Evaluation of the effect of Local Steroid Injection versus Ozone Therapy in Treatment of Frozen Shoulder

* M. N. Mawsouf and **M.S.M. Rezk

*Head of Ozone Therapy Unit, National Cancer Institute,Cairo- Egypt
** Faculty of Medicine, Al-Azhar University

Abstract

        The shoulder joint is anatomically complex with numerous structures contributing to both mobility and stability of the joint. Frozen shoulder is a descriptive term used to indicate a clinical syndrome characterized by the spontaneous onset of shoulder pain followed by a restricted range of active and passive gleno-humeral movement for which no other cause can be found. It is the second most common cause of shoulder pain and disability. The aim of this work was to evaluate the effect of local steroid injection versus ozone therapy in treatment of frozen shoulder.

The study was carried out on 60 patients suffering from unilateral painful stiff shoulder (frozen shoulder). A full history taking and clinical examination were applied to all patients. Laboratory investigations were also done including complete blood count (CBC), erythrocytic sedimentation rate (ESR), fasting blood glucose (FBG), post-parandial blood sugar (PPBS) and serum uric acid were done. Plain X-ray of shoulder was performed to all patients. Assessment was done using visual analogue scale (VAS), shoulder disability questionnaire score (SDQ-score) and range of motion (ROM) of shoulder. Assessment was carried on 1, 4 and 12 weeks of the study. Patients were classified randomly into three equal groups. Group I received 3 injections of 40 mg methyl prednisolon, one week interval. Group II received intra-articular ozone injection (10 ml of 15µ/ml ozone in oxygen) 3 times per week for 4 weeks. Group III received intra-articular steroid and ozone injection in the same dose and frequency as group I and II.

It was found that local steroid injection was effective in improving shoulder pain, SDQ-score and ROM of shoulder along the follow up period but with transient elevation of blood pressure and blood sugar level. After 4 weeks, the systolic blood pressure increased by 14.5% and F.B.S. increased by 51%. The VAS improved by 25, 49 and 67% after 1, 4 and 12 weeks respectively. SDQ-score improved by 12, 47 and 71% after 1, 4 and 12 weeks respectively.

Local ozone injection was found to be of delayed onset of action in comparison with local steroid injections. There was poor improvement of pain score, SDQ-score and ROM after one week. The VAS improved by 3.2%, SDQ-score improved by 2%. Local ozone injection was effective and comparable with local steroid injection in improving pain score, SDQ-score, ROM after 4 weeks and 12 weeks. After 4 weeks, the VAS improved by 48%, SDQ-score improved by 41.4%. After 12 weeks, the VAS improved by 63%, SDQ-score improved by 68.8%

Combination of ozone and steroids gave better results due to augmentation of the anti-inflammatory effect of both. The VAS improved by 94% and SDQ-score improved by 90.3% after 12 weeks.

Ozone therapy was safe on blood pressure and blood glucose during follow-up period; however FBG was recorded to be decreased by 14.5% with ozone therapy.