Short communicationVaccination-related shoulder dysfunction
Section snippets
Case 1
A healthy 71-year-old woman received a pneumococcal vaccine injection (Pneumovax, Merck) high into the right deltoid muscle at a local pharmacy. Within 2 days her shoulder began to hurt and she had difficulty moving her arm. She took a dose of acetaminophen and a dose of ibuprofen with no relief. She saw her family physician, who diagnosed her with subacromial bursitis. She declined a corticosteroid injection and was referred to physical therapy.
Five months later she continued to have shoulder
Case 2
A healthy 89-year-old man was provided with an influenza vaccine injection (Fluzone, Aventis Pasteur) high into the right deltoid muscle by a visiting health care worker. Within 2 days, he experienced severe right shoulder pain and loss of range of motion. Although he had experienced some mild occasional shoulder pain in the past, he never had severe pain or loss of range of motion.
He took acetaminophen to relieve some of his pain, but did not seek medical help until 2 months later when he
Discussion
In comparing the two cases, we note some interesting similarities. First of all, both patients reported receiving injections high into the deltoid muscle, within a centimeter or two of the acromion.
We researched the length and type of needles used, noting them to be 1 in. (2.5 cm) and #23 and #25 gauge. Then using 8–16 MHz ultrasound (Diasus, Dynamic Imaging), we measured how far the subdeltoid bursa extended distally from the acromion in each patient, noting this to be 3.5 cm for our female and 4.0
Acknowledgement
We thank Noel R. Rose MD, Ph.D. and Clifford Lowell MD for discussing the plausibility of our hypothesis and advising us in our literature review.
References (3)
Cited by (85)
Influenza vaccine related periostitis: A case report of a rare complication
2024, Radiology Case ReportsLetter to the editor regarding: “Frozen shoulder after COVID-19 vaccination”
2024, JSES InternationalRefractory shoulder injury related to vaccine administration: correlation with culture presence of Cutibacterium acnes
2023, JSES Reviews, Reports, and TechniquesAiming too high: Shoulder injury related to vaccine administration (SIRVA): A case series
2022, VaccineCitation Excerpt :Further research, including population-level epidemiological data, is needed to elicit reasons behind this imbalance. While we did not collect data on the needle type used, other studies have suggested that using the incorrect needle type for that patient can increase the risk of overpenetration and SIRVA, as can failing to account for individual patients' anatomical landmarks.[2,3,8,17] As in existing literature, we found that SIRVA was most common after the influenza vaccine.
Shoulder injury related to vaccine administration (SIRVA) after COVID-19 vaccination
2022, VaccineCitation Excerpt :Overpenetration has been implicated as the largest contributing factor to development of SIRVA, though correct technique also plays an important role [5]. The subdeltoid bursa is located between 0.8 cm and 1.6 cm below the skin surface, a distance easily penetrable by the standard 1-inch (25 mm) needle [25]. It is well-documented in the literature that a one-size-fits-all approach should not be uniformly applied to all adult deltoid IM vaccinations [26–28].