Disclosures: Evan R. Zeldin, MD: No financial relationships or conflicts of interest

Case Diagnosis: Biceps tenosynovitis induced by inadvertent vaccine administration into the sheath of the biceps tendon

Case Description: A 53-year-old female presented two weeks following administration of the influenza vaccination with right shoulder pain. She remarked that the vaccine had been administered in a more medial and superior location on her arm than usual. Since administration, the patient had aching, throbbing, and numbness of her hand as well as pain with shoulder movement. An oral steroid provided no relief.

Setting: Outpatient musculoskeletal ultrasound clinicAssessment/

Results: Physical exam of the right shoulder demonstrated tenderness over the bicipital grove. There was normal active/passive range of motion without effusion, crepitus, or deformity. Hawkins, Neer, and empty can tests were positive. Sonographic evaluation revealed a hypoechoic fluid collection in the region just lateral to the bicipital groove between the biceps tendon and the deltoid with a 2mm hyperechoic foci consistent with a retained needle tip versus inflammatory synechiae. The patient was referred to orthopedic surgery. Surgical exploration revealed a ruptured biceps tendon that had healed to the anterior capsule resulting in mechanical impingement as well as subacromial bursitis. A tenotomy and bursectomy were performed to improve function and the patient is currently in physical therapy.

Discussion: Proper administration of a vaccine calls for an intramuscular administration; the deltoid is a common target. Shoulder injury related to vaccine administration (SIRVA) can result from tissue damage sustained from improper injection. Ultrasonographic evaluation can localize the afflicted area, in this case, the biceps tendon showed findings consistent with tenosynovitis. This allows for surgical referral in order to correct the underling deficit.

Conclusion: Biceps tenosynovitis can result from improper administration of vaccine. Diagnosis can be made with ultrasonography prompting surgical referral if necessary. Given the largest ongoing vaccination campaign in human history, physiatrists should be aware of the differential diagnosis of shoulder pain post-vaccination.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/vaccination-gone-awry-a-case-of-biceps-tenosynovitis-diagnosed-via-ultrasonography-from-inadvertent-injection-of-the-biceps-tendon-a-case-series/