Shoulder Injury Related to Vaccine Administration: Diagnosis and Management

Abstract

Purpose Shoulder injury related to vaccine administration (SIRVA) is a rare but potentially debilitating injury characterized by persistent shoulder pain, typically occurring within 48 hours of intramuscular deltoid vaccine administration. With over 150 million flu vaccines being administered in the United States each year, and the US Centers for Disease Control’s goal of immunizing greater than 70% of the population for the coronavirus disease 2019 virus, cases of SIRVA can be expected to rise. Methods A search of current literature was done to identify published material corresponding to incidence, diagnosis, and treatment of SIRVA. Results Most events have been associated with poor needle placement and/or a local reaction to the delivered serum during vaccine administration. Shoulder injury related to vaccine administration events can lead to persistent and possibly permanent injury. Clinical evaluation involves a thorough history, physical examination, and often diagnostic studies including radiographs, magnetic resonance imaging, and nerve studies. Treatment is individually directed and should initially consist of observation and local symptom management. Recalcitrant cases or infections may warrant surgical intervention. Published outcomes vary widely, and our understanding of SIRVA remains limited. Conclusions Large-scale studies are necessary to better understand the pathophysiology of SIRVA, its treatment, and its outcomes. Overall, the initial priority in managing SIRVA should be awareness and prevention.

Shoulder injury related to rabies vaccine administration: a case report

“…To the Editor, Adverse reactions at vaccine injection sites are widespread, although the symptoms are generally mild and transient 1 . The most common findings are pain, swelling and redness at the injection site 2. Shoulder injury related to vaccine administration (SIRVA) has been defined as shoulder pain and limited range of motion in the shoulder after the administration of a vaccine into the upper arm, 1 and can be expected to become more common due to the increase in vaccination campaigns 3 . Although most cases are self-limiting, some people experience severe and persistent shoulder pain that requires treatment 3 .…”

“…The most common shoulder lesion is bursitis. 3 If the injection is made deep into the shoulder capsule, it can result in inflammation of the shoulder joint or bursal inflammation (synovitis) or infection (septic arthritis or bursitis); if into the rotator head, rotator cuff injury (tendinitis or rotator cuff rupture) can occur; and if into the subacromial or subdeltoid space, bursitis and/or adhesive capsulitis can develop 3 .…”

“…Patients with SIRVA typically complain of shoulder pain, weakness in the shoulder, decreased range of motion, paresthesia and tingling in the vaccinated arm 3 .Cases with shoulder pain lasting longer than 48 hours after vaccination and gradually worsening should be evaluated clinically 3 .Radiography (x-ray) images can be easily obtained, but will often not be positive or diagnostic in the early period 9 , and so the preferred imaging modality is MRI 9 . The most frequently reported MRI findings are increased fluid in the glenohumeral joint and subdeltoid/subacromial bursa, bone marrow edema, rotator cuff tear, a fluid signal in the bicipital groove and biceps tendinitis 6 .…”

“…The most frequently reported MRI findings are increased fluid in the glenohumeral joint and subdeltoid/subacromial bursa, bone marrow edema, rotator cuff tear, a fluid signal in the bicipital groove and biceps tendinitis 6 . In most injuries of this kind, no contrast material is used in the MRI evaluation 3 , although MRI with contrast enhancement is recommended if infection is suspected. Furthermore, MRI can effectively show the extent of damage to the bone and the surrounding soft tissue 3 .…”

“…There will likely be an increase in SIRVA cases with the increase in vaccination programs 3 , and so the first approach should be to prevent SIRVA through the use of appropriate injection techniques, and proper syringe, needle thickness and needle length selection 3 . The leading cause of SIRVA is the injection being applied "too high" into the deltoid region 6 .…”