Ozone therapy in idiopathic carpal tunnel syndrome. Biochemical, neurophysiological and clinical aspects.

Abstract

Purpose.
 Idiopathic Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy; however few and only retrospective studies have been found in search engines about Ozone Therapy. 
 The aim of this paper was to evaluate clinical and neurophysiological outcome following Ozone Therapy in CTS.
 We focused the attention on the evidences concerning the role of Subsynovial Connective Tissue (SSCT) in the pathogenesis of CTS and the ozone pre-conditioning effects linked to pain and inflammatory pathways and to fibrosis induced by Ischemia-Reperfusion Injury.
 
 Materials and methods.
 Thirty-five patients, aged between 21 and 80, were stratified clinically by Boston Carpal Tunnel Questionnaire (B.C.T.Q.) and Neurophysiologically by Padua’s Gravity Scale classifying patients into five Electro-myographic categories. The mean symptom duration was also recorded.
 The patients filled in the B.C.T.Q. before and after treatment as well underwent diagnostic neurophysiological tests, strictly standardized in stimulation parameters, electrodes placement and skin temperature.
 The Ozone Therapy was performed by injecting 4 ml of O2-O3 mixture at 10 ug/ml concentration under the transverse carpal ligament twice a week for eight sessions. 
 
 Results.
 We compared the B.C.T.Q. scores and the neurophysiological parameters obtained before and after O2-O3 treatment: the improvement of symptoms was significantly greater than the improvement of motor and sensory nerve conduction.
 The highest clinical improvement degree was found in patients classified in Mild and Moderate Groups.
 
 Discussion and Conclusion.
 Ischemia-Reperfusion Injury triggers oxidative stress in SSCT with activation of chemical mediators and neo-angiogenesis leading to non-inflammatory fibrosis that represent the allmark of CTS.
 Previous and retrospective studies based O2-O3 treatment on the main mechanisms of action shared by the treatment of herniated disc in the spine; our study focused the attention on pathophysiology of the SSCT trying to recognize the various stages of CTS pathogenesis by correlating with clinical and neuro-physiological tests.
 Further studies have to be carried out to better understand these relationships and optimize timing of Ozone Therapy.

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

“…In another more recent uncontrolled study, sensory nerve conduction and motor distal latency along with symptom severity (BCTQ questionnaire) were improved after eight sessions of O 2 -O 3 injections. [ 12 ] Contrary to these findings, the present study showed no significant changes in the electrodiagnostic and ultrasonographic parameters, although it should be noted that we used a single dose of O 2 -O 3 injection. Bahrami et al[ 1 ] compared the effectiveness of the single dose of O 2 -O 3 therapy against a control group (volar splint for eight weeks).…”

“…[ 10 , 11 ] Local injections have shown to be beneficial in mild to moderate cases, and there are promising results with corticosteroids (CS), progesterone, and platelet-rich plasma. [ 12 ] Local injection of CS is usually preferred in mild to moderate cases refractory to other modalities. There is often a rapid and significant improvement; however, it may not last in the long term.…”

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

“…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 ]. The nature of the fibrotic expression in SSc people with CTS seemed to be significantly associated with gene upstream for Col1 and Col3, TGF-β, and SMAD3 in CTS fibroblasts [ 137 , 138 ].…”

Non-Surgical Management and Post-Surgical Rehabilitation of Carpal Tunnel Syndrome: An Algorithmic Approach and Practical Guideline

“…Recent studies have recommended local ozone therapy in some musculoskeletal conditions (70,71). Rascaroli et al showed that neurophysiological and functional parameters after O2-O3 treatment were improved significantly more than the motor and sensory nerve conduction parameters (72). The best clinical improvements were found in mild and moderate CTS groups (72).…”

“…Rascaroli et al showed that neurophysiological and functional parameters after O2-O3 treatment were improved significantly more than the motor and sensory nerve conduction parameters (72). The best clinical improvements were found in mild and moderate CTS groups (72). Although ozone therapy is a safe and low-cost method with some promising outcomes in patients with mild to moderate CTS, at least for short-term (70), further studies are needed in the future.…”