Effectiveness of Proprioceptive Neuromuscular Facilitation Compared with Standardized Exercise-Based Physiotherapy for Chronic Shoulder Pain Treated with Ultrasound-Guided Corticosteroid Injections: A Randomized Controlled Trial

Background: Chronic shoulder pain associated with subacromial bursitis is a common clinical condition characterized by pain and functional limitation, factors that contribute significantly to chronic morbidity for the patient. The combination of ultrasound-guided corticosteroid injections and physical therapy may improve clinical outcomes. This study compared the effectiveness of Proprioceptive Neuromuscular Facilitation and standardized exercise-based physiotherapy after a common protocol of ultrasound-guided corticosteroid injections in patients with chronic shoulder pain associated with subacromial bursitis. Methods: A randomized controlled pilot study was conducted on adult patients with chronic shoulder pain (NRS ≥ 4), who received 3 weekly intra-bursal ultrasound-guided injections of corticosteroids and local anesthetic, followed by either 10 sessions of PNF or standardized exercise-based physiotherapy. The primary outcome was pain intensity assessed by NRS. Secondary outcomes included DASH, EQ-5D, EQ-VAS, and ROM, assessed at baseline, 2 weeks, 4 weeks, 12 weeks, and 24 weeks. Results: The PNF group showed greater improvements in selected outcomes and at some follow-up time points, particularly for functional measures and shoulder ROM. However, between-group differences were not consistent across all predefined outcomes. Conclusions: Both PNF-based rehabilitation and standardized exercise-based physiotherapy may improve clinical outcomes after ultrasound-guided corticosteroid injection in patients with subacromial bursitis. However, the added value of PNF appears limited to selected outcomes and time points, and its superiority over standardized physiotherapy cannot be definitively established.