Disclosures: Richard A. Rosales, MD: No financial relationships or conflicts of interest

Case Description: A patient was evaluated for chronic left shoulder pain. After a thorough history, it was discovered the pain began after a shingles vaccination one year prior.

Setting: Outpatient musculoskeletal clinic of an academic tertiary care hospital

Patient: A 62 year old patient with a history of diabetes and one year of left shoulder pain that began two days after receiving a shingles vaccine. She localized the pain to the posterolateral shoulder, exacerbated by extension and overhead activities. There were no alleviating factors, and no associated weakness. Assessment/

Results: Physical exam was notable for normal range of motion and strength. Special testing revealed a positive Neer’s, Empty Can, and Lift-off, and equivocal Hawkins. X-ray unremarkable. Diagnostic ultrasound (US) was performed in clinic and revealed subdeltoid and subcoracoid bursitis. She was prescribed physical therapy consisting of gentle strengthening and range of motion exercises, and Meloxicam, but at 3 week follow up this provided no relief. Next, an US-guided sub-acromial steroid injection was performed. This time, at three week follow up, patient reported 90% symptomatic relief.

Discussion: There have been a few case reports in the literature regarding chronic shoulder pain. Oftentimes it is associated with administration of the vaccine in a location more superior than recommended guidelines. Conservative management may work in some patients, but often they require intervention to relieve symptoms. As with any procedure, patients should be educated on the risks of vaccine administration, including chronic pain, as this could facilitate seeking treatment should it occur.

Conclusion: Shoulder pain is a common complaint in the PM&R outpatient clinic. Chronic shoulder pain is a rare sequela of vaccine administration, and can be determined by careful history-taking. Treatment options include NSAIDs, physical therapy, and steroid injection.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-disarming-vaccination-a-case-report/