Spontaneous Avascular Necrosis of the Humeral Head Following COVID-19 Vaccination

Document Type : CASE REPORT


1 Bradford Teaching Hospital Foundation Trust, United Kingdom

2 Department of Orthopaedics Ashford and St Peter’s Hospitals NHS Foundation Trust, Chertsey, United Kingdom


We report a case of a 40-year-old man who presented with left shoulder pain and marked functional impairment two days 
after receiving the second dose of the Pfizer COVID-19 vaccine. Advanced imaging demonstrated focal avascular necrosis 
(AVN) of his humeral head. Initial management included simple analgesics, activity modification, and an ultrasoundguided intra-articular hydrodilatation injection. The patient subsequently had an improved range of motion but persistent 
severe shoulder pain. He has now been offered surgical intervention. Despite having risk factors for developing AVN 
previously, the patient did not demonstrate any recent risk factors for developing the disease. COVID-19 vaccination is 
known to cause severe joint pain and stiffness rarely. However, avascular necrosis is not a known or documented side 
effect. His symptoms arose directly after the administration of the vaccine, with no other demonstrable cause. Therefore, 
we are reporting COVID-19 vaccination as a potential new risk factor for AVN of the humeral head.
Level of evidence: V


Main Subjects

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