Manual Therapy With Exercise vs. Corticosteroid Injection for Subacromial Pain Syndrome

Physical therapists and physical therapist assistants who treat patients with shoulder pain and field questions about whether an injection would work better or faster than rehabilitation.

Licensed physical therapists and physical therapist assistants working in outpatient orthopedics, primary care–adjacent settings, occupational health, and military or hospital-based musculoskeletal clinics.

Intended audience

Physical Therapy

Level

Intermediate

Delivery format

Online, asynchronous, self-paced course: interactive reading with audio or video, and a scored post-test.

Based on

This course is based on a single source: a systematic review and meta-analysis of randomized controlled trials comparing exercise and manual therapy (EMT) with corticosteroid injection in adults with subacromial pain syndrome (SAPS). The review followed PRISMA reporting guidance, was registered in PROSPERO before it began, searched PubMed, CINAHL, PEDro, ScienceDirect, the Cochrane Library, grey literature, and trial registries from inception to September 2023, rated trial quality with the PEDro scale, and graded certainty of evidence with GRADE.

Eight randomized controlled trials with 946 patients were included. Every claim, percentage, and conclusion in this course traces to that review. Where the review itself made a recommendation, this course reports it as the review’s recommendation rather than as instruction to the learner.

Scope note

This course does not cover surgical management, frozen shoulder, post-traumatic shoulder pain, rotator cuff repair, shoulder instability, or shoulder osteoarthritis. Patients with those conditions were excluded from the trials in this review.

After completing this course, you will be able to:

1. Describe the patient population, the two compared treatments, and the outcomes examined in this systematic review of subacromial pain syndrome.
2. State what the pooled results showed for shoulder disability, self-perceived recovery, and pain across the very short-, short-, mid-, and long-term follow-up periods.
3. Explain the review authors' conclusion, including how certain the evidence was and what limited that certainty.

1. Start Here: Course Overview and How to Earn Credit
2. Podcast: Manual Therapy With Exercise vs. Injection for the Painful Shoulder (about ten minutes)
3. Subacromial Pain Syndrome and the Two First-Line Options
4. How the Review Was Built: Trials, Patients, and Quality Checks
5. What the Pooled Results Showed: Disability, Recovery, and Pain
6. Where the Evidence Is Shaky: Mixed Methods, Mixed Patients, Low Certainty
7. What the Authors Say This Could Mean in the Clinic
8. Key Takeaways
9. Post-Test and Course Evaluation

Quinn Millington, PT, DPT, ECS is the instructor of record: the licensed clinician who reviewed this course and signed off on it. The name and credentials print on the certificate.

Disclosures. This course was developed by The ConEd Solution, which has a financial interest in its sale. No outside funding or sponsorship was received. The instructor of record has no affiliation with the authors of the source publication or their institutions.

This course awards 0.5 contact hours (30 min). How you earn them:

1. Complete the course. Every lesson, in order.
2. Pass the post-test. Score 80% or higher. Retakes are allowed.
3. Complete the evaluation. A short form rating each learning objective and the course.
4. Download your certificate. It is issued on completion and stays available in My Account.

The episode time is its measured length. Reading, post-test and evaluation times are estimates.

This course is designed to satisfy the quality requirements state boards set for continuing education. Requirements vary by state, and confirming that a course fits your renewal is up to you. Each state’s own acceptance statement is in the credit panel on this page.

1. This course is based on a single source: a systematic review and meta-analysis of randomized controlled trials comparing exercise and manual therapy (EMT) with corticosteroid injection in adults with subacromial pain syndrome (SAPS). The review followed PRISMA reporting guidance, was registered in PROSPERO before it began, searched PubMed, CINAHL, PEDro, ScienceDirect, the Cochrane Library, grey literature, and trial registries from inception to September 2023, rated trial quality with the PEDro scale, and graded certainty of evidence with GRADE.
2. Eight randomized controlled trials with 946 patients were included. Every claim, percentage, and conclusion in this course traces to that review. Where the review itself made a recommendation, this course reports it as the review's recommendation rather than as instruction to the learner.
3. Scope note
4. This course does not cover surgical management, frozen shoulder, post-traumatic shoulder pain, rotator cuff repair, shoulder instability, or shoulder osteoarthritis. Patients with those conditions were excluded from the trials in this review.