Disclosures: Jacob Boomgaardt, DO: No financial relationships or conflicts of interest

Case Diagnosis: 63 year old female presenting with neuralgic amyotrophy after receiving the second dose of her COVID-19 vaccine.

Case Description: Patient presented initially to orthopedic hand clinic with sudden-onset severe left shoulder and neck pain followed by left hand weakness. Symptoms began acutely less than two weeks after her second COVID-19 vaccine dose. Due to the persistence of motor symptoms she was referred for electrodiagnostic testing.

Setting: Academic Medical SettingAssessment/

Results: Nerve conduction studies were notable for reduced left median sensory nerve action potential amplitudes. Needle electromyography was notable for fibrillation potentials and enlarged, polyphasic motor unit action in the left abductor pollicis brevis, first dorsal interosseous, flexor pollicis longus, pronator teres, biceps brachii, deltoid, brachioradialis, and infraspinatus muscles. The patient’s findings were consistent with both a sub-acute left median neuropathy and left sub-acute left brachial plexopathy localizing to the upper trunk. Her electrodiagnostic findings in conjunction with her clinical history were consistent with neuralgic amyotrophy.

Discussion: Classic neuralgic amyotrophy can manifest as sudden onset severe pain in the shoulder or upper arm. Within hours to days, paresis can develop in the affected limb, often in a patchy distribution, most commonly in muscles innervated by the long thoracic, suprascapular, or anterior interosseous nerves. Less commonly, sensory symptoms can be present, most often paresthesias in the superficial radial or lateral antebrachial cutaneous nerve regions and/or a numb patch in the axillary nerve distribution. Notably, the pain is usually not in the same nerve territory distribution as the paresis or tingling.

Conclusion: Although vaccination is a recognized trigger for neuralgic amyotrophy, the incidence of post-vaccination neuralgic amyotrophy is rare. This is the second known case of NA after COVID-19 vaccination that we are aware of. It is important to recognize the clinical presentation of neuralgic amyotrophy and to consider associated etiologies which now include COVID-19 vaccine administration

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2021

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-case-of-neuralgic-amyotrophy-following-covid-19-vaccination/