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A randomized control trial of comparing ultrasound-guided ozone (O2-O3) vs corticosteroid injection in patients with shoulder impingement

Babaei-Ghazani, Arash MD1; Fadavi, Hamid Reza DO2; Eftekharsadat, Bina MD3; Ebadi, Safoora PhD1; Ahadi, Tannaz MD4; Ghazaei, Fatemeh MD1; Khabbaz, Mohamad Sadegh MD5

American Journal of Physical Medicine & Rehabilitation: June 10, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001240
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Introduction Ozone has been recently used as a safe alternative treatment in musculoskeletal disorders with fewer side 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 30 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 (VAS), Constant score, Shoulder Pain and Disability Scale (SPADI), shoulder range of motion (ROM) and ultra-sonographic measures before treatment, two weeks and two months after injections.

Results Patients’ VAS, SPADI 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 VAS score among patients receiving ozone, while during the same interval, patients’ pain slightly worsened in the corticosteroid group. The ROM and ultra-sonographic measures did not show statistical differences between the two groups.

Conclusion Corticosteroid injection improves the pain and disability scores more significantly than a one-time ozone injection. Ozone may serve as an alternative modalities in treating shoulder impingement when the use of steroids is contraindicated.

1Assistant Professor, Neuromusculoskeletal Research Center, Department of physical medicine and rehabilitation, Iran University of Medical Sciences, Tehran, Iran.

2Physical Medicine and Rehabilitation specialist with subspecialty in Interventional Pain Management, Clinical director, Mission Pain and Spine, Mission Viejo, CA, USA.

3Associate professor, Physical Medicine and Rehabilitation Research Center, Department of physical medicine and rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran.

4Associate professor, Neuromusculoskeletal Research Center, Department of physical medicine and rehabilitation, Iran university of Medical Sciences, Tehran, Iran.

5Physical Medicine and Rehabilitation specialist, Department of physical medicine and rehabilitation, Iran university of Medical Sciences, Tehran, Iran. (Corresponding author)

*Corresponding author: Mohamad Sadegh Khabbaz

All correspondence should be addressed to: Mohamad Sadegh Khabbaz, MD. Department of Physical Medicine and Rehabilitation, Firoozgar hospital, Valieasr square, Tehran, Iran. Fax: +98[21]88942970, Tel: +98[21]88908519, Mobile: +989120766393, E-mail: m.sadegh.khabbaz@gmail.com

Author Disclosures: There is no conflict of interest. No funding or grants or equipment provided for the project from any source and there are no financial benefits to the authors.

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