The Efficacy of Triple Shoulder Injection with Steroids and Ozone in the Treatment of Chronic Shoulder Pain and Range of Motion Limitation

Derya Bayram; İbrahim Aşık

doi:10.58600/eurjther2227

Authors

Derya Bayram Mardin Training and Research Hospital, Pain Clinic, Artuklu, Mardin, Türkiye https://orcid.org/0000-0001-8184-5184
İbrahim Aşık Department of Pain Medicine, Ankara University Faculty of Medicine Ibni Sina Hospital, Ankara, Türkiye https://orcid.org/0000-0002-4800-3150

DOI:

https://doi.org/10.58600/eurjther2227

Keywords:

shoulder pain, shoulder joint, ozone treatment, lumbar epidural steroid

Abstract

Objective: This study aimed to evaluate and compare the therapeutic effects of fluoroscopy-guided triple shoulder injections with steroids and, a combination of steroids and ozone.

Methods: Data were retrospectively collected from the files of 70 patients diagnosed with non-specific chronic shoulder pain and received triple shoulder injections. The patients were divided into two groups. One group included triple shoulder injections with steroids under fluoroscopic guidance, while the other group included combination of steroids and ozone. Pain intensity was evaluated with the Visual Analog Scale (VAS), the patient's quality of life and functionality were assessed using the Shoulder Pain and Disability Index (SPADI), and the active range of motion (ROM) of shoulder abduction, external rotation, and flexion were measured by goniometry. Beck Depression Inventory (BDI) was used to measure the severity of depression before the procedure. All measurements were recorded at baseline and 1, 3, and 6 months after the procedure.

Results: Baseline characteristics were similar in both groups. There was no statistical difference in VAS scores between the two groups at baseline, 1st, and 3^rd months. However, in the 6^th months, the VAS scores of patients treated with steroids plus ozone were significantly lower than those of patients treated with steroids (P<0.001). Both groups showed significant improvements in SPADI pain, disability, and total subscores compared to pre-treatment values (P < 0.001). There was a significant improvement in the ROM of the shoulder joint in both groups (p<0.001). However, patients who received ozone and steroid treatments showed a significantly greater increase in SPADI and ROM of shoulder joints in the 6th months (p<0.001). There was a positive correlation between BDI score and pain duration, and the severity of depression had no statistically significant effect on VAS scores.

Conclusion: Results of this study revealed that triple shoulder injection with steroids or a combination of steroids and ozone proved to be an effective therapeutic approach for patients suffering from shoulder pain and limited mobility. The combination of ozone with steroids may lead to better results than using steroids alone. Furthermore, a long duration of pain increases the risk of chronic depression in patients.

Metrics

Metrics Loading ...

References

Carroll MB, Motley SA, Smith B, Ramsey BC, Baggett AS (2018) Comparing corticosteroid preparation and dose in the improvement of shoulder function and pain: a randomized, single-blind pilot study. Am J Phys Med Rehabil. 97:450–455. http://dx.doi.org/10.1097/phm.0000000000000758

Lee SW, Tiu T, Roberts J, Lee B, Bartels MN, Oh-Park M (2018) Point-of-care ultrasonography findings and care use among patients undergoing ultrasound-guided shoulder injections. Am J Phys Med Rehabil. 97:56–61. http://dx.doi.org/10.1097/phm.0000000000000807

Cuce I, Sencan, S, Demir FU, Koc A, Çalış M (2019) Efficacy of fluoroscopy-guided triple shoulder injection for older patients with nonspecific shoulder pain. Eur Geriatr Med 10: 595–602. https://doi.org/10.1007/s41999-018-00159-9

Erdine S (2011) Üçlü omuz bloğu. In: Erdine S (eds), Algolojide Girişimsel Yöntemler. İstanbul, Nobel kitabevi, pp 195-198.

Gaujoux-Viala C, Dougados M, Gossec L (2009) Efficacy and safety of steroid injections for shoulder and elbow tendonitis: a meta-analysis of randomized controlled trials. Ann Rheum Dis. 68:1843–1849. http://dx.doi.org/10.1136/ard.2008.099572

Babaei-Ghazani A, Fadavi HR, Eftekharsadat B, Ebadi S, Ahadi T, Ghazaei F, Khabbaz MS (2019). A Randomized Control Trial of Comparing Ultrasound-Guided Ozone (O2-O3) vs Corticosteroid Injection in Patients With Shoulder Impingement. Am J Phys Med Rehabil. November. 98(11):1018-1025. http://dx.doi.org/10.1097/phm.0000000000001240

Bocci VA (2006) Scientific and medical aspects of ozone therapy. State of the art. Arch Med Res 37:425–435. https://doi.org/10.1016/j.arcmed.2005.08.006

Shanta H, Amruta S (2017). Ozone Therapy: An Excellent Treatment for Various Diseases International. Journal of Pharmacy and pharmaceutical research 10(3), 303-311.

Babaei-Ghazani A, Najarzadeh S, Mansoori K, Forogh B, Madani SP, Ebadi S, Fadavi HR, Eftekharsadat B (2018) The effects of ultrasound-guided corticosteroid injection compared to oxygen–ozone (O 2–O 3) injection in patients with knee osteoarthritis: a randomized controlled trial. Clin Rheumatol. 37:2517–2527. https://doi.org/10.1007/s10067-018-4147-6

Bumin G, Tüzün EH, Tonga E (2008). The Shoulder Pain and Disability Index (SPADI): Cross-cultural adaptation, reliability, and validity of the Turkish version. J Back Musculoskelet Rehabil. 21(1): 57-62. http://dx.doi.org/10.3233/bmr-2008-21108

Kapci EG, Uslu R, Turkcapar H, Karaoglan A (2008). Beck Depression Inventory-II: evaluation of the psychometric properties and cut‐off points in a Turkish adult population. Depress Anxiety, 25(10), E104-E110. https://doi.org/10.1002/da.20371

Kamel, SI, Rosas HG, Gorbachova T (2023) Local and Systemic Side Effects of Corticosteroid Injections for Musculoskeletal Indications. Am J Roentgenol. 1-12. https://doi.org/10.2214/AJR.23.30458

Seyam O, Smith NL, Reid I, Gandhi J, Jiang W, Khan SA (2018) Clinical utility of ozone therapy for musculoskeletal disorders. Med Gas Res. Sep 25;8(3):103-110. http://dx.doi.org/10.4103/2045-9912.241075

Atar MÖ, Korkmaz N, Aslan SG, Tezen Ö, Köylü Sinem Uyar, Demir Yasin, Kesikburun S (2023) Comparison of ultrasound-guided subacromial corticosteroid and ozone (O2-O3) injections in the treatment of chronic rotator cuff tendinopathy: a randomized clinical trial. Korean J Pain 36(1):128-136 http://dx.doi.org/10.3344/kjp.22221

Gurger M, Once G, Yilmaz E, Demir Ş, Calik I, Say Y, Kavakli A, Key S, Gurbuz MU, Bingollu O (2021) The effect of the platelet-rich plasma and ozone therapy on tendon-to-bone healing in the rabbit rotator cuff repair model. J Orthop Surg Res 16(1): 1-9 https://doi.org/10.1186/s13018-021-02320-w

Giurazza F, Guarnieri G, Murphy KJ, Muto M (2017) Intradiscal O2O3: rationale, injection technique,short-and long-term outcomes for the treatment of low back pain due to disc herniation. Can Assoc Radiol J 68:171–177. https://doi.org/10.1016/j.carj.2016.12.007

Foula AS, Sabry LS, Elmulla AF, Kamel MA, Hozien AI (2023) Ultrasound-guided Shoulder Intraarticular Ozone Injection Versus Pulsed Radiofrequency Application for Shoulder Adhesive Capsulitis: A Randomized Controlled Trial. Pain Physician. Jul;26(4):E329-E340. PMID: 37535775.

Benvenuti P (2006) Oxygen-ozone treatment of the knee, shoulder, and hip: A personal experience. Rivista Italiana di Ossigeno-Ozonoterapia 5:135-144. https://sid.ir/paper/655510/en

Kara M, Gürçay E (2020) A Single-Dose Injection of Ozone Is Not an Alternative of Corticosteroid Injection in Shoulder Impingement Syndrome. Am J Phys Med Rehabil. 99(7):e89. http://dx.doi.org/10.1097/phm.0000000000001303

Moretti B, Lanzisera R, Sisti GL, Moretti L, Patella V, Simone C (2005) O2-O3 therapy in tendinopathies and entrapment syndromes. Rivista Italiana di Ossigenoozonoterapia. 4(1):20-29.

Scarchilli A (2008) Indications and limits of intra-articular oxygen-ozone therapy for rotator cuff tendinopathy. Int J Ozone Ther. 7:49–52

Coombes BK, Bisset L, Vicenzino B (2010) Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomized controlled trials. Lancet. 376:1751–1767. http://dx.doi.org/10.1016/s0140-6736(10)61160-9

Ikonomidis S, Iliakis E, Eleftheriadou A, Bratanis D, Thomaidis R (2003) Conservative treatment of acute or chronic tendinitis with oxygen-ozone mixture. A double-blind clinical trial. Rivista Italiana di Ossigeno-Ozonoterapia. 2: 67–71.

Gjonovich A, Girotto L, GF Sattin (2002) L’Ossigeno-Ozonoterapia nella spalla dolorosa. (Article in Italian) Esperienza clinica. Riv Ital Ossigeno- Ozonoterapia 1: 37-40.

Cho CH, Jung SW, Park JY, Song KW, Yu KI (2013) Is shoulder pain for three months or longer correlated with depression, anxiety, and sleep disturbance? J Shoulder Elbow Surg. 22(2): 222-228. https://doi.org/10.1016/j.jse.2012.04.001

Roh YH., Lee BK, Noh JH, Oh JH, Gong HS, Baek GH (2012) Effect of depressive symptoms on perceived disability in patients with chronic shoulder pain. Arch Orthop Trauma Surg 132: 1251–1257. https://doi.org/10.1007/s00402-012-1545-0

Toprak M, Erden M (2019) ‘Sleep Quality, Pain, Anxiety, Depression and Quality of Life in Patients with Frozen Shoulder’. J Back Musculoskelet Rehabil. 32(2);287 – 291. http://dx.doi.org/10.3233/bmr-171010