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Case Reports
. 2023;11(2):140-143.
doi: 10.22038/ABJS.2022.67994.3243.

Spontaneous Avascular Necrosis of the Humeral Head Following COVID-19 Vaccination

Abdulrahman Kashkosh  1 , Christopher M Peake  2 , A Ali Narvani  2 , M A Imam  2
Affiliations
Case Reports

Spontaneous Avascular Necrosis of the Humeral Head Following COVID-19 Vaccination

Abdulrahman Kashkosh et al. Arch Bone Jt Surg. 2023.

Abstract

We report a case of a 40-year-old man who presented with left shoulder pain and marked functional impairment two days after receiving the second dose of the Pfizer COVID-19 vaccine. Advanced imaging demonstrated focal avascular necrosis (AVN) of his humeral head. Initial management included simple analgesics, activity modification, and an ultrasound-guided intra-articular hydrodilatation injection. The patient subsequently had an improved range of motion but persistent severe shoulder pain. He has now been offered surgical intervention. Despite having risk factors for developing AVN previously, the patient did not demonstrate any recent risk factors for developing the disease. COVID-19 vaccination is known to cause severe joint pain and stiffness rarely. However, avascular necrosis is not a known or documented side effect. His symptoms arose directly after the administration of the vaccine, with no other demonstrable cause. Therefore, we are reporting COVID-19 vaccination as a potential new risk factor for AVN of the humeral head.

Keywords: Avascular necrosis; COVID-19 vaccine; Hypercaogubility; Orthopaedics; Shoulder.

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Figures

Figure 1
Figure 1
Plain radiographs of the left shoulder, AP (Left) and Trans -axillary views (Right). Subchondral lucency and periarticular sclerosis can be seen as suggestive of AVN
Figure 2
Figure 2
CT body scan (Bone windows) taken 3 months prior to the onset of symptoms. This includes the left humeral head and demonstrates no obvious signs of AVN at the time of the scan. From left to right; Sagittal slice, Axial slice, Coronal Slice
Figure 3
Figure 3
MRI Scan of the left shoulder showing subchondral sclerosis and fracture with bone marrow oedema extending to the proximal humeral shaft. These findings are in keeping with AVN. From left to right; Coronal T1 weighted slice, Coronal T2 weighted slice, Axial proton density fat saturation image
See this image and copyright information in PMC

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