Sex: F
Vaccine: FLUX
Symptoms: Adhesion, Arthralgia, Bursa removal, Bursal fluid accumulation, Bursitis
Clinical narrative: Biceps tenosynovitis; Right shoulder pain/ pain with shoulder movement; Aching, throbbing, and numbness of her hand; Aching, throbbing, and numbness of her hand; tenderness over the bicipital grove; hypoechoic fluid collection in the region just lateral to the bicipital groove between the biceps tendon and the deltoid; Inflammatory synechiae; mechanical impingement; subacromial bursitis; ruptured biceps tendon; vaccine had been administered in a more medial and superior location on her arm than usual; This case was reported in a literature article and described the occurrence of bicipital tenosynovitis in a 53-year-old female patient who received Flu unspecified (Influenza vaccine) for prophylaxis.    On an unknown date, the patient received Influenza vaccine. On an unknown date, less than 2 weeks after receiving Influenza vaccine, the patient experienced bicipital tenosynovitis (serious criteria GSK medically significant), shoulder pain, pain in hand, numbness in hand, tenderness, bursal fluid accumulation, adhesion, impingement syndrome shoulder, subacromial bursitis, biceps tendon rupture and vaccine administered at inappropriate site. The patient was treated with steroids nos (Oral Steroid (Brand Unknown)) and non-drug therapy (Physical Therapy). On an unknown date, the outcome of the bicipital tenosynovitis, shoulder pain, pain in hand, numbness in hand, tenderness, bursal fluid accumulation, adhesion, impingement syndrome shoulder, subacromial bursitis, biceps tendon rupture and vaccine administered at inappropriate site were unknown.   The reporter considered the bicipital tenosynovitis, shoulder pain, pain in hand, numbness in hand, tenderness, bursal fluid accumulation, adhesion, impingement syndrome shoulder, subacromial bursitis and biceps tendon rupture to be related to Influenza vaccine.  Additional information was provided as follows: This case was reported in a literature article and described the occurrence of biceps tenosynovitis in a 53-year old female patient, who was vaccinated with unspecified influenza vaccine (manufacturer unknown) for prophylaxis. No information on patient's medical history, family history, concurrent condition or concomitant medication was provided. On an unspecified date, the patient received unspecified influenza vaccine (administration route and site unspecified, dosage unknown; batch number not provided). The age of vaccination was not provided. On an unspecified date, 2 (two) weeks following the vaccination, the patient presented with right shoulder pain. The patient remarked that the vaccine had been administered in a more medial and superior location on her arm than usual. Since administration, the patient had aching, throbbing, and numbness of her hand as well as pain with shoulder movement. An oral steroid provided no relief. Physical exam of the right shoulder demonstrated tenderness over the bicipital grove. There was normal active/passive range of motion without effusion, crepitus, or deformity. Hawkins, Neer, and empty can tests were positive. Sonographic evaluation revealed a hypoechoic fluid collection in the region just lateral to the bicipital groove between the biceps tendon and the deltoid with a 2 mm hyperechoic foci consistent with a retained needle tip versus inflammatory synechiae. The patient was referred to orthopedic surgery. Surgical exploration revealed a ruptured biceps tendon that had healed to the anterior capsule resulting in mechanical impingement as well as subacromial bursitis. A tenotomy and bursectomy were performed to improve function and the patient was currently in physical therapy. The authors commented, "Biceps tenosynovitis induced by inadvertent vaccine administration into the sheath of the biceps tendon. Proper administration of a vaccine calls for an intramuscular administration; the deltoid is a common target. Shoulder injury related to vaccine administration (SIRVA) can result from tissue damage sustained from improper injection. Ultrasonographic evaluation can localize the afflicted area, in this case, the biceps tendon showed findings consistent with tenosynovitis. This allows for surgical referral in order to correct the underling deficit." The authors concluded, "Biceps tenosynovitis can result from improper administration of vaccine. Diagnosis can be made with ultrasonography prompting surgical referral if necessary. Given the largest ongoing vaccination campaign in human history, physiatrists should be aware of the differential diagnosis of shoulder pain post-vaccination."