Shoulder Injury Related to Vaccine Administration (SIRVA): An Occupational Case Report

Abstract

Transient shoulder pain is a common complaint following intramuscular vaccine administration into the deltoid. More severe vaccination-associated shoulder complications comprising of weakness and decreased range of motion are categorized under the construct “shoulder injury related to vaccine administration” (SIRVA) that subsumes both subjective and objective findings consistent with injury. We describe the presentation and management of a case of SIRVA in a health care worker following seasonal influenza vaccine administration as part of a hospital-based employee health program and review the relevant biomedical literature. We present a case from a single medical center. All data were collected by professionals in occupational health by interviewing, performing physical examinations, and reviewing medical records associated with the injured worker. Severe pain and limited range of shoulder motion developed following an influenza vaccination that was administered using a poorly positioned, larger than recommended needle. Magnetic resonance imaging (MRI) demonstrated moderate glenohumeral joint effusion and synovitis, with fluid accumulating in the subscapularis recess within 1 week of injury. At 8 months after initial injury, MRI showed persistent mild tenosynovitis of the long head of the biceps tendon, interval accumulation of a large glenohumeral joint effusion, and infraspinatus tendinitis with subjacent reactive bone marrow edema. The affected worker experienced work restrictions but had no complete lost workdays to date due to the injury. Occupationally related SIRVA is a preventable adverse event that should be considered in workplace vaccine administration programs, and appropriate education and training provided to vaccine administrators to address this.

Use of Osteopathic Manipulation for Treatment of Chronic Shoulder Injury Related to Vaccine Administration

“…Multiple reports and reviews on SIRVA emphasize the need for proper injection techniques to avoid adverse injuries [3]. Common themes include appropriate needle length, using the acromion as a landmark, the motion and angle with which the needle is injected, and standardized skin preparation [4,5]. The patient in this case study subjectively reports an injection site below the recommended area.…”

“…Shoulder injury related to vaccine administration (SIRVA) is a rarer complication that occurs within 48 hours after injection and presents with long-term shoulder pain and restricted range of motion (ROM) [3,4]. Caused by improper landmarking and/or intramuscular injection techniques, SIRVA can result in post-injection complications, such as shoulder bursitis, adhesive capsulitis and inflammation to adjacent structures [5]. Current literature has emphasized prevention of these adverse events through proper injection techniques, with limited research done on treatments targeted towards SIRVA sequelae [6,7].…”

Lesão de Ombro após a Vacinação: Uma Revisão Sistemática

“…6 The structures reportedly involved have included the rotator cuff, labrum, capsule, bursa, deltoid muscle, and this included diagnoses of bursitis, rotator cuff tears, adhesive capsulitis, chondral injury, nerve injury and infection. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 The most common mechanism proposed is overpenetration of the deltoid muscle leading to injury either from a mechanical injury and/or from an immune response to the vaccine and/or adjuvants, and these events have frequently been correlated with an incorrect injection technique. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 Thus, the primary outcome of this review was to identify unique features of SIRVA and the clinical results.…”

Bilateral adhesive capsulitis following influenza vaccination: A case report

“…There are reported cases of shoulder injury related to vaccine administration (SIRVA). [2][3][4][5][6][7] Poor injection technique may result in certain shoulder-related adverse events, such as bursitis or tendonitis. In addition, the vaccine composition may induce an immune response in tissues surrounding the shoulder.…”

“…Local adverse reactions to vaccinations most commonly include redness, swelling, and pain at the injection site. There are reported cases of shoulder injury related to vaccine administration (SIRVA) 2‐7 . Poor injection technique may result in certain shoulder‐related adverse events, such as bursitis or tendonitis.…”