Combined subacromial-subdeltoid bursitis and supraspinatus tear following a COVID-19 vaccination: A case report

Abstract

Introduction: After a vaccine administration, many people have localized symptoms such as pain, redness, warmth, swelling, itching and/or bruising, which usually improve in a few days. If the clinical symptoms do not improve in this period, a shoulder injury related to vaccine administration (SIRVA) should be ruled out. The most common cause of a SIRVA is an improper injection technique. Herein, we reported the first case of combined subacromial-subdeltoid bursitis and supraspinatus tendon tear which was apparently caused by an improper COVID-19 vaccination technique.

Case presentation: A 51-year-old Thai female began to experience severe right shoulder pain about 3 hours after receiving a COVID-19 vaccination. Ultrasonography showed combined subacromial-subdeltoid bursitis and supraspinatus tendon tear. Her clinical symptoms gradually improved after treatment with an oral non-steroidal anti-inflammatory drug. Our investigation found that an improper injection technique had been used, namely inserting the needle too deeply, and using an incorrect landmark.

Conclusion: We report a case of combined subacromial-subdeltoid bursitis and supraspinatus tendon tear following a second dose of the Oxford-AstraZeneca COVID-19 vaccine. This is a rare condition which is usually related to an incorrect injection technique. To reduce the chance of SIRVA, the healthcare worker giving the injection should pay careful attention to find the appropriate landmark, and ensuring the correct needle length and direction of the injection.

Keywords: COVID-19; Injection; Pain; Shoulder; Vaccine.

Fig. 1

The landmark used for the COVID-19 vaccination in this patient.

Fig. 2

Initial radiographic images of the right shoulder in (A) anteroposterior, and (B) lateral transcapular views.

Fig. 3

With the right shoulder in the external rotation position, an ultrasonographic image over the lesser tuberosity and subscapularis in a long axis view showed a large amount of fluid in the subacromial-subdeltoid bursa in the anterior right shoulder. Hypoechoic subscapularis tendon was from anisotropy. (D; Deltoid muscle, Ssc; Subscapularis tendon and LT; Lessor tuberosity).

Fig. 4

With the right shoulder in the modified Crass position, an ultrasonographic image in a short axis view of supraspinatus tendon showed a large amount of fluid in the subdeltoid bursa with subjacent small full-thickness tear at the posterior fiber of supraspinatus.

Fig. 5

Comparing range of motion between right and left shoulders after conservative treatment (A) external rotation in arm at side, (B) forward flexion and (C) internal rotation.