Radiological Case: Shoulder Injury Related to Vaccine Administration: Isolated Teres Minor Tear

Danesh Bansal, MD; David R Di Lorenzo, MD


Appl Radiol. 2020;49(1):50-52. 

In This Article

Case Summary

A 59-year-old female with a weight of 153 lbs. (69 kg) and no significant medical history presented with acute left shoulder pain and limited range of motion that began fewer than 24 hours after receiving the tetanus and diphtheria (Td) vaccine for routine prophylaxis. The patient denied fever, prior shoulder pain, trauma, excessive lifting, pulling or exercising. On physical exam, the patient experienced limited range of motion, pain with active and passive movement, and tenderness over the deltoid tuberosity. The patient's reflexes, strength, and sensation were intact. After minimal relief with nonsteroidal anti-inflammatory drugs (NSAIDs), nonenhanced magnetic resonance imaging (MRI) of the left humerus was obtained.

An MRI performed 6 weeks from the start of symptoms demonstrated a high-grade partial-thickness tear of the teres minor tendon. In lieu of these findings, an orthopedics consult was recommended. At the time of the orthopedics visit, 7 weeks since the onset of injury, the patient's symptoms had drastically improved. The patient reported minimal pain with certain motions, such as getting dressed. The physical exam was positive for minimal tenderness at the deltoid insertion site. Reflexes, sensation, and strength were maintained. Given the improvement in symptoms, conservative management was recommended. The patient was started on a course of NSAIDs and referred to physical therapy for rotator cuff stretching and strengthening. At 2-month follow-up, the patient was back to her baseline without shoulder pain.