Ultrasonic aspiration for vaccination-related shoulder dysfunction

Abstract

Background: Chronic shoulder pain occurs rarely after a vaccination and is hypothesized to arise from the effects of unintentional vaccine injection into the subacromial bursa, rotator cuff, capsule or underlying bone. The avascular nature of the rotator cuff, as well as unknown genetic and environmental factors, may predispose to the persistence of pain and disability, referred to as vaccination-related shoulder dysfunction and shoulder injury related to vaccine administration (SIRVA). Methods: Ultrasonography, sonopalpation and ultrasound-guided anesthetic injections were used to locate the anatomical source of chronic (mean 20, range 8-42 months) shoulder pain after a vaccination in a consecutive series of 5 patients. Subsequently ultrasound-guided ultrasonic aspiration and debridement was performed using a 2.1 mm outer cannula with an inner needle vibrating at 28 kHz. Outcomes were assessed using the Quick Disabilities of the Arm, Shoulder and Hand (QDASH) scale at 2, 4, 12, 24 weeks and 1 year. Results: The distal infraspinatus and teres minor tendons, their insertions and or the adjacent bone were the source of pain in all 5 patients. The mean QDASH score improved from 65 points to 11 points at 2 weeks (P ¼ 0.001), and to 1 point at 4 weeks after the procedures (P ¼ 0.003). Improvements in pain and function remained stable at 1 year in 3 patients, for at least 24 weeks in 1 patient who died of unrelated causes, and 1 year in 1 patient for posterior shoulder pain who after a pain free interval developed anterior shoulder pain related to his previously asymptomatic osteoarthritis (P ¼ 0.013). Conclusion:The distal infraspinatus and teres minor tendons, their insertions and adjacent bone are a common source of chronic shoulder pain after a vaccination. Ultrasound-guided ultrasonic aspiration and debridement is a potentially effective treatment for resolving pain and restoring function.

Refractory shoulder injury related to vaccine administration: correlation with culture presence of Cutibacterium acnes

“…The location of the distal infraspinatus and teres minor tendons, their entheses, and the underlying bone has been previously reported as a common location for persistent shoulder pain after vaccination. 4 , 15 This was a similar location in this series as identified on MRI images, suggesting the area of maximal signal intensity. The benefit and timing of follow-up MRI for evaluation of response to treatment cannot be recommended based on this limited series because follow-up MRI was not routinely performed.…”

Shoulder Pain Following Influenza Vaccine Administration: A Clinical Vignette

“…Typical conservative management of rest, ice, activity modification, and physical therapy can also be helpful in these patients 1,3 . Steroid and other regenerative injections (platelet-rich plasma) into the specific location of the pathology have been shown to be helpful in some patients to reduce their levels of inflammation; however, in this case, it was deferred given the concern for infection and possible tendon injury 1,3,6,7 . However, these injuries may require surgical intervention, as evidenced in data from Hesse et al 3 showing that 32.5% of these patients may progress to that point.…”

“…1,3 Steroid and other regenerative injections (platelet-rich plasma) into the specific location of the pathology have been shown to be helpful in some patients to reduce their levels of inflammation; however, in this case, it was deferred given the concern for infection and possible tendon injury. 1,3,6,7 However, these injuries may require surgical intervention, as evidenced in data from Hesse et al 3 showing that 32.5% of these patients may progress to that point. The prognosis after surgery for SIRVA is unclear in the literature and may warrant further study.…”