgically with thumb spica splint, non-steroid anti-inflammatory
drugs, physical therapy and corticosteroid injections. Neural therapy is
a safe and effective method for the treatment of De Quervain
tenosynovitis. To the best of our knowledge, this is the first study to
have evaluated the long-term effect of neural therapy in patients with
De Quervain tenosynovitis. Nevertheless, there is a need for further
studies with larger sample sizes to confirm the widespread application
of these results.

\textbf{Authors' contributions:} B\selectlanguage{ngerman}ölük \selectlanguage{polish}Ş\selectlanguage{english}enlikci, Odaba\selectlanguage{polish}şı \selectlanguage{english}Y\selectlanguage{polish}ı\selectlanguage{english}lmaz were
responsible for designing the study protocol, conducting the search,
analysing data, and interpreting results.

Odaba\selectlanguage{polish}şı \selectlanguage{english}Y\selectlanguage{polish}ı\selectlanguage{english}lmaz, Nazl\selectlanguage{polish}ı\selectlanguage{english}kul Ural, were responsible for writing the study
protocol, analysing data and screening relevant studies.

\textbf{Financial Disclosure and conflict of interest:} None

\textbf{References}

Satteson E, Tannan SC. De Quervain Tenosynovitis. 2018 Nov 18.StatPearls

{[}Internet{]}. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.
Available from http://www.ncbi.nlm.nih.gov/books/NBK442005/ PubMed PMID:
28723034.

\textbf{2.} Oh JK, Messing S, Hyrien O, Hammert WC. Effectiveness of
Corticosteroid

Injections for Treatment of de Quervain's Tenosynovitis. Hand (N Y).
2017;12: 357-361.

\textbf{3.} Wagner ER, Gottschalk MB. Tendinopathies of the Forearm,
Wrist, and Hand.Clin Plast Surg. 2019 ; 46: 317-327.

\textbf{4.} Ippolito JA, Hauser S, Patel J, Vosbikian M, Ahmed I.
Nonsurgical Treatment of De Quervain Tenosynovitis: A Prospective
Randomized Trial. Hand (N Y). 2018; 30:1558944718791187.

\textbf{5.} Pensak MJ, Bayron J, Wolf JM. Current treatment of de
Quervain tendinopathy.~J Hand Surg Am.~2013; 38: 2247-2249.

\textbf{6.} Hadianfard M, Ashraf A, Fakheri M, Nasiri A. Efficacy of
acupuncture versus local methylprednisolone acetate injection in De
Quervain's tenosynovitis: a randomized controlled trial. J Acupunct
Meridian Stud. 2014 ;7:115-121.

\textbf{7.} da Silva JB, Batig\selectlanguage{ngerman}ália F. Acupuncture in De Quervain's
disease: a treatment proposal. Acupunct Med. 2014;32:70-72.

\textbf{8.} Rabago D, Nourani B. Prolotherapy for Osteoarthritis and
Tendinopathy: a Descriptive Review. Curr Rheumatol Rep. 2017;19:34.

\textbf{9.} Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A
Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal
Pain. Clin Med Insights Arthritis Musculoskelet Disord. 2016;9:139-159.

\textbf{10} . Fischer, L., Neuraltherapie. Neurophysiologie,
Injektionstechnik und Therapievorschläge. 4. Aufl. Haug, Stuttgart,
2014.

\textbf{11.} Nazlikul H. Nöralterapi Ders Kitab\selectlanguage{polish}ı. \selectlanguage{english}Nobel Kitapevi,
Istanbul, 2010.

\textbf{12} . Wewers ME, Lowe NK. A critical review of visual analogue
scales in the measurement of clinical phenomena. Res Nurs Health.1990;
13: 227-236.

\textbf{13.} Duru\selectlanguage{ngerman}öz MT, Poiraudeau S, Fermanian J, Menkes CJ, Amor B,
Dougadous M et al. Development and validation of a rheumatoid hand
functional disability scale that assesses functional 360 handicap. J
Rheumatol.1996; 23: 1167-1172.

\textbf{14} . Puente de la Vega Costa K, Gómez Perez MA, Roqueta C,
Fischer L. Effects on hemodynamic variables and echocardiographic
parameters after a stellate ganglion block in 15 healthy
volunteers.Auton Neurosci. 2016;197: 46-55.

\textbf{15.} Lane LB, Boretz RS, Stuchin SA. Treatment of de Quervain's
disease: role of conservative management. \emph{J Hand Surg Br} .
2001;26:258-260.

\textbf{16.} Stepan JG, London DA, Boyer MI, Calfee RP. Blood glucose
levels in diabetic patients following corticosteroid injections into the
hand and wrist. J Hand Surg Am. 2014;39:706-712.

\textbf{17.} Shin YH, Choi SW, Kim JK. Prospective randomized comparison
of ultrasonography-guided and blind corticosteroid injection for de
Quervain's disease. Orthop Traumatol Surg Res. 2020;106:301-306.

\textbf{18} . Omoke NI, Nnadozie UU. Clinical Outcome of Nonoperative
Treatment of de Quervain's Disease with Local Corticosteroid Injection
in Nigerian Setting. Niger J Surg. 2019 ;25:146-152.

\textbf{19.} Baldry PE. Acupuncture, trigger points and musculoskeletal
pain. 3rd edn. Oxford, UK: Elsevier Ltd, 2005.

\textbf{20.} Kuo YL, Hsu CC, Kuo LC, Wu PT, Shao CJ, Wu KC, et al.
Inflammation is present in De Quervain's disease -- Correlationstudy
between biochemical and histopathological evaluation.Ann Plast Surg.
2015; 74: 146-151.

\textbf{21.} Cassuto D, Sinclair R, Bonderovic M. Anti-inflammatory
properties of local anesthetics and their present and potential clinical
implications. Acta Anaesthesiol Scand. 2006; 50: 265--282.

\textbf{22.} Egli S, Pfister M, Ludin SM, Puente de la Vega K, Busato A,
Fischer L. Long-term results of therapeutic local anesthesia (neural
therapy) in 280 referred refractory chronic pain patients. BMC
Complement Altern Med. 2015; 15: 200-211.

\textbf{23.} Simons DG, Travell JG, Simons LS. Myofascial Pain and
Dysfunction: The Trigger Point Manual. Vol. 1. Lippincott William \&
Wilkins, Philadelphia, 1999.

\textbf{24.} Fischer L. Myofasciale Trigger punkte und Neuraltherapie
nach Huneke. EHK.1998; 3: 117--121.

\textbf{25.} Nazl\selectlanguage{polish}ı\selectlanguage{english}kul H, Ural FG, \selectlanguage{ngerman}Öztürk GT, Öztürk ADT. Evaluation of
neural therapy effect in patients with piriformis syndrome.J Back
MusculoskeletRehabil.2018; 31: 1105-1110.

\textbf{26.} Fischer L. Pathophysiologie des Schmerzes und
Neuraltherapie. Praxis.2003; 92: 2051--2059.

\textbf{27.} Weinschenk S. Neural therapy---A review of the therapeutic
use of local anesthetics.Acupuncture and Related Therapies.2012; 1:
5--9.

\textbf{28} . Balevi Batur E, Atan T. Neural therapy for fibromyalgia:
Myth or improving quality of life? Int J Clin Pract. 2021;75:e13719.

\textbf{29.} Tamam Y, Özdemir HH, Gedik A, Tamam C, Nazl\selectlanguage{polish}ı\selectlanguage{english}kul H. Efficacy
of peripheral lidocaine application (neural therapy) in the treatment of
neurogenic detrusor overactivity in multiple sclerosis patients.
Neurourol Urodyn. 2017; 36: 1832-1838.

\textbf{30.} Ji RR, Nackley A, Huh Y, Terrando N, Maixner W.
Neuroinflammation and Central Sensitization in Chronic and Widespread
Pain. Anesthesiology.2018; 129: 343-366.

\textbf{31.} Salvaggio I, Adducci E, Dell'Aquila L, Rinaldi S, Marini M,
Zappia L, Mascaro A. Facial pain: a possible therapy with stellate
ganglion block. Pain Med. 2008; 9: 958-962.

\textbf{Table 1.} The socio-demographic and clinical characteristics of
the participants\selectlanguage{english}
\begin{longtable}[]{@{}llll@{}}
\toprule
\begin{minipage}[b]{0.24\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.24\columnwidth}\raggedright\strut
\textbf{NT Group} \textbf{(n=18)}\strut
\end{minipage} & \begin{minipage}[b]{0.24\columnwidth}\raggedright\strut
\textbf{Control Group} \textbf{(n=18)}\strut
\end{minipage} & \begin{minipage}[b]{0.24\columnwidth}\raggedright\strut
P\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\textbf{Age(years) (Mean±SD)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
48.50\selectlanguage{ngerman}±10.85\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
46.61\selectlanguage{ngerman}±12.07\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
0.625*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\textbf{BMI (kg/m\textsuperscript{2}) (Mean±SD)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
28.32\selectlanguage{ngerman}±4.59\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
25.76\selectlanguage{ngerman}±4.00\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
0.084*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\textbf{Duration of complaints (months)(Mean±SD)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
6.88\selectlanguage{ngerman}±7.46\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
6.16\selectlanguage{ngerman}±5.59\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
0.988**\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\textbf{Gender(n,\%)} \textbf{Female} \textbf{Male}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
14 (77.8\%) 4 (22.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
16 (88.9\%) 2 (11.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
0.658***\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\textbf{Occupational status} \textbf{Deskjob} \textbf{Heavy-duty}
\textbf{Homemaker} \textbf{Retired}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
2 (11.1\%) 4 (22.2\%) 11 (61.1\%) 1 (5.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
6 (33.3\%) 3 (16.7\%) 9 (50.0\%) 0 (0.0\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
0.342***\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\textbf{Repititive trauma} \textbf{Yes} \textbf{No}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
11 (61.1\%) 7 (38.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
8 (44.4\%) 10 (55.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
0.317***\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\textbf{Dominant Hand} \textbf{Right} \textbf{Left}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
18 (100.0\%) 0 (0.0\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
16 (88.9\%) 2 (11.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
0.486***\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
\textbf{Side of intervention} \textbf{Right} \textbf{Left}\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
12 (66.7\%) 6 (33.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
13 (72.2\%) 5 (27.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.24\columnwidth}\raggedright\strut
0.717***\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
* T Test ** Mann Whitney U Test *** Chi-square Test NT: Neural
therapy\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
* T Test ** Mann Whitney U Test *** Chi-square Test NT: Neural
therapy\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
* T Test ** Mann Whitney U Test *** Chi-square Test NT: Neural
therapy\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
* T Test ** Mann Whitney U Test *** Chi-square Test NT: Neural
therapy\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\textbf{Table 2.} Comparisons of VAS values and DHI values between the
groups and within the groups\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
\begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\textbf{NT Group} \textbf{(n=18)}\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\textbf{Control Group} \textbf{(n=18)}\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\emph{p}\textsuperscript{\textbf{1}}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\textbf{Mean±SD}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\textbf{Mean±SD}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\textbf{Mean±SD}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{VAS}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{Pre-treatment}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
7.88\selectlanguage{ngerman}±1.18\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
7.88\selectlanguage{ngerman}±1.18\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
7.61\selectlanguage{ngerman}±1.24\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.481*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{First month after treatment}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1.66\selectlanguage{ngerman}±0.90\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1.66\selectlanguage{ngerman}±0.90\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
4.22\selectlanguage{ngerman}±1.47\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{\textless{}0.001*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{12th month after treatment}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1.66\selectlanguage{ngerman}±1.78\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1.66\selectlanguage{ngerman}±1.78\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3.83\selectlanguage{ngerman}±2.09\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{0.002*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{p}\textsuperscript{\textbf{2}}\textbf{\textless{}0.001**}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{p}\textsuperscript{\textbf{2}}\textbf{\textless{}0.001**}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{p}\textsuperscript{\textbf{2}}\textbf{\textless{}0.001**}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{DHI}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{Pre-treatment}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
40.55\selectlanguage{ngerman}±13.11\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
40.55\selectlanguage{ngerman}±13.11\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
26.83\selectlanguage{ngerman}±13.16\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{0.004***}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{First month after treatment}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
8.94\selectlanguage{ngerman}±5.81\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
8.94\selectlanguage{ngerman}±5.81\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
16.61\selectlanguage{ngerman}±10.27\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{0.009***}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{12th month after treatment}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
8.83\selectlanguage{ngerman}±11.49\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
8.83\selectlanguage{ngerman}±11.49\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
12.66\selectlanguage{ngerman}±7.89\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{0.252*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{p}\textsuperscript{\textbf{2}}\textbf{\textless{}0.001****}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{p}\textsuperscript{\textbf{2}}\textbf{\textless{}0.001****}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\emph{p}\textsuperscript{\textbf{2}}\textbf{\textless{}0.001****}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
* Mann Whitney U test ** Wilcoxon signed rank test *** t test **** t
test in dependent groups NT: Neural therapy; VAS: Visual Analog Scale;
DHI: Duru\selectlanguage{ngerman}öz Hand Index\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
* Mann Whitney U test ** Wilcoxon signed rank test *** t test **** t
test in dependent groups NT: Neural therapy; VAS: Visual Analog Scale;
DHI: Duru\selectlanguage{ngerman}öz Hand Index\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
* Mann Whitney U test ** Wilcoxon signed rank test *** t test **** t
test in dependent groups NT: Neural therapy; VAS: Visual Analog Scale;
DHI: Duru\selectlanguage{ngerman}öz Hand Index\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
* Mann Whitney U test ** Wilcoxon signed rank test *** t test **** t
test in dependent groups NT: Neural therapy; VAS: Visual Analog Scale;
DHI: Duru\selectlanguage{ngerman}öz Hand Index\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
* Mann Whitney U test ** Wilcoxon signed rank test *** t test **** t
test in dependent groups NT: Neural therapy; VAS: Visual Analog Scale;
DHI: Duru\selectlanguage{ngerman}öz Hand Index\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}\selectlanguage{ngerman}

\textbf{Table 3.} Comparisons of Finkelstein test positivity after
treatment\selectlanguage{english}
\begin{longtable}[]{@{}llllllll@{}}
\toprule
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textbf{NT group}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textbf{NT group}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textbf{Control group}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textbf{Control group}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textbf{Total}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textbf{Total}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
p\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textbf{n}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textbf{\%}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textbf{n}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textbf{\%}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textbf{N}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textbf{\%}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{First month follow-up}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{0.001*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Finkelstein test positivity}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
9\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
50.0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
9\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
26.0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Finkelstein test negativity}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{18}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{100.0}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
9\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
50.0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
27\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
75.0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{12th month follow-up}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.075*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Finkelstein test positivity}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
16.7\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
9\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
50.0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
12\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
33.3\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Finkelstein test negativity}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
15\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
83.3\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
9\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
50.0\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
24\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
66.7\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
* Chi-Square test (Fisher's Exact Test)\\
NT: Neural therapy\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
* Chi-Square test (Fisher's Exact Test)\\
NT: Neural therapy\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
* Chi-Square test (Fisher's Exact Test)\\
NT: Neural therapy\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
* Chi-Square test (Fisher's Exact Test)\\
NT: Neural therapy\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
* Chi-Square test (Fisher's Exact Test)\\
NT: Neural therapy\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
* Chi-Square test (Fisher's Exact Test)\\
NT: Neural therapy\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
* Chi-Square test (Fisher's Exact Test)\\
NT: Neural therapy\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
* Chi-Square test (Fisher's Exact Test)\\
NT: Neural therapy\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\textbf{Figure 1:} Participant flowchart

\textbf{Figure 2:} Local tenosynovitis injection

\textbf{Figure 3:} Segmental therapy, Intracutaneous quaddle
applications to C5-T8 spinous processes

\textbf{Figure 4:} Stellate ganglion injection, after pulling the distal
third of the sternocleidomastoid muscle laterally and palpated the
anterior tubercle of the transverse process of the sixth cervical
vertebra, entry point was 1 mm below the tubercle.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-2/Figure-2}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-3/Figure-3}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-4/Figure-4}

\end{center}
\end{figure}

\selectlanguage{english}
\FloatBarrier
\end{document}

