Lateral epicondylitis is one of the most common causes of elbow pain, leading to functional impairment and decreased quality of life. Various non-surgical treatment modalities have been proposed; however, the comparative effectiveness of these treatments remains unclear. This study aimed to compare the therapeutic effectiveness of ozone therapy and extracorporeal shock wave therapy in patients with chronic lateral epicondylitis.

This retrospective cohort study was conducted at the Physical Medicine and Rehabilitation Department of Uşak Training and Research Hospital between 2022 and 2024. A total of 75 adult patients diagnosed with chronic lateral epicondylitis were included. Patients received either ozone therapy (one session per week for three weeks) or extracorporeal shock wave therapy(ESWT), and all procedures were performed by the same physician. Patient allocation was non-randomized and based on clinical decision-making. Pain severity was assessed using the Visual Analogue Scale (VAS) for rest, activity, sleep, and compression pain. Functional status and disability were evaluated using the Disabilities of the Arm, Shoulder and Hand questionnaire(DASH) and the Patient-Rated Tennis Elbow Evaluation(PRTEE). Assessments were performed at baseline, immediately after treatment, and at and at follow-up points of 1 month, 3 months, and 6 months post-treatment. A two-factor repeated-measures analysis of variance (group × time) with Bonferroni post-hoc correction was performed to analyze the main outcome variables.

The ozone therapy group (n = 25, mean age 45.3 ± 6.5 years, 68% female) and the ESWT group (n = 26, mean age 47.0 ± 9.5 years, 80,8% female) were similar in terms of baseline demographic and clinical characteristics (p > 0.05). Both treatment groups showed statistically significant intra-group improvements in all outcome measures compared to baseline (p < 0.05 for all). When the two treatment methods were compared with each other, the ozone therapy group was found to be superior to the ESWT group at the 3rd and 6th months regarding pain at rest (3rd month: p < 0.05, 95% CI:-3.3 to -0.6; 6th month: p < 0.001, 95% CI: -3.4 to -1.1), pain during activity (3rd month: p < 0.05, 95% CI:-3.8 to -0.6; 6th month: p < 0.001, 95% CI: -4.4 to -1.2), and pain on manual compression (3rd month: p < 0.05, 95% CI:-3.8 to -0.6; 6th month: p < 0.05, 95% CI:-4.4 to -1.2). Additionally, in the ozone group, VAS scores during sleep at the 3rd and 6th months, PRTEE scores at the 1 st, 3rd, and 6th months, and DASH scores immediately post-treatment and at the 1 st, 3rd, and 6th months were observed to be more effective compared to the ESWT group (p < 0.05 for all comparisons, with 95% CIs provided in supplementary tables).

Our study demonstrated that ozone injection may be an effective and potentially superior alternative treatment modality compared with extracorporeal shock wave therapy in the management of chronic lateral epicondylitis. However, prospective randomized controlled trials are needed to confirm these findings.