Publications
Shoulder Muscle Tone, Function, and Factors Associated with Functional Recovery in Patients with Chronic Shoulder Pain: A Non-Randomized Comparative Study of Manual Therapy and Corticosteroid Injection
Authors: Yongtae Eom 1, Youngsook Bae 1, 2
Affiliations:
- Department of Physical Therapy, Graduate School of Public Health, Gachon University, Incheon 21936, Republic of Korea
- Department of Physical Therapy, College of Medical Science, Gachon University, 191 Hambangmoe-ro, Yeonsu-gu, Incheon 21936, Republic of Korea
Journal: Journal of Clinical Medicine - October 2026, Volume 15, Issue 20, Article no. 7854 (DOI: 10.3390/jcm15207854)
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Field & Applications:
- Medical
- Treatment evaluation
- Musculoskeletal disorder
- Musculoskeletal rehabilitation
- Physiotherapy
Background/Objectives: This study aimed to compare the effects of manual therapy (MT) and corticosteroid injection (CI) on shoulder muscle tone, function, and health-related quality of life (HRQOL) in patients with chronic shoulder pain (CSP) and to identify the muscle-tone change most strongly associated with functional recovery.
Methods: In this quasi-experimental, non-randomized study, 44 patients with CSP lasting >6 months were allocated to MT (n = 22) or CI (n = 22) according to the treating physician’s judgment. Each group received the assigned intervention for 4 weeks, together with conventional physical therapy and a home-based exercise program. Muscle tone (upper trapezius, anterior deltoid, posterior deltoid, and latissimus dorsi [LD]), the Patient-Specific Functional Scale (PSFS), and HRQOL were assessed at the baseline and at 2 and 4 weeks. Exploratory linear regression analyses examined factors associated with changes in PSFS scores.
Results: Both groups showed significant improvements in muscle tone, shoulder function, and HRQOL. Compared with CI, MT produced greater improvements in muscle tone, PSFS scores, and EuroQol Visual Analogue Scale (EQ VAS) scores. All participants achieved the PSFS minimal important change of ≥2 points. The proportion of participants achieving a post hoc exploratory threshold of ≥5 points was higher with MT than with CI (90.9% vs. 13.6%). In separate regression models adjusted for treatment group, changes in LD tone and EQ VAS were each associated with the change in PSFS score.
Conclusions: Both groups showed short-term improvements, with greater gains in muscle-tone measures and function in the MT group. These findings do not establish that MT itself is superior to CI, and the exploratory LD association requires confirmation.
Keywords: chronic shoulder pain, manual therapy, muscle tone, EQ-5D-5L, EQ VAS, posterior deltoid muscle
Both the MT and CI groups showed short-term improvements in shoulder muscle-tone measures, patient-specific function, and health-related outcomes during their 4-week multimodal treatment programs. Greater improvements in several muscle-tone measures and PSFS scores were observed in the MT group than in the CI group. However, non-randomized treatment selection, concomitant therapies, the small sample size, and the short follow-up period preclude a causal conclusion that MT itself is more effective than CI. In exploratory analyses adjusted for treatment group, PD tone change was not associated with PSFS change, whereas LD tone change and EQ VAS change were associated with PSFS change in separate models. These associations do not establish mechanisms of functional recovery and require confirmation in larger studies.