Disclosures: Laura Pilgram, MD: No financial relationships or conflicts of interest

Case Diagnosis: A patient presenting with L shoulder pain and weakness after initial COVID-19 vaccination is found to have Parsonage-Turner syndrome (PTS).

Case Description: The patient presented to musculoskeletal clinic 1 month after onset of severe left shoulder pain and weakness. Symptoms started without trauma or inciting event. Pain lasted for 2 weeks, but he had persistent weakness. He did report having his first dose of COVID-19 vaccine 10 days prior. On examination, he was noted to have 4/5 in left shoulder abduction and 3/5 external rotation strength, with left infraspinous fossa atrophy and scapular dyskinesis. Electrodiagnostic evaluation 2 months after symptom onset revealed mononeuritis multiplex involving the suprascapular and anterior interosseous nerve with abnormal spontaneous activity and polyphasic units in the supraspinatus and infraspinatus, and polyphasic units in flexor pollicis longus.

Setting: Rehabilitation Hospital, outpatient clinicAssessment/

Results: The clinical presentation and electrodiagnostic findings were consistent with a diagnosis of Parsonage-Turner syndrome (PTS). Given timing relative to vaccination, this was reported to FDA MedWatch for further investigation. Two months after onset, the patient has no pain, but has residual left shoulder abduction and external rotation weakness, improved from initial evaluation

Discussion: This is the first case to our knowledge of PTS after COVID-19 vaccination. Although the precise pathogenesis of PTS remains unclear, it frequently involves an autoimmune trigger, such as infection or immunization, with cases reported after influenza and tetanus diphtheria-pertussis vaccination. During mRNA vaccination trials, autoimmune neurologic events were uncommon. In contrast, many neurologic sequelae including PTS, neuropathies, plexopathies, and strokes have been reported in association with COVID-19 infection.

Conclusion: It is important to remain vigilant for potential neurologic and other complications after both COVID-19 and COVID-19 vaccination. The data continues to show that the risks of COVID-19 infection greatly exceed those of the vaccine, which is effective with an overall low rate of side effects.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2021

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/parsonage-turner-syndrome-after-covid-19-vaccination-a-case-report/