Shoulder Injury Related to Vaccine Administration and a Growing Challenge: A Focused Review

Abstract

Shoulder injury related to vaccine administration (SIRVA), an entity that causes acute shoulder pain and may limit range of motion (ROM) after vaccination, is a condition where a small but significant percentage of patients are experiencing in light of the current push for mass immunizations against SARS-CoV-2 worldwide. A search of literature related to SIRVA was performed across multiple electronic databases. Women, patients reporting vaccine injection location to be too high, and patients without prior history of shoulder pain were the most common historical factors in those experiencing SIRVA. Tenderness to palpation and limited shoulder ROM were the most associated physical examination findings. When using magnetic resonance imaging, tendinopathy, subacromial-subdeltoid bursitis, and rotator cuff tears (partial or complete) were the most common findings. Radiographic imaging rarely aided the diagnosis. SIRVA is an entity that health care providers should be aware of to improve the care of patients that may experience these symptoms after vaccine administration.

Establishment of prediction equations for subcutaneous tissue thickness in two representative intramuscular deltoid injections

“…In the axillary method, intramuscular injection is performed at a lower position than the conventional method (just below the midportion of the mid-acromion lateral border at the level of the upper end of the anterior and posterior axillary line). In recent reports, the safest anatomic site was found to be 7–13 cm below the mid-acromion [2] . However, the development of the axillary method was based on a limited number of volunteers (15 men and 15 women).…”

“…In recent years, the COVID-19 pandemic and increased vaccinations have led to several opportunities for intramuscular injections [2] , and a rapid increase in vaccine administration has resulted in an increased risk and incidence of SIRVA [2] , [3] , [4] , [5] , [6] . Therefore, it is becoming increasingly important to consider appropriate intramuscular injection methods.…”

Changes in the mean incidence and variance of orthopedic diseases before and during the COVID-19 pandemic in Korea: a retrospective study

“…The vaccine was introduced late in Korea (early 2021), and it could also have caused shoulder pain. Among patients with shoulder injury related to vaccine administration, patients without prior history of shoulder pain, limited shoulder range of motion, and subacromial-subdeltoid bursitis were the most common demographics [ 29 ]. As frozen shoulder is affected by a variety of predisposing factors, further studies are needed.…”

A commentary on “post-SARS-CoV-2-vaccine shoulder pain: Is it relevant to the vaccine injection? – Correspondence” (int J surg 2022;100:106603)

“…The technique of administration is a factor that should be considered. Most reported incidences of pain after vaccination are due to poor administration techniques and the background physiological status of the vaccine recipient for whom obesity can be an important contribution risk factor [ 2 ]. Furthermore, post vaccination activity can also be a factor associated with pain.…”