Arm Pain Following Second Mrna Sars-cov-2 Vaccination - Page #1

Author: Justin Quinette, DO
Senior Editor: Marc Hilgers, MD, PhD, FAMSSM
Editor: Amanda Goodale, DO

Patient Presentation:
A 35-year-old left hand dominant female physical therapist presented to a sports medicine clinic with right arm and shoulder pain 7 days after receiving the second mRNA SARS-CoV-2 vaccination.

Approximately 12 hours after the mRNA SARS-CoV-2 vaccine was administered into the right upper arm, the patient developed significant pain and diffuse swelling extending from the right shoulder/axillary region to the mid-forearm. There was no other associated trauma, radicular symptoms or prior injury. She rated her pain as 3/10 at rest and 5-6/10 with activity. She tried ibuprofen, antihistamines and compression wraps at home which resulted in mild improvement of her symptoms. However, due to her continued pain and decreased range of motion, she sought further evaluation.

Physical Exam:
Inspection: Right upper extremity was noted to have diffuse swelling from the shoulder to mid-forearm.
Palpation: There was diffuse, nonfocal tenderness to palpation involving the biceps, triceps and deltoid regions. No palpable fluctuance was appreciated.
Range of motion: Active range of motion testing demonstrated right shoulder flexion 0-100, abduction 0-60, external rotation 45. Passive range of motion testing demonstrated right shoulder flexion of 0-120 and abduction 0-100.
Strength: 5/5 strength noted in bilateral upper extremities.
Neurovascular: Right upper extremity was neurovascularly intact including anterior interosseous nerve and posterior interosseous nerve testing. Bilateral upper extremity myotome and dermatome assessments were intact.

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