key: cord-0927253-vrny72rh authors: Sahu, Dipit; Shetty, Gautam title: Frozen shoulder after COVID-19 vaccination date: 2022-03-18 journal: JSES Int DOI: 10.1016/j.jseint.2022.02.013 sha: 54e9433fbeabe61e6e61097a6b2fba79ec6e0c20 doc_id: 927253 cord_uid: vrny72rh AIMS: The data on frozen shoulder and shoulder injury related to vaccine administration (SIRVA) after COVID-19 vaccination are absent from the literature. Hence the purpose of this case series was to describe the clinical presentation and short-term follow-up of patients who developed frozen shoulder after COVID-19 vaccination. METHODS: In the present study, 10 patients (9 women and 1 man) with a mean age of 53±8 years (range, 43-68 years) who presented to the shoulder surgeon’s practice center with painful stiffness of the shoulder following COVID-19 vaccination between 1(st) June and 30(th) September 2021 were retrospectively evaluated. RESULTS: All 10 patients had normal radiographs and were diagnosed as frozen shoulder. Eight patients (80%) had a co-morbidity during presentation (4 patients with hypothyroidism, 3 patients with diabetes mellitus, and 1 patient with prediabetes/hyperglycemia). Symptoms developed immediately after the vaccination in 6 patients (60%), at 48 hours in one patient (10%), and at 10 days in 3 patients (30%). The mean pain visual analogue scale (VAS) score was 6.5±1.9 (range, 2.5-8), and both active and passive range of motion (ROM) were limited in all the patients at the time of presentation. CONCLUSION: The musculoskeletal specialists who will see such patients with painful shoulder stiffness should be aware of the frozen shoulder diagnosis, which can occur following COVID-19 vaccination so that such patients can be identified and treated early. The data on frozen shoulder and shoulder injury related to vaccine administration (SIRVA) after 5 COVID-19 vaccination are absent from the literature. Hence the purpose of this case series was 6 to describe the clinical presentation and short-term follow-up of patients who developed frozen 7 shoulder after COVID-19 vaccination. In the present study, 10 patients (9 women and 1 man) with a mean age of 53±8 years (range, 10 43-68 years) who presented to the shoulder surgeon's practice center with painful stiffness of the 11 shoulder following COVID-19 vaccination between 1 st June and 30 th September 2021 were 12 retrospectively evaluated. 13 All 10 patients had normal radiographs and were diagnosed as frozen shoulder. Eight patients 15 (80%) had a co-morbidity during presentation (4 patients with hypothyroidism, 3 patients with 16 diabetes mellitus, and 1 patient with prediabetes/hyperglycemia). Symptoms developed 17 immediately after the vaccination in 6 patients (60%), at 48 hours in one patient (10%), and at The musculoskeletal specialists who will see such patients with painful shoulder stiffness should 23 be aware of the frozen shoulder diagnosis, which can occur following COVID-19 vaccination so 24 that such patients can be identified and treated early. Data were analyzed using descriptive statistics such as mean ± standard deviation and range. Ten patients (9 women and 1 man) with a mean age of 53±8 years (range, 43-68 years) 84 developed painful shoulder stiffness following COVID-19 vaccination . All 10 patients had Eight patients (80%)had a co-morbidity during presentation (4 patients with hypothyroidism, 3 92 patients with diabetes mellitus, and 1 patient with prediabetes/hyperglycemia) ( Table. 1) . 93 Six patients (60%) had no symptoms in their affected shoulder, and 4 (40%) patients had mild, 94 intermittent shoulder pain before the vaccination (Table. 1 (Table. 2). Pain improved 90% and 70% in 2 patients, 106 who had undergone shoulder steroid injection. The majority of the patients with SIRVA seek treatment from musculoskeletal specialists. 21 Hence, a clinical description and data regarding shoulder injury after the COVID-19 vaccine is Complete recovery of ROM and pain in frozen shoulder may take more than 1 year; 10 earlier 173 reports on SIRVA after influenza vaccination have reported that recovery may continue for more 174 than 6-12 months. 1 Thus, we expect our patients to have a protracted course of recovery that may 175 last up to a year or even more. Our study suffers from certain limitations. The current study is a retrospective study on a small 177 number of patients. Currently, vaccination is the most effective strategy against COVID-19. Our 178 paper is reporting only a rare problem after the vaccine, and it is not meant to raise doubts about 179 the efficacy or overall usefulness of the vaccine. Frozen shoulder after COVID vaccination has not yet been reported and a longer follow-up is 181 not yet available. A larger study and a longer follow-up will be needed and is currently underway to accurately define the prognosis and significance of the frozen shoulder after vaccination. 183 However, by describing this hitherto unreported problem after COVID-19 vaccine, we hope that 184 frozen shoulder after vaccination can be identified and treated appropriately and timely. These side effects of COVID-19 vaccines, such as frozen shoulder, may likely be seen more J o u r n a l P r e -p r o o f Shoulder injury related to vaccine 197 administration (SIRVA) Combined subacromial-subdeltoid bursitis and 200 supraspinatus tear following a COVID-19 vaccination : A case report Immunological studies in frozen shoulder Immunological studies in frozen 205 shoulder Shoulder Injury after Vaccination: A Systematic Review Subacromial-subdeltoid bursitis 209 following COVID-19 vaccination: a case of shoulder injury related to vaccine 210 administration (SIRVA). Skeletal Radiol Shoulder 213 injury related to Sinovac COVID-19 vaccine: A case report Post-vaccination frozen shoulder syndrome. report of 3 cases Covid-19) vaccines structure, mechanisms and effectiveness: A review Long-term outcome of frozen shoulder The pathology of frozen shoulder Coronavirus 228 Pandemic (COVID-19) Related to Vaccine Administration (SIRVA): Petitioner claims to the National Vaccine 231 Shoulder Stiffness: 234 Current Concepts and Concerns. Arthrosc. -J. Arthrosc. Relat. Surg Inadvertent injection of COVID-19 vaccine into deltoid muscle vasculature 237 may result in vaccine distribution to distance tissues and consequent adverse reactions Ministry of Health and Family Welfare; Government of India. Indian COVID-19 vaccine 241 tracker Management of adults with primary frozen shoulder in secondary care (UK FROST): a 244 multicentre, pragmatic, three-arm, superiority randomised clinical trial Telehealth for consultation and shoulder 247 rehabilitation: a preliminary study on the perspectives of 30 patients during the COVID-19 Shoulder Elb Estimating the early impact of vaccination against COVID-19 on deaths among elderly 251 people in Brazil: Analyses of routinely-collected data on vaccine coverage and mortality Risk factors in 254 idiopathic adhesive capsulitis: A case control study Shoulder Injury Related to Vaccine Administration This research observational study was conducted retrospectively from data obtained for clinical purposes. The hospital local Research Ethics Committee decided that no ethical approval is required.