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?

Study Overview

• Status: Completed
• Conditions: Chronic Shoulder Pain; Subacromial Bursitis of the Shoulder
• Intervention / Treatment: Drug: Ultrasound-Guided Corticosteroid Injections plus PNF; Drug: Ultrasound-Guided Corticosteroid Injections plus Conventional Physiotherapy

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Phase 2; Phase 1

Contacts and Locations

Study Locations

• Italy
  • CZ
    • Catanzaro, CZ, Italy, 88100
      • University "Magna Graecia "of Catanzaro

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

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;

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Control group	Drug: Ultrasound-Guided Corticosteroid Injections plus Conventional Physiotherapy; Participants in this group receive a combined interventional and rehabilitative treatment. Initially, all patients undergo a cycle of three ultrasound-guided subacromial corticosteroid injections (metilprednisolone 40 mg) administered once weekly to reduce inflammation and pain. Following the injection phase, participants complete a conventional physiotherapy program consisting of supervised sessions including passive and active mobilization exercises, muscle strengthening, stretching, and proprioceptive training aimed at improving shoulder mobility, function, and overall physical performance.
Experimental: Study group	Drug: Ultrasound-Guided Corticosteroid Injections plus PNF; Participants in this group receive a combined interventional and rehabilitative treatment. Initially, all patients undergo a cycle of three ultrasound-guided subacromial corticosteroid injections (metilprednisolone 40 mg) administered once weekly to reduce inflammation and pain. Following the injection phase, participants complete a structured physiotherapy program based on Proprioceptive Neuromuscular Facilitation (PNF), consisting of supervised sessions aimed at improving shoulder mobility, muscle strength, coordination, and neuromuscular control through specific movement patterns and facilitation techniques.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain intensity measured by the Numeric Rating Scale (NRS)	Pain intensity was assessed using the Numeric Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst imaginable pain), where higher scores indicate greater pain. Patients rated their average pain over the previous 24 hours at each timepoint (baseline and follow-up).	Baseline, 2 weeks, 1 month, 3 months, and 6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Upper limb function (DASH)	Upper limb function was assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, a self-reported measure ranging from 0 to 100, where higher scores indicate greater disability. Participants completed the questionnaire at baseline and follow-up timepoints.	Baseline, 2 weeks, 1 month, 3 months, and 6 months
Health-related quality of life (EQ-5D-3L Index)	Health-related quality of life was assessed using the EuroQol 5 Dimensions 3 Levels (EQ-5D-3L) Index, ranging from values below 0 (health states worse than death) to 1 (full health), where higher scores indicate better health status. The index was derived from patient responses to the EQ-5D-3L descriptive system at each assessment timepoint.	Baseline, 2 weeks, 1 month, 3 months, and 6 months
Perceived health status (EQ-VAS)	Perceived health status was assessed using the EuroQol Visual Analogue Scale (EQ-VAS), ranging from 0 (worst imaginable health) to 100 (best imaginable health), where higher scores indicate better perceived health. Patients self-reported their health status at each assessment timepoint.	Baseline, 2 weeks, 1 month, 3 months, and 6 months
Shoulder Range of Motion (ROM)	Shoulder range of motion was assessed using a goniometer, measuring active movements (flexion, abduction, and external rotation) in degrees. Higher values indicate better joint mobility. Measurements were performed at each assessment timepoint.	Baseline, 2 weeks, 1 month, 3 months, and 6 months

Collaborators and Investigators

• Sponsor: University of Catanzaro

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2025
• Primary Completion (Actual): March 1, 2025
• Study Completion (Actual): May 29, 2025

Study Registration Dates

• First Submitted: March 22, 2026
• First Submitted That Met QC Criteria: March 27, 2026
• First Posted (Actual): April 2, 2026

Study Record Updates

• Last Update Posted (Actual): April 2, 2026
• Last Update Submitted That Met QC Criteria: March 27, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: 380/2024

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Data will be available upon reasonable request to the corresponding author, for researchers who provide a methodologically sound proposal. Data will be shared after approval by the study investigators and in compliance with applicable regulations.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No