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Painless idiopathic neuralgic amyotrophy after COVID-19 vaccination: A case reportOn December 11, 2020, the Food and Drug Administration issued an emergency use authorization of the Pfizer-BioNtech COVID-19 vaccine for coronavirus disease 2019 (COVID-19) infection prevention, consisting of two intramuscularly administered doses 21 days apart. 1 Large-scale placebo-controlled studies showed a 95% efficacy for COVID-19 infection prevention, with injection-site pain, fatigue, and headaches being commonly reported adverse events. 2 Although idiopathic neuralgic amyotrophy (INA) has been reported after COVID-19 infection, there are currently no published cases of INA occurring after COVID-19 vaccination. 3 A 35-year-old left-hand dominant woman presented with new-onset painless left-arm weakness, numbness, and paresthesias 9 days after receiving the Pfizer-BioNtech COVID-19 vaccine in the right deltoid. She had no history of neurologic diseases or allergies and denied recent trauma or infection. A detailed physical examination showed left upper extremity decreased antigravity strength in the deltoid, supraspinatus, biceps brachii, triceps brachii, extensor carpi radialis, extensor digitorum communis, extensor indicis proprius, flexor digitorum superficialis, and flexor digitorum profundus. Left-arm light touch sensation was decreased in the lateral antebrachial cutaneous (LAC), radial, and median nerve distributions. Hyporeflexia of the left biceps, brachioradialis, and triceps deep-tendon reflexes was present. Normal strength, sensation, and reflexes were present in the right upper extremity, without increased tone, fasciculations, or atrophy. She exhibited left medial scapular winging, with negative provocative tests for radiculopathy, musculoskeletal shoulder pathology, and peripheral nerve entrapment.Cervical spine computed tomography showed mild degenerative changes without foraminal narrowing. She was started on high-dose prednisone after neurology and physiatry evaluations, with paresthesia improvement and weakness stabilization within 1 week of medication initiation. Serologic evaluation including C-reactive protein, erythrocyte sedimentation rate, antinuclear antibody, rheumatoid factor, Lyme antibodies, and angiotensin-converting enzyme was negative. COVID-19 IgG and IgM antibodies were detected.The patient was reevaluated 6 weeks after symptom onset with significant strength improvement and resolved numbness and paresthesias. She underwent

BACKGROUND Returning patients to preinjury status is the goal of a trauma system. Trauma centers (TCs) provide inpatient care, but postdischarge treatment is fragmented with clinic follow-up rates of <30%. Posttraumatic stress disorder (PTSD) and depression are common, but few patients ever obtain necessary behavioral health services. We postulated that a multidisciplinary Center for Trauma Survivorship (CTS) providing comprehensive care would meet patient's needs, improve postdischarge compliance, deliver behavioral health, and decrease unplanned emergency department (ED) visits and readmissions. METHODS Focus groups of trauma survivors were conducted to identify issues following TC discharge. Center for Trauma Survivorship eligible patients are aged 18 to 80 years and have intensive care unit stay of >2 days or have a New Injury Severity Score of ≥16. Center for Trauma Survivorship visits were scheduled by a dedicated navigator and included physical and behavioral health care. Patients were screened for PTSD and depression. Patients screening positive were referred for behavioral health services. Patients were provided 24/7 access to the CTS team. Outcomes include compliance with appointments, mental health visits, unplanned ED visits, and readmissions in the year following discharge from the TC. RESULTS Patients universally felt abandoned by the TC after discharge. Over 1 year, 107 patients had 386 CTS visits. Average time for each appointment was >1 hour. Center for Trauma Survivorship “no show” rate was 17%. Eighty-six percent screening positive for PTSD/depression successfully received behavioral health services. Postdischarge ED and hospital admissions were most often for infections or unrelated conditions. Emergency department utilization was significantly lower than a similarly injured group of patients 1 year before the inception of the CTS. CONCLUSION A CTS fills the vast gaps in care following TC discharge leading to improved compliance with appointments and delivery of physical and behavioral health services. Center for Trauma Survivorship also appears to decrease ED visits in the year following discharge. To achieve optimal long-term recovery from injury, trauma care must continue long after patients leave the TC. LEVEL OF EVIDENCE Therapeutic, Level III.