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.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.