Table 2 PTS following COVID-19 vaccination, literature review
Author | Method | Condition | Findings | Intervention | Conclusion |
|---|---|---|---|---|---|
1-Vitturi et al 2021 [44] | Case report and review of the literature | Age: 51 Sex: M Lesion: - Lt UE increasing pain around region of vaccination (first dose of the ChAdOx1-S recombinant vaccine- Vaxzevria, AstraZeneca, Oxford, UK) - 1 m after vaccination: hypoesthesia, abduction and elevation limitation | Clinical examination: - UE proximal muscles atrophy - Deltoid, BB, TB, and infraspinatus muscles paresis EMG (3 months after the onset): - Brachial plexus neuritis - Peripheral neurological damage: Mild to moderate - Some reinnervation: in deltoid, BB, TB, infraspinatus, EPL & EPB, and first interosseous muscles - Lt axillary nerve action potential: ↓Amplitude Diagnosis: PTS | Self-medicate: Paracetamol, NSAIS and Pregabalin Care unit medicate: NSAID, Pregabalin, and PT | Five months later: Partial recovery, slight local muscle weakness *PTS could be an uncommon side effect of the COVID-19 vaccination *This case study demonstrates how crucial it is to be more aware of this link in order to identify and diagnose patients early on and improve therapeutic outcomes |
2-Amjad et al 2021 [63] | Case Report and Literature Review | Age: 78 Sex: M Lesion: - Bilateral hand weakness (more in Rt) - History of Pfizer/BioNTech (BNT162b2) COVID-19 vaccine injection, second dose (three weeks before weakness) - History of coronary artery disease | Clinical examination: - ↓Rt-hand grip and wrist flexion strength Laboratory analysis: - NL Brain, cervical spine, and thoracic spine MRI: - NL NCS: - Lt: Brachial plexopathy (lower trunk) - Bilateral median neuropathies at the wrist, - Bilateral ulnar sensory neuropathy EMG: - Bilateral first dorsal interosseous, Rt deltoid, biceps, and triceps muscles: ↓Motor unit recruitment | Prednisone (oral, 40 mg/day) Occupational therapy | ↓↓↓Pain Weakness: Slight recovery Recommendation: Physicians should be able to take quick action when the number of PTS patients increases with the implementation of a thorough COVID-19 vaccination campaign. With a good prognosis, this usually goes away on its own |
3-Chua et al 2022 [17] | Case Report and Literature Review | Age: 64 Sex: M Lesion: - Lt shoulder girdle pain and weakness - History of second COVID-19 vaccine (mRNA-1273; ModernaTX, Inc.; Cambridge, Massachusetts) dose injection )Before the onset of pain( - Be worse 2 weeks later - Lt fourth and fifth digits: Sensory loss with paresthesia and hypoesthesia, as well as on the ulnar aspect of the forearm - History of hypertension and hyperlipidemia | Clinical examination: - Lt finger extensors: ↓Strength in the - Sensation: “Was impaired to light touch distally in the Lt fourth and fifth digits and to a lesser extent in the third digit” EMG: - Lt ulnar SNAP, Lt ulnar-AbdDM CMAPs: ↓Amplitude - Lt EI and flexor digitorum profundus to digit IV: ↓Recruitment pattern, ↑ Lt FDI Spontaneous activity MRI: - ↑Short-TI inversion recovery (STIR) signal - ↑ T2-weighted signal, with mild T1 post contrast enhancement of the medial Lt scalene muscles along the inferior brachial plexus (inflammatory changes and intramuscular edema) Diagnosis: - “Mild, patchy, and acute-to-subacute lower trunk brachial plexopathy” | Prednisone (80 mg/day, Up to 3 days, Followed by a rapid taper of 20 mg decrease per day to off) | One month later: ↑Finger sensation and strength Four months later: Near complete improvement Recommendation: To have a better knowledge of PTS's pathophysiology, more research on the condition following COVID vaccination is necessary This is critical because following a COVID-19 immunization, temporary shoulder pain is not uncommon. If a subject experiences shoulder pain in addition to weakening or changes in sensation in their affected extremity, PTS should be considered a possibility |
4-Shields et al 2022 [42] | Case Series Clinical and EMG Findings in 6 Patients | Lesion: - Shoulder pain and weakness (5 ipsilateral side to the injection site and 1 contralateral side 2 after 1st dose of the vaccine and 4 after the 2nd vaccine dose) Vaccination history: - 4 subjects: Pfizer-BioNTech COVID-19 vaccine - 2 subjects: Moderna COVID-19 vaccine prior to symptom onset (Mean duration: 17 days, range: 5 days–8 weeks) | EMG: - 3 subjects: Upper trunk/lower trunk involvement - 1 subjects: Posterior cord - 1 subjects: AIN - 1 patient: PIN Cervical MRI in 5 subjects: - NL - Subject #1, brachial plexus MRI: No abnormalities of the brachial plexus Diagnosis: PTS | Prednisone/prednisolone in, gabapentin 4 subjects: PT | Pain in all 6 subjects: Improvement or near complete treatment Arm/hand muscle strength: 3 subjects no improvement, 3 subjects with some recovery Recommendation: Although total healing may not always happen, the best results are provided by early detection of this ailment and treatment with corticosteroids and PT |