Ozone therapy and joint injection

Ozone therapy and steroid joint injection are used to treat many painful syndromes affecting the joints, muscles and tendons.

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Introduction

Ozone is a highly soluble gas with great oxidiz-
ing activity. In contact with biological fluids ozone
forms lipid oxidation products and reactive oxygen
species.


 These substances react with white blood
cells  triggering  the  production  of  cytokines,  pro-
teins strongly conditioning inflammatory reactions,
and  red  blood  cells  enhancing  the  oxygen  supply 
to tissues.

Ozone is used to treat many painful syndromes
affecting the joints, muscles and tendons even when
peripheral  neurological  impairment  is  present.

Its  painkilling  mechanism  is  thought  to  be  based 
on  stimulation  of  the  antinociceptive  apparatus 
mediated  by  endogenous  opioids  and  serotonin 
thereby raising the pain threshold. In addition, the
marked   anti-inflammatory   properties   of   ozone  
reduce oedema, joint swelling and compression on
nerve root structures.
 Ozone favours tissue hyper-
oxygenation  following  increased  vascularization 
due  to  neoangiogenesis

  improving  local  tissue 
trophism and the inhibitory capacity of inflamma-
tory metabolites.
There  is  a  consensus  in  literature  reports  that 
the sum of the beneficial effects of ozone reduces
local pain favouring the recovery of joint function
and  motion  lost  during  the  painful  phase  (walk-
ing,  going  up  and  down  staires,  washing,  dressing 
and   feeding).   Ozone   injections   (intra-articular,  
peri-articular  or  percutaneous)  are  considered  a 
Oxygen-Ozone Treatment of the Knee,
Shoulder and Hip.


Administration and Dose
After  thorough  examination  of  the  patient  and 
obtaining  signed  informed  consent  to  oxygen-
ozone  injection,  the  gas  mixture  is  administered. 
Ordinary sterile conditions are maintained for dis-
infection of the patient’s skin as well as the syringe,
needles  and  hands.  The  increasing  use  of  oxygen-
ozone  injections  to  treat  inflammatory-degenera-
tive diseases of the joints has led to a specific treat-
ment  protocol  defining  the  gas  concentrations, 
doses  and  infiltration  techniques  to  follow.  Some 
authors  favour  a  single  intra-articular  injection 
with or without instrumental guidance. Others pre-
fer  the  peri-articular  approach  with  injection  into 
certain standardized painful points for each district.

 Experience  has  shown  that  there  is  no  single 
effective  dose  for  all  patients:  the  ozone  probably 
needs to reach an activation threshold to exert its
potent  pharmacological  effects.  The  latest  indica-
tions  of  the  Italian  Federation  of  Oxygen-Ozone 
Therapy  clearly  recommend  smaller  amounts  of 
gas

 than in the past with slightly higher concentra-
tions  of  ozone.  The  gas  mixture  should  be  inject-
ed  slowly,  always  after  aspiration.  The  protocol 
includes  an  initial  cycle  of  at  least 3-5  injections 
Oxygen-Ozone Treatment of the Knee, Shoulder and Hip.

at weekly intervals. The infiltration is usually pain-
less.  The  route  of  administration  and  ozone  dose 
are reported in clinical cases for each of the main
joints treated.

Knee


Oxygen-ozone  therapy  is  used  to  treat  patients 
with  gonarthosis  (initial  and  late),  inflammatory 
disease   due   to   overloading,   patellar   tendinitis,  
goosefoot  bursitis  of  the  knee,  synovitis  during 
inflammatory  arthritis,  bursitis,  knee  pain  caused 
by joint cartilage degeneration due to femoral-rot-
ular chondropathy, knee pain following surgery.
The patient is placed in a supine position with the
knee in extension. After having located the patella
its  medial  margin  is  pressed  to  subluxation  in  the 
lateral margin to increase the articular rim as much
as  possible.  A  21G  needle  is  inserted  along  the 
superolateral margin of the patella (to the superior
third). After thorough sepsis and aspiration, 10-15
cc of the gas mixture is injected slowly at variable
concentrations  depending  on  the  disease  and  in 
any  case  not  more  than  25  μg/ml.  The  patient  is 
invited  to  perform  some  flexion-extension  move-
ments  of  the  knee  to  better  distribute  the  drug 
throughout the joint including the recesses.


Shoulder



Oxygen-ozone  therapy  is  used  to  treat  patients 
with inflammatory rotator cuff tendinopathy (also
due to overloading), tendinitis of the supraspinatus
muscle  caused  by  impingement,  tenosynovitis  of 
the  long  head  of  the  biceps,  subacromial  bursitis, 
frozen  shoulder,  pain  following  surgery,  painful 
shoulder in the course of inveterate rupture of the
cuff.
Oxygen-ozone  is  injected  into  the  shoulder  via 
the posterior approach, laterally under the inferior
margin of the acromion using a 22G needle. After
aspiration and thorough asepsis up to 10cc of oxy-
gen-ozone  mixture  are  injected  slowly  at  varying 
concentrations depending on the condition but not
more than 25 μg/ml. If clinically indicated, it is also
useful  to  puncture  the  subacromial  bursa  and  the 
stretch of the long head of the biceps muscle with a
27G needle injecting microdoses of 0.5-1 cc.
Whenever possible oxygen-ozone therapy should
be flanked by a period of rehabilitation with indi-
vidually prescribed exercises.



Hip


Oxygen-ozone  therapy  is  used  to  treat  hip  pain 
due  to  functional  overload,  pain  caused  by  cox-
arthrosis  (initial  and  late),  trochanteric  bursitis, 
hip   tendonitis   and   pain   following   hip   surgery.  
Whenever  possible  oxygen-ozone  therapy  should 
be flanked by a period of rehabilitation with indi-
vidually prescribed exercises.
The  lateral  approach  is  indicated  in  oxygen-
ozone therapy of the hip. After having located the
cranial margin of the greater trochanter and after
sterilizing  the  area  a  25G  needle  is  inserted  in  a 
direction  perpendicular  to  the  greater  trochanter 
and after aspiration slowly injecting 5 cc of an oxy-
gen-ozone mixture at a concentration of 25 μg/ml.

Ozone therapy and joint injection

Ozone therapy, joint, injection, DJD, osteoarthritis