Abstract
Purpose.
 Idiopathic Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy; however few and only retrospective studies have been found in search engines about Ozone Therapy. 
 The aim of this paper was to evaluate clinical and neurophysiological outcome following Ozone Therapy in CTS.
 We focused the attention on the evidences concerning the role of Subsynovial Connective Tissue (SSCT) in the pathogenesis of CTS and the ozone pre-conditioning effects linked to pain and inflammatory pathways and to fibrosis induced by Ischemia-Reperfusion Injury.
 
 Materials and methods.
 Thirty-five patients, aged between 21 and 80, were stratified clinically by Boston Carpal Tunnel Questionnaire (B.C.T.Q.) and Neurophysiologically by Padua’s Gravity Scale classifying patients into five Electro-myographic categories. The mean symptom duration was also recorded.
 The patients filled in the B.C.T.Q. before and after treatment as well underwent diagnostic neurophysiological tests, strictly standardized in stimulation parameters, electrodes placement and skin temperature.
 The Ozone Therapy was performed by injecting 4 ml of O2-O3 mixture at 10 ug/ml concentration under the transverse carpal ligament twice a week for eight sessions. 
 
 Results.
 We compared the B.C.T.Q. scores and the neurophysiological parameters obtained before and after O2-O3 treatment: the improvement of symptoms was significantly greater than the improvement of motor and sensory nerve conduction.
 The highest clinical improvement degree was found in patients classified in Mild and Moderate Groups.
 
 Discussion and Conclusion.
 Ischemia-Reperfusion Injury triggers oxidative stress in SSCT with activation of chemical mediators and neo-angiogenesis leading to non-inflammatory fibrosis that represent the allmark of CTS.
 Previous and retrospective studies based O2-O3 treatment on the main mechanisms of action shared by the treatment of herniated disc in the spine; our study focused the attention on pathophysiology of the SSCT trying to recognize the various stages of CTS pathogenesis by correlating with clinical and neuro-physiological tests.
 Further studies have to be carried out to better understand these relationships and optimize timing of Ozone Therapy.
Highlights
IntroductionIdiopathic Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy; inquiring the main search engines, only few and retrospective studies [37,44] are available about Ozone Therapy.In these papers O2-O3 treatment is based on three main mechanisms of action shared by the treatment of herniated disc in the spine: a) indirect vessel-mediated mechanical decompression of the nerve roots by increasing intra and trans-tissue oxygenation with reduced hypoxia and venous and lymphatic stasis 22; b) action on the cell-mediated inflammatory response both by inhibiting the release of proteinase by macrophages and polymorphonucleates and by increasing immunosuppressive cytokines (interleukin 10, TGF-beta); c) action on the bio-humoral inflammatory response, inhibiting the release of prostaglandins and pro-inflammatory bradykinins we have got plenty of papers about pathophysiology of SubSynovial Connective Tissue (SSCT) in CTS.It is widely accepted that repetitive motion of the wrist, hand and fingers can lead to CTS by a shear strain sufficient to injure the Subsynovial Connective Tissue (SSCT), triggering a noninflammatory fibrosis of the subsynovial connective tissue, as his histomorphological hallmark.In the last decade several Authors focused their attention on the different biochemical and vascular pathways that characterize the different stages leading to SSCT fibrosis [9,11,13, 14,15,16 17,18,27,39,40,43].We can recognize the early stages by tenosynovial swelling in MRI image [41].The oxidative stress in subsynovial connective tissue, caused by repeated transient ischemia-reperfusion injury (IRI), was demonstrated by high levels of MDA ( MalonilDiAldehyde, a marker of lipid membrane peroxidation ), upregulation of eNOS ( endothelial Nitric Oxide Synthase ) and activation of NF-kb ( a marker of cells immunoreactivity ), with significant positive correlation between subjective symptom severity and immunoreactivities of eNOS and NF-kb [27]
Ischemia-Reperfusion Injury triggers oxidative stress in Subsynovial Connective Tissue (SSCT) with activation of chemical mediators and neo-angiogenesis leading to non-inflammatory fibrosis that represent the allmark of Carpal Tunnel Syndrome (CTS)
Previous and retrospective studies based O2-O3 treatment on the main mechanisms of action shared by the treatment of herniated disc in the spine; our study focused the attention on pathophysiology of the SSCT trying to recognize the various stages of CTS pathogenesis by correlating with clinical and neuro-physiological tests
Summary
Idiopathic Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy; inquiring the main search engines, only few and retrospective studies [37,44] are available about Ozone Therapy.In these papers O2-O3 treatment is based on three main mechanisms of action shared by the treatment of herniated disc in the spine: a) indirect vessel-mediated mechanical decompression of the nerve roots by increasing intra and trans-tissue oxygenation with reduced hypoxia and venous and lymphatic stasis 22; b) action on the cell-mediated inflammatory response both by inhibiting the release of proteinase by macrophages and polymorphonucleates and by increasing immunosuppressive cytokines (interleukin 10, TGF-beta); c) action on the bio-humoral inflammatory response, inhibiting the release of prostaglandins and pro-inflammatory bradykinins we have got plenty of papers about pathophysiology of SubSynovial Connective Tissue (SSCT) in CTS.It is widely accepted that repetitive motion of the wrist, hand and fingers can lead to CTS by a shear strain sufficient to injure the SSCT, triggering a noninflammatory fibrosis of the subsynovial connective tissue, as his histomorphological hallmark.In the last decade several Authors focused their attention on the different biochemical and vascular pathways that characterize the different stages leading to SSCT fibrosis [9,11,13, 14,15,16 17,18,27,39,40,43].We can recognize the early stages by tenosynovial swelling in MRI image [41].The oxidative stress in subsynovial connective tissue, caused by repeated transient ischemia-reperfusion injury (IRI), was demonstrated by high levels of MDA ( MalonilDiAldehyde, a marker of lipid membrane peroxidation ), upregulation of eNOS ( endothelial Nitric Oxide Synthase ) and activation of NF-kb ( a marker of cells immunoreactivity ), with significant positive correlation between subjective symptom severity and immunoreactivities of eNOS and NF-kb [27]. Idiopathic Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy; inquiring the main search engines, only few and retrospective studies [37,44] are available about Ozone Therapy In these papers O2-O3 treatment is based on three main mechanisms of action shared by the treatment of herniated disc in the spine: a) indirect vessel-mediated mechanical decompression of the nerve roots by increasing intra and trans-tissue oxygenation with reduced hypoxia and venous and lymphatic stasis 22; b) action on the cell-mediated inflammatory response both by inhibiting the release of proteinase by macrophages and polymorphonucleates and by increasing immunosuppressive cytokines (interleukin 10, TGF-beta); c) action on the bio-humoral inflammatory response, inhibiting the release of prostaglandins and pro-inflammatory bradykinins.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
