# Adhesive Capsulitis Following Improper Tetanus-Diphtheria (Td) Booster Administration

## TL;DR

A rare case of adhesive capsulitis occurred after a Td vaccine was improperly administered in the shoulder, highlighting a potential complication of vaccination.

## Contribution

This is the first reported case of adhesive capsulitis following improper Td booster administration.

## Key findings

- A middle-aged woman developed adhesive capsulitis after a Td vaccine was injected improperly into her shoulder.
- The patient experienced persistent shoulder pain and stiffness for four months without a clear diagnosis.
- The case raises questions about whether vaccine-induced adhesive capsulitis follows a different recovery timeline than typical cases.

## Abstract

Adhesive capsulitis following vaccination is a rare complication secondary to improper intramuscular (IM) deltoid vaccine administration. It is considered a subset of the broad category known as shoulder injury related to vaccine administration (SIRVA). SIRVA typically results from improper shoulder anatomic localization prior to injection, leading to erroneous placement of the needle into the glenohumeral joint capsule or subacromial space. This can trigger a wide array of pathologies, including adhesive capsulitis.

We present the first known case of adhesive capsulitis following improper tetanus-diphtheria (Td) vaccine administration. The patient, a previously healthy middle-aged female, began experiencing significant anterior left shoulder pain the day following a Td booster vaccination. She remarked receiving the injection “higher up” in the shoulder than normal. Over the next two weeks, she began noting significant shoulder stiffness, which was followed by a progressive loss of shoulder range of motion. Her symptoms persisted for four months without definitive diagnosis or treatment. After four months of symptoms, the patient visited an outpatient sports medicine clinic where the diagnosis of adhesive capsulitis was made. Although the patient was referred for physical therapy, focusing on gentle range of motion (ROM) and stretches, followed by a planned isometric strengthening program once ROM improved, she was eventually lost to follow-up, and her recovery is unclear. Given the rarity of the diagnosis, it is unclear if adhesive capsulitis, secondary to improper IM vaccination, follows the same temporal course as “classic” adhesive capsulitis or results in a different timeframe of recovery. Further studies are needed on this subject.