Comparison of intra-articular ozone and steroid injection in patients with adhesive capsulitis

Adhesive capsulitis is a disease characterized by a significant decrease in the active and passive range of motion(ROM) of the glenohumeral joint along with pain. Ozone therapy has demonstrated promising results in treating various diseases. This study aims to compare the efficacy of intraarticular ozone administration with steroid injection in treating adhesive capsulitis.

Our study is a single-blind, prospective and comparative clinical trial. The study included 40 patients who were randomly assigned to one of two groups. The study group received 8 sessions of intra-articular ozone injection under ultrasound guidance, while the control group received a single intra-articular steroid injection. Patient evaluations were conducted before treatment, as well as 4 and 12 weeks after treatment. The study utilized three evaluation scales: the visual analog scale(VAS) for pain, the Shoulder Pain and Disability Index (SPADI), and ROM measurements.

Both treatment groups demonstrated a statistically significant improvement in range of motion, SPADI, and VAS scores compared to their values at baseline and weeks 4 and 12. However, no statistically significant difference was found between the two groups in the magnitude of improvement across these outcomes.

The study results demonstrate that ozone injection repeated eight times led to improvements in pain, function, and range of motion that were not statistically different from those observed with a single corticosteroid injection in treating adhesive capsulitis. Although the study was not designed as a non-inferiority trial, the findings suggest that intra-articular ozone administration may be a potentially beneficial alternative treatment option. Key Points • This study demonstrates that intra-articular ozone (O₂-O₃) injection resulted in significant clinical improvements in pain, function, and range of motion in patients with primary adhesive capsulitis. • Despite differences in injection frequency, both ozone and corticosteroid injections led to improvements, with no statistically significant difference between groups. • This study contributes to the limited literature on ozone therapy for adhesive capsulitis and suggests its potential as an alternative to corticosteroid injection, particularly for patients who may not tolerate steroids. • Further research with longer follow-up periods is warranted to confirm the long-term efficacy and safety of ozone therapy in adhesive capsulitis management.