Thickening of the bursal walls is also noted (arrow). Ultrasound of the right shoulder ( e) demonstrates hypoechoic fluid accumulation within the subacromial-subdeltoid bursa (arrowheads) more than 3.0 mm. Supraspinatus tendinosis is seen with the signal-alteration (asterisk).
The ( b) coronal and ( c) sagittal T2-weighted fat-suppressed MR images, and the ( d) axial proton density-weighted axial image demonstrating the lateral to medial extension of fluid in the subacromial-subdeltoid bursa (arrowheads) with synovial hypertrophy (red arrows).
( a) Radiograph of the right shoulder in AP view shows soft tissue density of fat pad adjacent to the subacromial-subdeltoid bursa (arrow). Subacromial-subdeltoid bursitis on the right shoulder 8 weeks after the COVID-19 vaccination. The correlation with hypertrophic synovial tissue raised the hypothesis of an underlying inflammatory cause. The fluid-filled subacromial-subdeltoid bursa was greater than is commonly seen for overuse bursitis caused by mechanical stress. Shoulder MRI and ultrasound 8 weeks after vaccination supported a diagnosis of subacromial-subdeltoid bursitis and rotator cuff tendinopathy (Fig. Routine X-rays of the shoulder were performed and did not provide helpful diagnostic information (Fig. Gerber’s test was not performed due to pain complaints. Neer’s, Hawkins’, Yocum’s, and O’Brien’s tests were positive, while Jobe’s and Patte’s tests were negative. The active range of motion in the shoulder was limited with active painful arc (45° of abduction, 20° of extension, 45° of flexion). The strength of the rotator cuff muscles and the normal passive range of motion were preserved. Active and passive ranges of motion were evaluated through orthopedic maneuvers. Upon physical examination, there was mild swelling of the upper arm and localized shoulder tenderness around the top of the humeral head and deltoid. Initial treatment included ice pack, topical diclofenac cream, and a combination of caffeine, carisoprodol, sodium diclofenac, and paracetamol for 5 days from the vaccine injection.Įight weeks after the vaccination, the patient was still experiencing persistent pain in the right shoulder and reduced range of motion with inability to perform daily activities. Photograph of the patient receiving her first dose of the COVID-19 vaccine (Oxford-AstraZeneca, Serum Institute of India) in Brazil’s vaccination program into the upper third of the right deltoid muscle, which is considered higher than the recommended area (red circle) The large number of vaccine doses administered daily can lead to a significant increase in workload and rushed procedures, and as a consequence, the risk of inappropriately injected vaccines can also rise. Raising awareness of this underreported potential complication is crucial, as millions of people receive the injection with the ongoing roll-out of COVID-19 vaccination programs. To our knowledge, this is the first case reported of post-vaccination subacromial-subdeltoid bursitis after a COVID-19 vaccination due to the unintentional injection of vaccine solution into the bursa, resulting into a robust immune-mediated inflammatory reaction. However, potential adverse effects related to global COVID-19 vaccination still need to be further explored. In the past 2 years, much has been studied about the multi-systemic involvement of COVID-19. In this setting, bursitis, adhesive capsulitis, and glenohumeral synovitis may occur, with potential need for medical assistance due to severe prolonged pain and joint mobility restriction. The relationship between vaccine injection into synovial tissue and inflammation of the structures underlying the deltoid muscle has been well established. Although subacromial-subdeltoid bursitis is a common health problem with a prevalence of approximately 1% in the general US population, its occurrence within the context of SIRVA is still underreported in the literature. Cases of shoulder injury related to vaccine administration (SIRVA), defined as shoulder pain and limited range of motion occurring after the administration of a vaccine intended for intramuscular administration in the upper arm, have been reported in the medical literature, and influenza is the most frequently vaccine reported. Vaccination injection site adverse reactions are common, and symptoms are usually mild and transient, with pain, swelling, and redness at the site of injection being the most common clinical findings.