Comparison of Ultrasound-Guided Local Ozone (O2-O3) Injection Versus Corticosteroid Injection in Patients With Mild to Moderate Carpal Tunnel Syndrome

Abstract

Objective Recently, ozone injection has been used to treat various musculoskeletal diseases. This study was performed to compare ultrasound-guided corticosteroid versus ozone injections in the treatment of carpal tunnel syndrome. Design Forty patients with mild to moderate carpal tunnel syndrome were enrolled and randomly placed in one of the two groups of receiving a corticosteroid or ozone injection under ultrasound guidance. To determine the effectiveness of both injection techniques and compare their outcomes, visual analog scale and scores of Boston Carpal Tunnel Questionnaire, as well as ultrasound and electrodiagnostic criteria, were followed at 0, 6, and 12 wks after the injection. Results Both groups showed improvement in visual analog scale and Boston Carpal Tunnel Questionnaire at week 6, and this improvement continued until the 12th week after the injections. However, electrodiagnostic values of sensory nerve action potentials and compound motor action potentials latency, and ultrasound carpal tunnel syndrome criteria showed significant improvement only among the subjects in the corticosteroid group at 6 and 12 wks after the injection (P < 0.05). Conclusions Ozone might be as effective as corticosteroid injection in reducing pain and improving the function. Objective improvements in electrodiagnostic and ultrasound criteria of carpal tunnel syndrome were shown only among patients after corticosteroid injection.

Ultrasound-Guided Interventions for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analyses

“…Of the five other RCTs of UPIT using other injectates [ 58 , 59 , 60 , 61 , 62 ] ( Table 7 ), one compared HA with normal saline [ 58 ]; one evaluated hyaluronidase vs. steroids [ 59 ]; one investigated hyaluronidase vs. normal saline [ 60 ]; one compared insulin alone vs. steroids alone, steroids alone, and steroids followed by insulin [ 61 ]; and one evaluated ozone vs. steroids [ 62 ].…”

Efficacy and safety of platelet-rich plasma in the treatment of carpal tunnel syndrome: A network meta-analysis of different injection treatments

“…Subsequently, 121 studies were excluded, and 5 studies were added through searching for references. In all, 18 RCTs met the inclusion criteria ( Peters-Veluthamaningal et al, 2010 ; Ginanneschi et al, 2012 ; Karadaş et al, 2012 ; Atroshi et al, 2013 ; Bahrami et al, 2015 ; Wu et al, 2017c ; Dernek et al, 2017 ; Uzun et al, 2017 ; Raeissadat et al, 2018 ; Wu et al, 2018 ; Güven et al, 2019 ; Senna et al, 2019 ; Shen et al, 2019 ; Boonhong and Thienkul, 2020b ; Hsu et al, 2020 ; Chen et al, 2021 ; Forogh et al, 2021 ). We extracted the outcomes (changes in the visual analog scale, symptom severity scale, and functional status scale) for further data analysis in a short-term (before or near 12 weeks) follow-up period.…”

“…Changes in the visual analog scale were available in 10 studies with 571 participants ( Ginanneschi et al, 2012 ; Karadaş et al, 2012 ; Bahrami et al, 2015 ; Wu et al, 2017c ; Dernek et al, 2017 ; Raeissadat et al, 2018 ; Wu et al, 2018 ; Hsu et al, 2020 ; Forogh et al, 2021 ) ( Figure 5 ). Generally, 5% dextrose injections might be the best choice among these interventions (MD −1.22, 95% CI −2.66 to 0.23; SUCRA = 79.2%), followed by triamcinolone (high-dose) injections (MD −0.69, 95% CI −2.11 to 0.73; SUCRA = 62.7%) and PRP injections (MD −0.39, 95% CI −1.67 to 0.89; SUCRA = 60.0%).…”

“…The results of changes in the symptom severity scale were provided in 13 studies with 770 participants ( Peters-Veluthamaningal et al, 2010 ; Atroshi et al, 2013 ; Bahrami et al, 2015 ; Uzun et al, 2017 ; Raeissadat et al, 2018 ; Güven et al, 2019 ; Senna et al, 2019 ; Shen et al, 2019 ; Boonhong and Thienkul, 2020b ; Hsu et al, 2020 ; Chen et al, 2021 ; Forogh et al, 2021 ) ( Figure 5 ). The most effective intervention was hydroxyprogesterone injections (MD −0.62, 95% CI −1.09 to −0.16; SUCRA = 91.0%), followed by methylprednisolone (low-dose) injections (MD 0.98, 95% CI 0.33 to 1.64; SUCRA = 90.1%).…”

“…Twelve studies with 659 participants provided the data on changes in the functional status scale ( Peters-Veluthamaningal et al, 2010 ; Bahrami et al, 2015 ; ; Uzun et al, 2017 ; Raeissadat et al, 2018 ; Güven et al, 2019 ; Senna et al, 2019 ; Shen et al, 2019 ; Boonhong and Thienkul, 2020b ; Hsu et al, 2020 ; Chen et al, 2021 ; Forogh et al, 2021 ) ( Figure 5 ). The most effective intervention might be hydroxyprogesterone injections (MD 0.12, 95% CI −0.30 to 0.54; SUCRA = 99.5%), followed by triamcinolone (low-dose) injections (MD −0.02, 95% CI −0.54 to 0.49; SUCRA = 87.4%) and PRP injections (MD −0.26, 95% CI −0.43 to −0.09; SUCRA = 77.1%).…”