Age: 44.0
Sex: M
Vaccine: COVID19, FLU3, HEP
Symptoms: Arthralgia, Magnetic resonance imaging joint, Mobility decreased, Muscular weakness, Pain
Clinical narrative: During office visit exam: Patient presented with shoulder pain/weakness on 11/05/2024.                                                                                                 ? The patient presents today for evaluation of right shoulder pain and weakness that started approximately one week ago, shortly after receiving three vaccines (COVID (right side), flu, and HEP B (left side)). ? They report that when the vaccines were administered, particularly the one(s) in the right arm, it felt really deep and painful. ? Within a couple of hours after the vaccines, the patient noticed weakness in the right shoulder with any movement, especially upward motion. ? The next day, the symptoms worsened. ? Currently, a week later, the patient describes some improvement but still experiences significant weakness and pain with movements involving the right arm behind the back, such as pulling up pants or putting on a jacket. ? The patient also notes a dull ache at rest in the right shoulder area. ? While the left shoulder is also affected, with some weakness and limited range of motion, the symptoms are much more pronounced on the right side. ? The patient denies any recent trauma or injury to the shoulders. ? They have been doing regular weightlifting exercises but stopped after the onset of symptoms. ? The patient has not experienced this type of issue with previous vaccinations, which typically only caused soreness to the touch at the injection site. ? The patient is concerned that the vaccine may have been injected too deeply or in the wrong location, potentially causing damage based on their research. ? They deny any significant shoulder problems prior to the vaccines. ? Musculoskeletal: Weakness in shoulder. Pain with shoulder movement. Limited range of motion in shoulder. Ache in shoulder at rest. Soreness with back movement. Exam Right shoulder: - No atrophy, swelling, ecchymosis, or deformity - No tenderness over the AC joint, SC joint, scapula, acromion, proximal humerus, biceps tendon, or trapezius muscle - slightly reduced internal rotation - Impingement testing:POS Neer?s, negative Hawkin?s - Rotator cuff testing: negative empty can test - Labral stress: POS O?Brien?s test  Left shoulder: - No atrophy, swelling, ecchymosis, or deformity - No tenderness over the AC joint, SC joint, scapula, acromion, proximal humerus, biceps tendon, or trapezius muscle - slightly reduced range of motion on internal rotation - Impingement testing: negative Neer?s, negative Hawkin?s - Rotator cuff testing: negative empty can test - Labral stress: negative O?Brien?s test                                                                                                                                                                                            Assessment & Plan Concern for Shoulder Injury Related to Vaccine Administration (SIRVA), as this started right after vaccine administration. Cannot r/o other shoulder injury, but history points to SIRVA. Exam shows signs of tendonitis. Discussed options for imaging. Will order MRI as most senstive for this condition. Try naproxen daily, while awaiting imaging.