Risk of bursitis and other injuries and dysfunctions of the shoulder following vaccinations

Arias, Luis H. Martín; Fadrique, Rosario Sanz; Gil, María Sáinz; Salgueiro, Esther

doi:10.1016/j.vaccine.2017.07.055

Cited by 58 publications

(75 citation statements)

References 44 publications

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“…Martin Arias et al reviewed the international literature and the Spanish Pharmacovigilance System database and found 45 cases of a vaccine-related shoulder injury that included subdeltoid bursitis, osteonecrosis, frozen shoulder, septic shoulder and nerve palsies [ 10 ]. They reported vaccines other than influenza causing shoulder injury including pneumococcal polysaccharide, human papillomavirus, diphtheria-tetanus-poliomyelitis and hepatitis A although most (28, 62%) were associated with an influenza vaccine.…”

Section: Discussionmentioning

confidence: 99%

Post-Influenza Vaccine Subdeltoid bursitis

Jenkins¹,

Rupp²,

Goebel³

2020

Cureus

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A 61-year-old female presented three months following an influenza vaccination with ongoing pain since the injection and was diagnosed by MRI with subdeltoid bursitis. The patient received a short course of prednisone and several months of physical therapy before returning to pain-free function. The primary reason for injection-related subdeltoid bursitis is improper administration. It is a preventable issue, and improved training of healthcare workers on proper vaccine administration may decrease its occurrence.

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Section: Discussionmentioning

confidence: 99%

Post-Influenza Vaccine Subdeltoid bursitis

Jenkins¹,

Rupp²,

Goebel³

2020

Cureus

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“…Available data are too limited to estimate the incidence of SIRVA. Previously published cases have followed adult influenza vaccination, likely owing to the high frequency of seasonal influenza vaccination compared to other adult vaccines 4,5 . Injection of vaccine through muscle into bone or joint is also more likely during administration into the deltoid muscle compared with other sites used in the infant primary schedule (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…quadriceps muscle) 6 . An exaggerated local immune response may occur secondary to vaccine delivered into the shoulder joint 3,4,7 …”

Section: Discussionmentioning

confidence: 99%

“…SIRVA is a rare adverse event following immunisation. SIRVA is thought to occur when a vaccine has been given incorrectly either too high in the deltoid or too deep into the joint space damaging surrounding structures including bursa/tendons and potentially inducing an immune‐mediated response locally resulting in pain and restricted movement 1–4 . Following an extensive literature search, SIRVA has not been identified or reported in any other paediatric cases.…”

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confidence: 99%

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Shouldering responsibility for a vaccine related injury

Cox

Nogic

Addison

et al. 2020

J Paediatrics Child Health

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We report a paediatric case of suspected shoulder injury related to vaccine administration (SIRVA). A 15-month-old child presented to a paediatric acute care facilty with a 10-day history of localised tenderness and limitation of movement of his right shoulder and arm. Twelve month immunisations had been administered 4 days prior to the onset of initial symptoms. Abnormalities within the shoulder joint were detected on ultrasound and magnetic resonance imaging (MRI). Symptoms resolved with conservative management including non-steroidal anti-inflammatory medication. SIRVA is a rare adverse event following immunisation. SIRVA is thought to occur when a vaccine has been given incorrectly either too high in the deltoid or too deep into the joint space damaging surrounding structures including bursa/tendons and potentially inducing an immune-mediated response locally resulting in pain and restricted movement. 1-4 Following an extensive literature search, SIRVA has not been identified or reported in any other paediatric cases. The risk of SIRVA would be reduced if immunisation

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“…However, upper arm and shoulder injury related to vaccine administration is an emerging, and likely under-reported, phenomenon. [12,[15][16][17] The standard deltoid landmark needs to be updated: three fingers below the acromion should be considered the upper (superior) boundary for safe deltoid injections, and an additional lower boundary, at the axillary line, should be added for optimal client safety. The safe injection zone is between these upper and lower boundaries, along the coronal (vertical) axis of the outer aspect of the client's arm.…”

Section: Discussionmentioning

confidence: 99%

Best practice for deltoid intramuscular injections in older adults: Study in cadavers

Davidson

Bertram

2019

JNEP

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Most injectable vaccines are administered via deltoid intramuscular injection (IMI). Nursing students are taught to perform deltoid IMI in their entry-to-practice education program. However, best practice evidence is lacking regarding specific techniques of deltoid IMI, and students are often taught what their instructor was taught in his/her own entry-to-practice (ETP) program. Nursing textbooks provide instructions and diagrams for how to perform deltoid IMI, but rarely cite underpinning empirical evidence. This study tested the injection techniques of bunching (squeezing) or flattening (stretching) the deltoid muscle before administering IMI using medical school donated cadavers. Flattening technique resulted in over-penetration of deltoid injections more than 85% of the time in these older adults, whereas nearly 80% of deltoid IMI are successful using bunching technique. Body mass index (BMI) and needle length are also crucial considerations when administering deltoid IMI. Nurses, and other health professionals who use deltoid IMI to administer vaccines to older adults, should determine the client’s body mass index to select the appropriate needle length. Based on these results, bunching technique is recommended. Flattening technique is not recommended for older adults with a BMI < 30.

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Risk of bursitis and other injuries and dysfunctions of the shoulder following vaccinations

Cited by 58 publications

References 44 publications

Post-Influenza Vaccine Subdeltoid bursitis

Post-Influenza Vaccine Subdeltoid bursitis

Shouldering responsibility for a vaccine related injury

Best practice for deltoid intramuscular injections in older adults: Study in cadavers

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