Proprioceptive Neuromuscular Facilitation vs Conventional Therapy With Ultrasound-Guided Corticosteroid Injections for Subacromial Bursitis

Efficacy of a Proprioceptive Neuromuscular Facilitation Versus Conventional Physical Therapy, Combined With Ultrasound-guided Corticosteroids Injections, in Subacromial Bursitis: a Randomized Controlled Trial

This study aims to evaluate the effectiveness of a combined treatment approach for people with chronic shoulder pain caused by subacromial bursitis.

Subacromial bursitis is a common condition that can cause pain, stiffness, and reduced ability to move the shoulder. These symptoms often interfere with daily activities such as dressing, lifting objects, or reaching overhead, and may negatively affect quality of life.

In current clinical practice, corticosteroid injections are frequently used to reduce inflammation and relieve pain, especially in patients with persistent symptoms. Physiotherapy is also an essential part of treatment, helping to restore movement, strength, and function. However, it is not yet clear which type of rehabilitation program provides the best results when combined with injections.

In this study, all participants receive three ultrasound-guided corticosteroid injections administered once per week. Ultrasound guidance allows the physician to accurately deliver the medication into the affected area, improving safety and precision.

After the injections, participants are randomly assigned to one of two rehabilitation programs. One group performs a program based on Proprioceptive Neuromuscular Facilitation (PNF), a technique that uses specific movement patterns to improve muscle coordination, flexibility, and strength. The other group receives conventional physiotherapy, including standard exercises aimed at improving shoulder mobility and function.

Participants are evaluated over time to assess changes in pain, daily function, quality of life, and shoulder movement, with follow-up lasting up to six months.

The purpose of this study is to determine whether one rehabilitation approach is more effective than the other when combined with corticosteroid injections.

The study aims to answer the following question:

Does a rehabilitation program based on Proprioceptive Neuromuscular Facilitation (PNF), combined with ultrasound-guided corticosteroid injections, lead to better improvements in pain, function, quality of life, and shoulder mobility compared to conventional physiotherapy in patients with subacromial bursitis?

Inclusion Criteria:

• Adults aged ≥ 18 years
• Diagnosis of chronic shoulder pain (duration ≥ 3 months)
• Pain intensity ≥ 4 on the Numeric Rating Scale (NRS)
• Body Mass Index (BMI) < 30 kg/m²
• Ability to understand and provide written informed consent

Exclusion Criteria:

• Severe cognitive impairment (Mini-Mental State Examination < 24) or inability to provide informed consent
• Severe cardiovascular or cerebrovascular diseases
• History of neurological or psychiatric disorders
• Active oncological disease
• Rheumatoid arthritis
• Previous shoulder arthroplasty
• Severe osteoporosis
• Use of oral analgesics, intra-articular injections, physiotherapy, or physical therapies within 15 days prior to enrollment;