WHOLE BLOOD OZONATED WITH PROCAINE. A CASE REPORT ON ULNAR NERVE DISLOCATION

a. Barbu¹ , G. Arcuri², C. Faletti³, O. Bottinelli⁴

¹ Physiatric Clinic, Treviso, Italy
² Head of Orthopedic Rehabilitation at Clinical Institute Città di Pavia del Gruppo San Donato, Pavia, Italy
³ Musculoskeletal Radiology Service at Clinica Fornaca di Sessant del Gruppo Humanitas, Turin, Italy
⁴ Researcher at the Department of Radiology of the University of Pavia, Pavia, Italy

Correspondence to:

Journal of Orthopedics 2025 January-April; 17(1): 35-45
https://doi.org/10.69149/orthopedics/2025v17iss1_6

Received: 19 February 2025 Accepted: 27 March 2025

Download PDF

Abstract

Ulnar nerve dislocation is a complex and challenging condition characterized by the displacement of the ulnar nerve from its anatomical position in the epitrochleo-olecranon groove. This condition can lead to pain, a “snapping elbow” sensation, and, in more advanced cases, sensory and motor deficits. Among the innovative therapeutic options, Platelet-Rich Plasma (PRP) has shown promise in promoting healing and alleviating symptoms. However, the high cost and limited accessibility of PRP pose a barrier for many patients. An alternative therapeutic approach involves mixing ozonated whole blood with procaine, which combines the inflammatory effects of whole blood with the anti-inflammatory effects of oxygen-ozone therapy and procaine. This study is based on a case report of a single patient with a dislocated right elbow ulnar nerve. The solution was prepared by mixing 9 mL of whole blood, 1 mL of procaine (10 mg/mL), and 9 mL of oxygen-ozone (20 gamma) in two 20 mL syringes connected to a three-way system. The infiltration was performed without ultrasound guidance, following the guidelines and best clinical practices of the New Italian Oxygen-Ozone Federation (Nuova FIO). A single infiltration of ozonated whole blood with procaine yielded clinically and ultrasonographically significant results as early as the first week. The patient’s subjective “discomfort” correlated with objective observations of a tendency toward ulnar nerve subluxation during dynamic ultrasound maneuvers. Magnetic resonance imaging performed approximately three months post-treatment revealed a thickened, taut Osborne ligament in continuity with a thin fibrous scar tissue on STIR sequences. Although a single infiltration and prolonged immobilization for approximately one month led to noticeable improvements, they were insufficient to ensure complete healing of the ulnar nerve dislocation. This outcome is comparable to PRP studies, as regenerative treatments generally require multiple sessions. Further studies are needed to explore the potential application of this innovative regenerative treatment in other ligamentous and/or tendinous injuries involving substance loss.

Keywords: conservative treatment, dislocation, ozonated whole blood, ozone therapy, procaine, ulnar nerve