Winged scapula caused by Parsonage-Turner syndrome after BNT162b2 mRNA COVID-19 vaccination

Abstract

A 45-year-old Japanese woman presented with difficulty moving her left shoulder. Ten months previously, the day after she had received her second dose of the BNT162b2 mRNA COVID-19 vaccine, a severe stabbing pain occurred in her entire left upper extremity. The pain resolved within 2 weeks, although she developed difficulty moving her left shoulder. A left winged scapula was observed. Electromyography showed left upper brachial plexopathy with acute axonal involvement and abundant acute denervation potentials, consistent with Parsonage-Turner syndrome (PTS). PTS should be considered in patients with post-neuralgic motor paralysis of the unilateral upper extremity, which can occur after COVID-19 vaccination.

Parsonage–Turner Syndrome following COVID-19 Vaccination: A Systematic Review

“…This systematic review included 30 articles [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ] and 10 meeting abstracts [ 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ] reporting on 59 cases. Among them, 36 (61.0%) patients received a mRNA vaccine (24 with BNT162b2, Pfizer, 10 with mRNA-1273, Moderna) [ 22 , 24 , 25 , 26 , 27 , 29 , 30 , 34 , 36 , 37 , 38 , 39 , 40 , 41 , …”

“…The outcome of PTS was unclear in three (8.3%) individuals in the mRNA group and six (33.3%) in the viral vector vaccines group. In patients receiving mRNA vaccines, one had a complete remission of symptoms by week 3 [ 39 ], two cases had a full recovery after 2 months [ 47 , 48 ], and one was reported to regain full range of motion and strength as well as axillary nerve sensitivity at 1 year [ 45 ]. The clinical examination was found to be improved in twenty-eight (84.8%) patients, and one (3%) individual had no residual pain but increased weakness at the 3-month follow-up [ 41 ].…”

“…Among them, 36 (61.0%) patients received a mRNA vaccine (24 with BNT162b2, Pfizer, 10 with mRNA-1273, Moderna) [22,[24][25][26][27]29,30,34,[36][37][38][39][40][41][45][46][47][48]50,51,53,56,60] and 18 (30.5%) received a viral vector vaccine (15 with AstraZeneca, 2 This systematic review included 30 articles and 10 meeting abstracts [52][53][54][55][56][57][58][59][60][61] reporting on 59 cases. Among them, 36 (61.0%) patients received a mRNA vaccine (24 with BNT162b2, Pfizer, 10 with mRNA-1273, Moderna) [22,[24][25][26][27]29,30,34,[36][37][38][39][40][41][45]…”

“…In one case, the pain resolved, but the patient continued to present hand weakness at a three-month follow-up [ 50 ]. Resolution of symptoms within two months after rehabilitation was reported in one patient [ 47 ]. However, in another case, receiving physical therapy and electric stimulation, muscle weakness persisted over four months [ 50 ].…”