Shoulder Pain and Dysfunction After Vaccination

Abstract

Background:Persistent shoulder pain and dysfunction after vaccination are relatively rare but well-known complications after inoculations into the deltoid muscle. The term SIRVA (shoulder injury related to vaccine administration) is frequently used to encompass many of these occurrences; however, multiple distinct pathologies with similar presentations have been reported after vaccination. We performed a systematic review of the literature on vaccine-related shoulder injuries to help guide practitioners in appropriate workup and treatment based on specific diagnoses.Methods:PubMed was used to search for combinations of multiple keywords (including vaccine, immunization, SIRVA, injury, inflammation, bursitis, Parsonage-Turner syndrome, and neuritis), and all references of each potential article were reviewed. A total of 56 articles were included. Patient demographics, vaccine information, presentation, diagnostic studies, treatment, and outcomes were recorded.Results:Diagnoses were divided into 3 categories: (1) local inflammatory reaction (SIRVA), (2) brachial neuritis, and (3) direct nerve injury. The included articles reported on 57 cases of SIRVA, 18 of brachial neuritis, and 4 of direct nerve injury. The diagnoses reported for the SIRVA cases included frozen shoulder, pseudoseptic arthritis, subacromial bursitis, rotator cuff injury, and lytic lesions of the humeral head. Various treatments were used, and most patients had resolution of symptoms with conservative treatment including physical therapy, analgesics, and/or corticosteroid injections. Advanced imaging rarely provided information that affected treatment. The brachial neuritis and direct nerve injury cases were typically confirmed with electromyography/nerve conduction studies. Treatment of these 2 categories was nonoperative in all cases, typically with analgesics and/or corticosteroids, and most patients had symptomatic improvement after a few months, with most patients regaining strength. However, some (1 of 3 patients with brachial neuritis and >1 year of follow-up and 2 of 4 patients with direct injury) had residual weakness.Conclusions:Medical professionals should be aware of the various pathologies that can lead to prolonged shoulder pain after vaccination. Fortunately, most of these conditions can be treated successfully with nonoperative modalities, although differentiating among the diagnoses can help guide treatment, as some likely benefit from systemic corticosteroids or localized corticosteroid injections. Outcomes for most patients have been good, with the majority recovering without residual pain or deficits.Level of Evidence:Prognostic Level IV.

Application of a nerve stereoscopic reconstruction technique based on ultrasonic images in the diagnosis of neuralgic amyotrophy

“…Can ultrasound-guided precise corticosteroid injection be used to reduce the side effects of systemic hormone therapy? or to further increase the efficacy on the basis of systemic hormone therapy ( Yang et al, 2021 ; Wright et al, 2023 )? Can increased introneural pressure due to severe swelling be used as an indicator of surgical intervention?…”

SIRVA: Shoulder injury related to vaccine administration

“…16,17 Diffuse weakness and neuropathic changes in non-dermatomal and myotomal patterns may indicate a brachial neuritis aetiology (Parsonage-Turner syndrome). 6,[18][19][20] A case report also exists of isolated infraspinatus myositis. 21 A variety of radiological structural changes have been reported, including calcification, degeneration, and rotator cuff tears.…”

“…The most commonly described pattern is that of pain and stiffness consistent with frozen shoulder (FS; or adhesive capsulitis). 4-6 Placement of the vaccination in the subdeltoid bursa or other pericapsular tissue has been postulated to result in an inflammatory capsular process. Other studies have suggested a subacromial subdeltoid bursitis as the primary pathology, 7-13 while there have also been case reports of calcific tendonitis.…”