Disclosures: Matthew A. Cascio, DO: No financial relationships or conflicts of interest

Case Diagnosis: Parsonage Turner Syndrome following COVID-19 Vaccination

Case Description or Program Description: A 35-year-old female, with history of left humerus osteosarcoma s/p resection with hemiarthroplasty at age 15, presented with left shoulder pain one day after receiving the first COVID-19 Moderna vaccine dose in her right deltoid. She initially presented to the emergency room, where radiographs showed no acute pathology. Two days later, she visited an outpatient orthopedist with persistent pain, and was prescribed a medrol dosepak, Percocet, and cyclobenzaprine, with left shoulder radiographs again unremarkable. She presented to our outpatient sports medicine clinic after failing prior treatments. Physical examination demonstrated tenderness to palpation throughout her left shoulder, with left upper extremity weakness. Bloodwork revealed mild leukocytosis (10.68) and thrombocytopenia (451). Left shoulder CT was unremarkable, and blood cultures were negative.

Setting: Outpatient sports medicine clinic

Assessment/Results: Parsonage-Turner syndrome (PTS) was suspected, and she was prescribed a Prednisone taper and Gabapentin. Her pain and weakness improved over a 1-month span.

Discussion (relevance): PTS, commonly referred to as Neuralgic amyotrophy, is an inflammatory, non-traumatic, brachial plexus disorder. PTS is hypothesized to be an immune process, with patients describing events including infection, surgery, or vaccination preceding onset. PTS presents classically with upper extremity pain, followed by weakness throughout the unilateral upper/middle brachial plexus. Diagnosis is primarily clinical, but can be supported by electrodiagnostic testing demonstrating denervation. Treatment often includes glucocorticoids, with most patients slowly regaining full function.

Conclusions: There have thus far been a select few PTS cases following COVID-19 vaccination. It is unclear the role that our patient’s prior left humeral hemiarthroplasty played in her PTS development, however its presence makes this case increasingly interesting. As patients continue to receive vaccine boosters in the fight against the COVID-19 pandemic, it is important to keep the diagnosis of PTS in mind for patients with pain and weakness following vaccination.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/more-than-a-sore-shoulder-post-covid-shot-a-case-of-parsonage-turner-syndrome-following-covid-19-vaccination/