Age: 50.0
Sex: F
Vaccine: FLU4
Symptoms: Activities of daily living impaired, C-reactive protein normal, Differential white blood cell count normal, Full blood count normal, Headache
Clinical narrative: Even as it was administered, this year's flu shot was unusually painful to me. At the time, I thought that perhaps the pain I felt was still within the normal range and may have been caused by the particular combination of chemicals in this year's vaccine. After I received the flu shot, I headed back to work. Within 3-4 hours, I was in extreme pain whenever I tried to use my left arm. I remember audibly gasping in pain multiple times when I unthinkingly moved my left arm while meeting with my undergraduate research assistant that afternoon.  The pain continued, and I continued to brush it off as just an inconvenience that will surely go away soon. My first suspicion that something might be wrong was when my husband, son, and mother-in-law, all of whom received the flu shot a few days after I did, were, unlike me, all feeling fine and reporting no pain. It also gave me pause when my daughter, who had received the flu shot a few days before I did and had mentioned a sore arm afterwards, was astonished at the level of pain I was feeling even several days after receiving the shot. A week after I had received the flu shot, the pain was still there and even getting worse instead of better. At that point I decided that this cannot be within the normal range. I called the ask-a-nurse hotline to learn what I should be doing or not doing to help my arm start to heal. I was not sure if I should put ice packs or hot pads on my arm, and I was not sure if it would be better to try to move it despite the pain or to avoid moving it. The nurse advised me to contact my physician. I immediately called my internist's office asking for advice. They called me back later and advised me to take pain killers and to call them again after two weeks if the pain still persisted by then. I soon discovered that I could not wait that long. The pain became debilitating, and I became scared that I might suffer a permanent loss of functioning in my arm.  A couple of days after calling my internist, I asked my husband to call a friend who is a physician for further advice. He suggested that I see an orthopedist. The next morning, I went into the walk-in orthopedics clinic and saw an orthopedist. He prescribed Celebrex, a strong anti-inflammatory medication for 1-2 months maximum because of concerns about my liver functioning, given that I am already on another medication (Methimazole for Graves' disease) that could damage my liver. Celebrex helped with the pain, but I could not take it for more than a month because it gave me headaches so severe that they caused me to wake up in pain. Sometimes the headaches caused me to have to leave work and seek rest in bed in a dark room in the middle of the day. These headaches were worrisome to me because, normally, I rarely have headaches at all. When I stopped taking Celebrex, the headaches stopped, but the pain in my left shoulder returned the very next day and was worse than ever. Shortly after I stopped taking Celebrex, I saw my internist for an annual exam. I mentioned to her that I was really worried about the worsening pain in my shoulder. Because of the pain, I was unable to sleep through the night, had to enlist my husband for help in dressing myself and was even struggling to drive. These disruptions to my life were making me wonder if I should just go back to taking the Celebrex despite the headaches it gave me. She examined me and determined that I probably had a rotator cuff injury. She recommended that I see a physical therapist and switch back to over-the counter pain killers. I immediately scheduled sessions with a physical therapist. The first couple of sessions were fine, but after the fourth visit, the pain in my shoulder was worse. When I again found that I was in more pain after my fifth visit, I visited the orthopedist for another appointment. He advised me to stop the physical therapy since it had not helped and to have an MRI to find out what was going on. The MRI results showed edema in the humeral head and surrounding soft tissue, including the teres minor, which most likely resulted from direct trauma. Based on these results, my orthopedist advised me to try steroids. He explained that they would help with the inflamed tissue, but not with the inflamed bone, which could take many months to heal. I opted to receive doses of the Dexamethasone steroid via Iantopheresis patches, as I could not bear the thought of having any more shots in my left arm. After three doses I felt a decrease in the pain, but now, only two weeks after the third dose, the pain is coming back. I wake up several times a night due to subtle movements I make in my sleep that aggravate my pain. I feel the pain slowly getting worse every day. This injury is causing me a lot of distress and is disrupting my life significantly. I am at a loss for what to do. My physical therapist had indicated that, at a maximum, I could only receive one more dose of the steroid Dexamethasone if I need it, but no more.  I want to do everything I can to avoid the need for surgery. With medications and physical therapy both being ultimately ineffective, I just don't know what else can be done. I am very worried about the potential that I may never find relief from the disruptive impacts this shoulder injury has had on my life. I will be scheduling another appointment with my orthopedist soon in order to explore what my options are at this point. In addition, after coming across an article in a radiology journal in which the authors describe cases very similar to mine that ended up with an erosion in the humerus head and/or atrophy in the surrounding tissue, I have requested a referral to a shoulder specialist for a second opinion about the best course of action. I hope to hear back from them soon.