560 - Case Report: Adhesive Capsulitis following improper Tetanus, Diphtheria (Td) booster administration

Case Diagnosis: Adhesive Capsulitis

Case Description: A 51-year-old female with no pertinent past medical history presented with persistent left anterior shoulder pain for four months. The pain began the day following Td (Tetanus, Diphtheria) booster vaccination. She described receiving the injection “rather high up” in the shoulder. Pain was exacerbated with overhead activities 24 hours following administration. Over two weeks, her pain worsened along with stiffness, significantly limiting shoulder range-of-motion. Her symptoms continued for two months. Shen then visited Urgent Care who prescribed oral prednisone without relief. On examination, the patient could passively range her left shoulder to 100 degrees of abduction, 110 degrees of flexion, and 20 degrees of external rotation. Internal rotation limited by pain. Range-of-motion was full in the right shoulder. Strength and sensation were intact. Shoulder X-Ray revealed minimal degenerative changes of the left glenohumeral joint. Based on the findings, the patient was diagnosed with Adhesive Capsulitis and referred to physical therapy.

Discussions: Shoulder Injury Related to Vaccination Administration (SIRVA) is a rare complication of improper vaccination administration. The most common presentation is transient musculoskeletal pain, followed by subacromial bursitis and adhesive capsulitis. To date, no case of Adhesive Capsulitis has been reported following Td vaccination. Given the rarity of SIRVA, the patient went undiagnosed for months, leading to significant impairment in the patient’s daily function. Loss of shoulder range-of-motion following vaccination is concerning for adhesive capsulitis or other SIRVA pathology. Earlier diagnosis and intervention could have reduced the patient‘s symptoms and improved functional range-of-motion.

Conclusions: This case highlights the importance of clinicians' awareness of SIRVA, proper vaccination technique and the benefits of early diagnosis in guiding downstream interventions.