SHOULDER PAIN AFTER  
VACCINATION


As our nation begins a large-scale coronavirus disease 2019 (COVID-19) immunization campaign barely a year since the deadly virus emerged in the US, it is critically important for all to understand proper intramuscular (IM) administration technique to avoid a preventable and disabling occurrence called shoulder injury related to vaccine administration (SIRVA).

This is especially important right now, as healthcare workers who may not normally administer vaccines may be called upon to help administer the new COVID-19 vaccines which may cause shoulder injury and may further cause chronic shoulder pain and such conditions.

SIRVA is a shoulder injury triggered by the incorrect injection of a vaccine into the shoulder capsule (joint) rather than the deltoid muscle. It is caused by using an incorrect IM injection technique or improper landmarking of the IM injection site (the deltoid muscle) that results in the unintended injection of the vaccine (and/or trauma from the needle) into and around the underlying bursa of the shoulder.






This results in an inflammatory process that causes injury to the musculoskeletal structures of the shoulder (e.g., tendons, ligaments, bursae).


Symptoms of SIRVA include

Ø persistent shoulder pain,       weakness, and

Ø limited range of motion

that typically develop within hours to a few days after receiving a vaccine.

These symptoms do not improve with over-the-counter analgesics. The resulting chronic shoulder pain and inability to carry out daily activities that were possible prior to vaccination often lead patients to seek medical intervention.

Patients are often diagnosed with inflammatory shoulder injuries (e.g., bursitis, rotator cuff tears, frozen shoulder syndrome, adhesive capsulitis) that do not appear to be any different than routine shoulder injuries, except that the shoulder symptoms started within days of an IM deltoid vaccination.

How to Prevent SIRVA

The key to avoiding SIRVA is to recognize the anatomical landmarks for identifying the deltoid muscle and to use proper IM administration technique. Proper landmarking of the deltoid muscle requires determining the upper and lower borders of a safe injection zone.First, the patient’s shoulder should be exposed completely. When a shirt cannot be removed, the sleeve should be rolled up or the arm removed from the sleeve rather than pulling the shirt’s neck over the shoulder.

Injections below or too far to the side of the deltoid muscle can hit the radial or axillary nerve, respectively, which can result in neuropathy or paralysis.

Thus, ensure the administrator of injection should be skilled professional.

How to treat such shoulder pain  

Physiotherapy treatment including Ultrasonic Therapy, cryotherapy and strength exercises can help to improve with shoulder pain and such conditions.

It is always advisable to consult your physiotherapist or orthopedic consultant before initiate any treatment.

Multiple resources related to proper vaccination techniques are provided by the Centers for Disease Control and Prevention (CDC) and the Immunization Action Coalition (IAC). These resources have been compiled in articles by Deborah Wexler, MD, Additionally, the University of Waterloo School of Pharmacy in Ontario, Canada, offers a helpful infographic on proper landmarking to prevent SIRVA.

 

                                             

C-1/190, PALAM VIHAR, GURUGRAM (HR)

Dr SUDHIR BHARDWAJ (PT)

+91-9650383603

+91-9717260921

SHOULDER PAIN AFTER VACCINE
 


 

 


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