Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Peripheral swelling, Renal impairment, Rotator cuff syndrome, Ultrasound scan normal, X-ray limb abnormal
Clinical narrative: Reported Symptoms:  10003246:ARTHRITIS;  Narrative:  Other Relevant HX:  Per chart review:  10/21/21 (Primary Care RN Note):  "Pt left Care Team VM his right arm was sore post Covid booster 10/7/21.  Pt called back and denied warmth, redness at R arm covid injection site.  Describes local tenderness R arm at injection site and will monitor." 11/10/21 (PCP visit):  "72 year old male with a PMH of HTN, CAD, BRADYCARDIA, TIA, PACEMAKER, LOW BACK PAIN, MIGRAINES, LUNG NODULES who presents today with complaints of RIGHT ARM PAIN FOLLOWING A COVID BOOSTER SHOT GIVEN ON 10/7/21.  THE ARM ACHES ALL THE TIME AND IS HAVING DIFFICULTY WITH ELEVATION ABOVE THE HEAD. PHYSICAL EXAM MUSCULOSKELETAL:  RIGHT BICEP PAIN ON PALPITATION ASSESSMENT AND PLAN RIGHT BICEP PAIN:  SYMPTOMATIC LIKELY NOT RELATED TO COVID VACCINE MUSCLE KNOT NOTED ON EXAM - RECOMMEND GENTLE MASSAGE, ICE, IBUPROFEN 400 MG Q6 HOURS ALTERNATING WITH TLENOL 500 MG Q4 2/2 DECREASE KIDNEY FUNCTION IF NO IMPROVEMENT OR IF SYMPTOMS WORSENING WILL CONSIDER FURTHER TESTING 02/07/2022:  "Pt called back with update:  'My R arm pain persists since Covid vaccine 10/7/22. Decreased ROM and constant R arm pain at level 7. Asking about any imaging for this?"  02/07/2022 ADDENDUM STATUS:  COMPLETED CARE TEAM RN - PLEASE CALL PATIENT. I WILL PLACE CC CONSULT FOR ULTRASOUND RIGHT BICEPT FOR FURTHER EVALUATION OF PAIN.  02/24/2022 ADDEDUM STATUS:  COMPLETED Pt called Care Teams " I need a MRI of my R arm, pain is constant, level 7 in tricep and R shoulder since covid shot in October 2021" Pt has normal ROM. Pt had community U/S done 2/18/22 and tech told him no tear. He would need a MRI done and to see if any nerve damage.  2/25/22:  US RUE ON  2/18/22 NEGATIVE/NORMAL  6/30/22: EMG Study Note: "HISTORY Reason for consultation: 73 y/o MALE presenting with a chief complaint of RUE pain  HPI: Onset: Nov '21 after receiving COVID-19 booster in R deltoid Location: R shoulder girdle Radiation: no Quality: sore/achy/stiff to sharp, throbbing Severity: moderate-severe Exacerbated with: overhead and behind-back reaching Alleviated with: rest, GHJ cortisone shot performed outside facility (helpful) Numbness/tingling: no Weakness: no Other: no Impression: 1. This is a NORMAL study. 2.  There is no electrodiagnostic evidence for C5-T1 radiculopathy, brachial plexopathy, myopathy, or peripheral neuropathy in the RIGHT upper limb. 3. Clinically, he presents as having resolving subacromial bursitis with subacromial shoulder impingement syndrome following his COVID-19 vaccination.  DDx includes (now resolved, as AROM is not restricted) adhesive capsulitis given  good response to GHJ injection.  He may continue to improve with expectant care,  or else could consider a short course of physical therapy for a shoulder stabilization program." 12/16/22 (PCP Video Visit): "73 M with history of TIA, Afib, CAD spMI and DES x2, lumbago, who had swelling  of the arm and shoulder pain with limited ROM after a covid vaccine one year  ago. his Xrays shows mild AC and GH OA.  EMG was WNL, an opinion from PMnR was acute subacromial bursitis and impingement syndrome following vaccine, with some degree of froen shoulder he did recieved a steroid injection which helped his sxs. adn they have since