Wrist Extensor Tenosynovitis After COVID-19 Vaccination

We present the case of a 54-year-old right-handed woman with no medical history rheumatic disease or trauma to upper extremities who developed painful nodules along her left extremity and torso immediately after receiving mRNA-1273 SARS-CoV-2 vaccine booster for COVID-19 in extremity. Most subsided within several days, but persisted over dorsum wrist physical examination imaging findings consistent second fourth extensor compartment tenosynovitis. She ultimately underwent excision tenosynovitis, followed by repeat recurrence symptoms. Adverse effects vaccines have been well-documented literature.1Beatty A.L. Peyser N.D. Butcher X.E. et al.Analysis covid-19 type adverse following vaccination.JAMA Netw Open. 2021; 4e2140364Crossref Scopus (157) Google Scholar Reporting less common side secondary administration has increased. Arthritic inflammatory reactions well-documented, most cases typically treated conservatively non-steroidal anti-inflammatory medication without glucocorticoids.2Choi Y.K. Moon J.Y. Kim J. al.Postvaccination multisystem syndrome adult evidence prior sars-cov-2 infection.Emerg Infect Dis. 2022; 28: 411-414Crossref (6) This report highlights clinical presentation an complication requiring surgical management. Since initial introduction vaccines, nearly 70% population United States completed entire “primary series” vaccinations, 17% having received at least one dose.3Centers Disease Control (CDC)COVID Data Tracker.https://covid.cdc.gov/covid-data-tracker/#datatracker-homeDate accessed: May 27, 2023Google Volume literature on reported increased, including not limited unilateral axillary and/or cervical lymphadenopathy ipsilateral arm,4Wu Oitment C. Silverman Grey T.M. Bhanot K. Unilateral causing medial cord plexopathy: report.JBJS Case Connector. 12Crossref (0) neurologic effects,5Hosseini R. Askari N. A review neurological vaccination.Eur J Med Res. 2023; 102Crossref (3) injection site pain, erythema, induration edema, fatigue, headache, fever, chills, myalgia, arthralgia, lymphadenopathy, hypersensitivity reactions.6Omar I.M. Weaver J.S. Samet J.D. Serhal A.M. Mar W.A. Taljanovic M.S. Musculoskeletal manifestations covid-19: currently described symptoms multimodality findings.RadioGraphics. 42: 1415-1432Crossref (7) number uncommon also reported, Bell’s palsy (MODERNA) vaccine, local such as bursitis, infectious processes septic arthritis.7Cirillo Doan The association between vaccination palsy.Lancet 22: 5-6Abstract Full Text PDF PubMed Scholar, 8Ursini F. Ruscitti P. Raimondo V. al.Spectrum short-term musculoskeletal administration: 66 cases.Ann Rheum 81: 440-441Crossref (14) 9Massel D.H. Haziza S. Rivera Mohile Subhawong T.K. Hernandez V.H. Septic arthritis shoulder pfizer vaccination: 11Crossref (8) publication reports tenosynovitis mRNA MODERNA vaccine. presented outpatient clinic chief complaint multiple months wrist. that she first shot 3 before this arm. Immediately beginning day injection, tracked torso. Many presentation, except those these were any active passive range motion extension fingers. On examination, palpable fluid-filled tendon sheath observed. No signs erythema infection existed, patient endorsed pain dorsal resisted digits. was pain. Finkelstein’s test negative, otherwise neurovascularly intact sensation light touch median, radial, ulnar nerve distributions appropriate capillary refill fingertips. Magnetic resonance (MRI) obtained 109 days administration, demonstrating severe mild compartment, well pericapsular bone marrow cystic/erosive changes potential (Figure 1, Figure 2). Given severity advanced tissue, elected pursue tenosynovectomy compartments.Figure 2Coronal MRI tenosynovitis.View Large Image ViewerDownload Hi-res image Download (PPT) surgery approximately 7 onset marked, incision made hand third compartments. Dissection retinaculum revealed tenosynovium “bulging” underneath retinaculum. removed, pollicis longus released transposed, posterior interosseous resected. exposed excised from tendons, measuring 4 × 2 cm (Fig. 3). immediate complications noted. Surgical pathology demonstrated synovial hyperplasia chronic inflammation. At follow-up visit, overall improvement, continued difficulty motion. referred occupational therapy starting 6 weeks surgery, attended 13 sessions 10 weeks. 3-month follow-up, swelling wrist, synovitis. subsequently taken back operating room, where dissection through old incision, synovitis again encountered tendon. fibrosis reactive changes. After 11 discharged recommendations home exercise plan. Written informed consent accompanying images. is arm, which localized tendons compartments Advanced signal process. nodules, recurrence. effect profiles two widely utilized Pfizer well-documented. These include are complications1Beatty (eg, redness, swelling), systemic events1Beatty myalgias), rare serious events10Fraiman Erviti Jones M. al.Serious events special interest randomized trials adults.Vaccine. 40: 5798-5805Crossref (32) cardiomyopathy, thrombosis, Guillain–Barré Syndrome).11Abara W.E. Gee Marquez al.Reports Guillain-Barré States.JAMA 6e2253845Crossref (5) describing attributable To our knowledge, injected arm COVID vaccination. Extensor itself well-established phenomenon. both relatively uncommon. It associated frequent repetitive use often occurring athletes rowers. Tenosynovitis etiologies seen setting Rheumatoid other causes. can non-rheumatoid setting, distal radius fracture trauma.12Adams J.E. Habbu Tendinopathies wrist.J Am Acad Orthop Surg. 2015; 23: 741-750Crossref (55) patient’s shot. Searching “Vaccine Event System” database provided Centers Prevention reveals date, 26 instances “tenosynovitis,” attributed 16 Pfizer–Biontech version, pharmaceutical companies.13United Department Health Human Services (DHHS)Public Service (PHS), (CDC)/Food Drug Administration (FDA), Vaccine System (VAERS). CDC WONDER On-Line Database.http://wonder.cdc.gov/vaers.htmlDate 26, surgically tissue “fibrosis changes,” it likely did cause rather, vaccine-induced immune-mediated response affected That being said, able undergo expectant management there only 69.5% US primary series vaccinations per Prevention, utmost rarity should deter patients undergoing vaccination.2Choi Finally, further exploration via well-controlled studies needed explore causal relationship complications. Clinicians be cognizant various presentations allow prompt