Isolated long thoracic nerve palsy following COVID-19 vaccine: a case report. (preprint)

ABSTRACT

Introduction: We report an adult man who developed an isolated long thoracic nerve palsy three days following vaccination against COVID-19. To the best of our knowledge this is the first well-documented case of this association. Case presentation A 46-year-old white man developed back pain, followed by pain in the right axilla and scapular region, clumsiness of the right arm and unusual position of his shoulder blade, three days after receiving a second dose of the Pfizer-BioNTech COVID-19 vaccine. When he consulted a neurologist six months later, the pain had subsided, but the other symptoms persisted despite physiotherapy. Main clinical findings were right scapular winging and marked amyotrophy of the serratus anterior, with preservation of the other muscles of the shoulder and scapula. Nerve conduction studies yielded a low amplitude with a slightly prolonged latency of the right long thoracic nerve. Needle electromyography showed decreased compound motor action potentials on the right and was normal on the left. Main diagnosis and interventions: A diagnosis of post-immunisation long thoracic neuritis was made. The patient was treated with physiotherapy. Conclusions: Clinicians should be aware of the possibility of neuritis of any nerve after COVID-19 vaccination.