Intra-Carpal Injection of Ozone versus Methylprednisolone in Carpal Tunnel Syndrome of Systemic Sclerosis Patients: A Randomized Single-Blind Clinical Trial

Abstract

BACKGROUND: Carpal tunnel syndrome (CTS) is the most entrapment syndrome in general and is the most frequent peripheral nervous system involvement in systemic sclerosis (SSc). Local injection of steroid hydrodissection or ozone-oxygen showed favourable outcome in CTS in general. OBJECTIVES: To compare the clinical efficacy of ozone versus methylprednisolone intracarpal injection upon pain, functional status, and nerve conduction in patients with CTS due to SSc. STUDY DESIGN: A randomized single-blinded trial. SETTING: Anesthesia, pain, and rheumatology clinics in a university hospital. METHODS: Fifty CTS patients with > 3 months duration of SSc were equally randomized into either group O (injection of ozone/oxygen 25 mu-g/mL in 20 mL) or group M (methylprednisolone acetate 40mg, and 40 mg lidocaine in 20 mL). Visual analog scale (VAS) was measured pre-injection, then re-evaluated post-injection at 4 time points (1 week, 1 month, 3 months , and 6 months); Cochin Hand Function Scale (CHFS); and a median nerve electrophysiologic study was done before injection, then by the end of 3 months and 6 months. RESULTS: VAS was significantly lower in group M after 1 week (P = 0.01). Group O showed significantly lower VAS after 3 and 6 month (P < 0.001). Additionally, there was a significant decrease in the VAS during the whole study period within each group, in comparison to its baseline value. CHFS was significantly lower in the ozone group after 6 months (P < 0.001). The sixth month’s sensory conduction was significantly higher in group O (P = 0.002). The motor distal latency was significantly lower in the ozone group after 3 and 6 months (P < 0.001). LIMITATIONS: Follow-up period could be furtherly extended. CONCLUSION: Both intracarpal ozone or methylprednisolone afford favorable effects upon CTS in patients with SSc. However, ozone alleviates pain much more, enhances the hand functional status, and improves median nerve conduction in study with over six months duration. KEY WORDS: Carpal Tunnel Syndrome, systemic sclerosis, methylprednisolone, ozone

Oxygen-Ozone Therapy for Reducing Pro-Inflammatory Cytokines Serum Levels in Musculoskeletal and Temporomandibular Disorders: A Comprehensive Review

“…Carpal tunnel syndrome (CTS) is one of the most common entrapment disorders in general and the most recurring peripheral nervous system involvement in SSc [ 130 , 131 ]. Elawamy et al demonstrated that both intracarpal ozone or methylprednisolone reported advantageous impacts upon CTS in people with SSC; nonetheless, ozone relieves pain, enhances the hand functioning, decreases the duration and frequency of Raynaud’s attacks, declines the size of ulceration, and improves median nerve conduction study over the 6-month follow-up [ 132 ]. Rascaroli et al found slight improvements in sensory and motor parameters after ozone therapy, and Bahrami et al showed improvement of median sensory nerve action potential latency, compared to the pre-treatment level in both groups (one group treated with wrist volar splint alone, the other group treated with ozone injection and splint) [ 133 , 134 , 135 , 136 ].…”

Local ozone injection compared to local glucocorticoid injection in carpal tunnel syndrome: A randomized controlled trial

“…[ 19 ] Pain relief in conditions such as low back pain and knee osteoarthritis is reported by two studies. [ 28 , 34 ]…”

“…[ 29 ] However, as the results of the present study suggest, ultrasonographic and electrodiagnostic parameters were significantly changed after treatment only in the CS group. Elawamy et al[ 28 ] demonstrated improved pain, function, neurophysiological, and ultrasonographic improvement six months after receiving O 2 -O 3 injection in systemic sclerosis patients with CTS compared to methylprednisolone. It is worth noting that the dosage of O 2 -O 3 was 25 mu-g/mL in 20 mL, and the procedure was done on a special patient population (i.e., systemic sclerosis patients).…”

“…[ 25 - 27 ] Recent studies have shown promising yet inconclusive results on implementing O 2 -O 3 in the management of CTS. [ 1 , 22 , 28 ]…”