Intracarpal Ozone vs Methylprednisolone for Carpal Tunnel Syndrome in Patients With Systemic Sclerosis

wrist infiltration
Models. (Photo By BSIP/UIG Via Getty Images)
Researchers compared the clinical efficacy of ozone vs methylprednisolone intracarpal injection on pain, functional status, and nerve conduction in patients with carpal tunnel syndrome due to systemic sclerosis.

Patients with carpal tunnel syndrome (CTS) due to systemic sclerosis (SSc) may benefit from intracarpal ozone or methylprednisolone injection for pain alleviation; however, intracarpal ozone may offer more benefits, according to study results published in Pain Physician.

A team of researchers from Egypt conducted a randomized, single-blinded trial in patients with CTS due to SSc to determine the clinical efficacy of intracarpal ozone vs methylprednisolone injection for pain, functional status, and nerve conduction.

The primary outcome was the pain visual analog scale (VAS), which was measured at 1 week, 1 month, 3 months, and 6 months after injection. Secondary outcomes included variation in Cochin Hand Function Scale, changes in ulcer size, and Raynaud attack frequency and duration. 

A total of 50 patients who had SSc for more than 3 months were randomly assigned to either receive ozone injection (ozone/oxygen 25 μg/mL in 20 mL) or methylprednisolone acetate (40mg, and 40 mg lidocaine in 20 mL).

One week postinjection, the pain VAS was significantly lower among participants in the methylprednisolone group (P =.01) compared with the ozone group; however, after 3 and 6 months, the ozone group had a significantly lower VAS. Each group, compared with its baseline values, had a significant improvement in VAS (decreased values).

The Cochin Hand Function Scale significantly improved during the follow-up periods in both the groups by 6 months (P <.001); however, results were more improved among patients who received ozone.

The Raynaud attack frequency and duration was also significantly lower at 3 months and 6 months in the ozone vs methylprednisolone group, as well as ulcer size and VAS for pain after 3 months and 6 months.

Compared with the methylprednisolone group, the ozone group had a significantly smaller cross-sectional area of the median nerve with a significantly higher sensory conduction at 6 months. Although differences in motor conduction were not significantly different between the 2 groups, motor distal latency was significantly lower in the ozone vs methylprednisolone group at 3 and 6 months.

Study limitations were the short follow-up period and that analgesic consumption was not recorded,

“Both intracarpal ozone or methylprednisolone afforded favorable effects upon symptoms of CTS in patients with [SSc]; however, ozone alleviates pain, enhances the hand functional status, decreases the duration and frequency of Raynaud’s attacks, declines the size of ulceration, and improves median nerve conduction study over 6 month duration,” the researchers concluded.


Elawamy A, Hassanien M, Talaat EA, Ali AM, Roushdy ASI, Kamel EZ. Intra-carpal injection of ozone versus methylprednisolone in carpal tunnel syndrome of systemic sclerosis patients: a randomized single-blind clinical trial. Pain Physician. 2021;24(4):E453-E458.