Risk for Subdeltoid Bursitis After Influenza Vaccination

Subacromial-subdeltoid bursitis following COVID-19 vaccination: a case of shoulder injury related to vaccine administration (SIRVA)

“…Atanasoff and colleagues, in a retrospective study about SIRVA, reported that in 93% of the cases, shoulder pain occurred less than 24 h after vaccination and immediately following injection in 54% [2]. This adverse reaction can also be caused when the injection is too deep, going through the muscle and into the bursa [4,7,8,10]. Bodor and Montalvo found that the subdeltoid bursa extended from 3.0 to 6.0 cm beyond the lateral border of the acromion at a depth from 0.8 to 1.6 cm [7] which could be easily reached by the 2.5-cm (1-in.)…”

“…Guidelines for proper administration, including explicit instruction to avoid the upper third of the deltoid, would help to reduce the risk of penetrating the bursa during vaccine injections [2]. Inappropriate technique could potentially reduce vaccine efficacy or increase the risk for local adverse reactions [4,10].…”

“…Vaccination injection site adverse reactions are common, and symptoms are usually mild and transient [1][2][3], with pain, swelling, and redness at the site of injection being the most common clinical findings [3,4]. Cases of shoulder injury related to vaccine administration (SIRVA), defined as shoulder pain and limited range of motion occurring after the administration of a vaccine intended for intramuscular administration in the upper arm, have been reported in the medical literature [2,3,[5][6][7][8], and influenza is the most frequently vaccine reported [1,3,9,10]. Although subacromial-subdeltoid bursitis is a common health problem with a prevalence of approximately 1% in the general US population [11], its occurrence within the context of SIRVA is still underreported in the literature.…”

Post-Influenza Vaccine Subdeltoid bursitis

“…A retrospective cohort study by Hesse et al of almost three million people who received the influenza vaccine revealed 16 cases of subdeltoid bursitis occurring within two days of vaccine administration [ 12 ]. The mean age was 57.5, with over two-thirds being women.…”

“…Most vaccines are administered by nurses, although vaccination by pharmacists is becoming more popular as payment for some vaccines is provided by the patient’s prescription insurance. In the large cohort study by Hesse et al, most of the vaccines causing bursitis were administered by medical assistants who have less training than nurses [ 12 ]. However, this may be due to medical assistants administering more vaccinations than nurses who have other duties and not that the medical assistants are more likely to give the vaccine incorrectly.…”