A Randomized Control Trial of Comparing Ultrasound-Guided Ozone (O2-O3) vs Corticosteroid Injection in Patients With Shoulder Impingement

Abstract

Introduction Ozone has been recently used as a safe alternative treatment in musculoskeletal disorders with fewer adverse effects than corticosteroids. The aim of this study was to compare the efficacy of a single injection of ozone with that of a corticosteroid in the treatment of shoulder impingement. Design Thirty patients with shoulder pain and clinical signs and symptoms of impingement were randomly assigned into two groups: ultrasound-guided injection with ozone or corticosteroid. Patients’ symptoms were evaluated by visual analog scale, constant score, shoulder pain and disability scale, shoulder range of motion, and ultrasonographic measures before treatment, 2 wks, and 2 mos after injections. Results Patients’ visual analog scale, shoulder pain and disability scale and constant score improved significantly in both groups (P < 0.001), but the benefits were in favor of corticosteroid group (P < 0.001). At intervals between the two follow-ups, an improvement was observed in the visual analog scale score among patients receiving ozone, whereas during the same interval, patients’ pain slightly worsened in the corticosteroid group. The range of motion and ultrasonographic measures did not show statistical differences between the two groups. Conclusions Corticosteroid injection improves the pain and disability scores more significantly than a one-time ozone injection. Ozone may serve as an alternative modality in treating shoulder impingement when the use of steroids is contraindicated.

Oxygen–Ozone Therapy in the Rehabilitation Field:State of the Art on Mechanisms of Action, Safety andEffectiveness in Patients with Musculoskeletal Disorders

“…In the last four decades, several hypotheses have been proposed to clarify the mechanisms underpinning the antioxidant, antalgic, anti-inflammatory and immunomodulatory actions of medical O 2 O 3 mixture. However, despite its various and heterogenous medical applications, the biochemical effects of the O 2 O 3 mixture are far from being understood in detail, even though its chemical properties seem to play a pivotal role in exerting its positive effects in different pathological conditions [13,[29][30][31][32][33][34][35].…”

“…Several studies have assessed the effects of O 2 O 3 therapy in different pathological conditions related to musculoskeletal pain [29][30][31][32][33][34][35]. It is widely accepted that pain is a common symptom related to the inflammation process, and O 2 O 3 therapy might play a key role not only in the management of inflammation but also in nociceptive perception and modulation [29][30][31][32][33][34][35].…”

“…Several studies have assessed the effects of O 2 O 3 therapy in different pathological conditions related to musculoskeletal pain [29][30][31][32][33][34][35]. It is widely accepted that pain is a common symptom related to the inflammation process, and O 2 O 3 therapy might play a key role not only in the management of inflammation but also in nociceptive perception and modulation [29][30][31][32][33][34][35]. Hence, an increase in serotonin and endogenous opioids has been shown after O 2 O 3 administration, and these antioxidant molecules could induce pain relief by stimulating antinociceptive pathways [12,[56][57][58][59][60].…”

Ozone Preconditioning: Waking up the dragon

“…An increasing number of reports document the effectiveness of ozone PC for pain relief in a variety of chronic conditions including low back pain related to disc herniation, degenerative disc disease, sciatica, failed back surgery, as well as post-traumatic, inflammatory, and degenerative joint pain [19-28] [349][350][351][352][353][354][355][356][357][358][359][360][361][362][363][364][365][366]. In such cases ozone has been injected directly into the disc space, neural foramen or joint capsule.…”

Comparison of ultrasound-guided subacromial corticosteroid and ozone (O2-O3) injections in the treatment of chronic rotator cuff tendinopathy: a randomized clinical trial

“…To the authors’ knowledge, there is only one study in the literature comparing the efficacy of corticosteroid and ozone (O 2 -O 3 ) injections in the management of shoulder disorders [ 17 ]. The study, conducted in patients with shoulder impingement syndrome, demonstrated that a one-time corticosteroid injection provided more significant improvement in disability and pain scores than a one-time ozone injection [ 17 ]. The authors hypothesized that three-time ozone injection would improve pain, function, and quality of life more than a one-time steroid injection.…”