Korean J Pain.  2023 Jan;36(1):128-136. 10.3344/kjp.22221.

Comparison of ultrasound-guided subacromial corticosteroid and ozone (O₂-O₃ ) injections in the treatment of chronic rotator cuff tendinopathy: a randomized clinical trial

• Atar M
• Korkmaz N
• Aslan SG
• Tezen
• Köylü SU
• Demir Y
• Kesikburun S

• KMID: 2537619
• DOI: http://doi.org/10.3344/kjp.22221

Abstract

Background
The authors aimed to compare the effects of a one-time ultrasound (US)-guided subacromial corticosteroid injection and three-time ozone (O₂-O₃ ) injection in patients with chronic supraspinatus tendinopathy.
Methods
Participants were randomly assigned to the corticosteroid group (n = 22) or ozone group (n = 22). Injections in both groups were administered into subacromial bursa with an US-guided in-plane posterolateral approach. Primary outcome measure was the change in the Western Ontario Rotator Cuff Index (WORC) score between baseline and 12-weeks post-injection. Secondary outcome measures included visual analog scale and Shoulder Pain and Disability Index scores. Assessments were recorded at baseline, and 4-weeks and 12-weeks post-injection.
Results
Forty participants completed this study. Based on repeated measurement analysis of variance, a significant effect of time was found for all outcome measures in both groups. Both the groups showed clinically significant improvements in shoulder pain, quality of life, and function. Baseline, 4-week post-injection, and 12-week post-injection WORC scores (mean ± standard deviation) were 57.91 ± 18.97, 39.10 ± 20.50 and 37.22 ± 27.31 in the corticosteroid group, respectively and 69.03 ± 15.89, 39.11 ± 24.36, and 32.26 ± 24.58 in the ozone group, respectively. However, no significant group × time interaction was identified regarding all outcome measures.
Conclusions
Three-time ozone injection was not superior to a one-time corticosteroid injection in patients with chronic supraspinatus tendinopathy. It might be as effective as corticosteroid injection at 4-weeks and 12-weeks post-injection in terms of relieving pain and improving quality of life and function.

Keyword

Adrenal Cortex Hormones; Bursa; Synovial; Ozone; Pain Management; Rotator Cuff; Shoulder Pain; Steroids; Tendinopathy; Ultrasonography; Interventional

Figure

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  Fig. 1 (A) Measurement of the thicknesses of the subacromial bursa (1) and supraspinatus tendon (2). (B) Measurement of the acromiohumeral distance (3). A: acromion, D: deltoid, HH: humeral head, ST: supraspinatus tendon.

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  Fig. 2 Ultrasound-guided subacromial bursa injection with an in-plane posterolateral approach. Arrows: needle, A: acromion, D: deltoid, HH: humeral head, ST: supraspinatus tendon, SB: subacromial bursa, LAT: lateral.

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  Fig. 3 CONSORT diagram of the study.

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  Fig. 4 Change of the outcome measures over time in corticosteroid and ozone (O2-O3) groups based on the repeated-measure analysis of variance (estimated marginal means are shown). (A) Visual analog scale (VAS). (B) The Western Ontario Rotator Cuff Index (WORC). (C) Shoulder Pain and Disability Index (SPADI).

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