{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T07:53:24Z","timestamp":1793692404482,"version":"4.5.1"},"reference-count":18,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T00:00:00Z","timestamp":1743638400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Ozone therapy is used for its immunomodulatory, antioxidant, and analgesic properties in several fields. It can be useful in the rehabilitation of musculoskeletal disorders. Studies showed that O2-O3 therapy can reduce pain and improve functioning in patients affected by low back pain and knee osteoarthritis. Only a few studies have been published about the efficacy of this treatment in upper limb disease. Objective: The aim of this study is to investigate the use of ozone therapy in upper limb pathologies, evaluating its quantity, quality, and reported results in upper limb musculoskeletal disease, supraspinatus tendinopathy, shoulder impingement, adhesive capsulitis, chronic epicondylitis, and carpal tunnel syndrome. O2-O3 reduces inflammation by stimulating anti-inflammatory cytokines and inactivating pro-inflammatory molecules, relieves pain by interacting with pain receptors and improving blood circulation, promotes the regeneration of damaged tissues by stimulating growth factors and improving vascularization, and, finally, activates endogenous antioxidant defense systems by protecting cells from oxidative damage. Methods: A comprehensive search was conducted on PubMed and Scopus using the following MeSH terms: ozone therapy, infiltration joint, musculoskeletal disease, rehabilitation, upper limb, shoulder, wrist, hand, elbow, including English papers published in the last five years. Results: Five papers have been selected: four randomized controlled trials and one retrospective cohort study. The RCTs compared the effectiveness of intra-articular ozone injection with steroid injection alone or with other conservative treatments in shoulder diseases; one paper studied the effectiveness of ozone injection and orthoses in carpal tunnel syndrome compared to orthoses alone; one paper used ozone injections compared with steroid injection in patients with chronic lateral epicondylitis. A total of 218 patients were studied in these trials. Conclusions: Ozone treatment seemed to improve pain and function as well as other therapies in upper limb musculoskeletal disease. However, the trials\u2019 protocols and the upper limb areas treated are different. Further studies are needed to define the effectiveness of ozone therapy in upper limb diseases in rehabilitation fields.<\/jats:p>","DOI":"10.3390\/jcm14072452","type":"journal-article","created":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T03:36:45Z","timestamp":1743737805000},"page":"2452","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Effects of Oxygen\u2013Ozone Injections in Upper Limb Disorders: Scoping Review"],"prefix":"10.3390","volume":"14","author":[{"given":"Gianpaolo","family":"Ronconi","sequence":"first","affiliation":[{"name":"Department of Geriatrics, Orthopedics and Rheumatology, Universit\u00e0 Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy"},{"name":"Fondazione Policlinico Universitario \u201cAgostino Gemelli\u201d IRCCS, Department of Geriatrics, Orthopedics and Rheumatology, L.go A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariani","family":"Mariantonietta","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario \u201cAgostino Gemelli\u201d IRCCS, Department of Geriatrics, Orthopedics and Rheumatology, L.go A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sefora","family":"Codazza","sequence":"additional","affiliation":[{"name":"ASL Frosinone, Complex Operational Unit, Integrated Home Care Assistance, 00163 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Cutaia","sequence":"additional","affiliation":[{"name":"Department of Neurosciens, Sense Organs and Thorax, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Zeni","sequence":"additional","affiliation":[{"name":"Department of Neurosciens, Sense Organs and Thorax, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Forastiere","sequence":"additional","affiliation":[{"name":"Department of Neurosciens, Sense Organs and Thorax, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Ferriero","sequence":"additional","affiliation":[{"name":"Unit of Physical and Rehabilitation Medicine, Istituti Clinici Scientifici Maugeri IRCCS, 21049 Tradate, Italy"},{"name":"Department of Biotechnology and Life Sciences, University of Insubria, 21110 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola Emilia","family":"Ferrara","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario \u201cAgostino Gemelli\u201d IRCCS, Department of Geriatrics, Orthopedics and Rheumatology, L.go A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1097\/PHM.0000000000001240","article-title":"A Randomized Control Trial of Comparing Ultrasound-Guided Ozone (O2-O3) vs Corticosteroid Injection in Patients With Shoulder Impingement","volume":"98","author":"Fadavi","year":"2019","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"103","DOI":"10.4103\/2045-9912.241075","article-title":"Clinical utility of ozone therapy for musculoskeletal disorders","volume":"8","author":"Seyam","year":"2018","journal-title":"Med. Gas. Res."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Lino, V.T.S., Marinho, D.S., Rodrigues, N.C.P., and Andrade, C.A.F. (2024). Efficacy and safety of ozone therapy for knee osteoarthritis: An umbrella review of systematic reviews. Front. Physiol., 15.","DOI":"10.3389\/fphys.2024.1348028"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"De Sire, A., Agostini, F., Lippi, L., Mangone, M., Marchese, S., Cisari, C., Bernetti, A., and Invernizzi, M. (2021). Oxygen-Ozone Therapy in the Rehabilitation Field: State of the Art on Mechanisms of Action, Safety and Effectiveness in Patients with Musculoskeletal Disorders. Biomolecules, 11.","DOI":"10.3390\/biom11030356"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"128","DOI":"10.3344\/kjp.22221","article-title":"Comparison of ultrasound-guided subacromial corticosteroid and ozone (O2-O3) injections in the treatment of chronic rotator cuff tendinopathy: A randomized clinical trial","volume":"36","author":"Atar","year":"2023","journal-title":"Korean J. Pain"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"E329","DOI":"10.36076\/ppj.2023.26.E329","article-title":"Ultrasound-guided Shoulder Intraarticular Ozone Injection Versus Pulsed Radiofrequency Application for Shoulder Adhesive Capsulitis: A Randomized Controlled Trial","volume":"26","author":"Foula","year":"2023","journal-title":"Pain Physician"},{"key":"ref_8","first-page":"61","article-title":"Interesting effectiveness of ozone injection for carpal tunnel syndrome treatment: A randomized controlled trial","volume":"11","author":"Bahrami","year":"2019","journal-title":"Orthop. Res. Rev."},{"key":"ref_9","first-page":"317","article-title":"Comparison of corticosteroid injection and ozone injection for relief of pain in chronic lateral epicondylitis","volume":"85","author":"Ulusoy","year":"2019","journal-title":"Acta Orthop. Belg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2171","DOI":"10.1177\/0363546516669944","article-title":"Intra-articular Steroid Injection for Frozen Shoulder: A Systematic Review and Meta-analysis of Randomized Controlled Trials With Trial Sequential Analysis","volume":"45","author":"Sun","year":"2017","journal-title":"Am. J. Sports Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1097\/PHM.0b013e318255978a","article-title":"Blind or ultrasound-guided corticosteroid injections and short-term response in subacromial impingement syndrome: A randomized, double-blind, prospective study","volume":"91","author":"Dogu","year":"2012","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Ronconi, G., Codazza, S., Panunzio, M., La Cagnina, F., Ariani, M., Gatto, D.M., Coraci, D., and Ferrara, P.E. (2023). The Effects of Ultrasound-Guided Intra-Articular Injections with Hyaluronic Acid and Corticosteroids in Patients with Hip Osteoarthritis: A Long-Term Real-World Analysis. J. Clin. Med., 12.","DOI":"10.3390\/jcm12206600"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1177\/230949901602400115","article-title":"Platelet-rich plasma versus steroid injection for subacromial impingement syndrome","volume":"24","author":"Say","year":"2016","journal-title":"J. Orthop. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"227","DOI":"10.5397\/cise.2019.22.4.227","article-title":"Current Trends for Treating Lateral Epicondylitis","volume":"22","author":"Kim","year":"2019","journal-title":"Clin. Shoulder Elb."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.ptsp.2015.06.002","article-title":"Autologous blood injection for treatment of lateral epicondylosis: A meta-analysis of randomized controlled trials","volume":"18","author":"Chou","year":"2016","journal-title":"Phys. Ther. Sport"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"597","DOI":"10.26603\/001c.24148","article-title":"Platelet-Rich Plasma versus Corticosteroid Injection for the Treatment of Lateral Epicondylitis: A Systematic Review of Systematic Reviews","volume":"16","author":"Kemp","year":"2021","journal-title":"Int. J. Sports Phys. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Ferrara, P.E., Codazza, S., Coraci, D., Malerba, G., Ferriero, G., and Ronconi, G. (2021). State of art in intra-articular hip injections of different medications for osteoarthritis: A systematic review. BMC Musculoskelet. Disord., 22.","DOI":"10.1186\/s12891-021-04866-6"},{"key":"ref_18","first-page":"CD015101","article-title":"Local corticosteroid injection versus surgery for carpal tunnel syndrome","volume":"8","author":"Ashworth","year":"2024","journal-title":"Cochrane Database Syst. Rev."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/7\/2452\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:09:27Z","timestamp":1760029767000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/7\/2452"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,3]]},"references-count":18,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["jcm14072452"],"URL":"https:\/\/doi.org\/10.3390\/jcm14072452","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,3]]}}}