Sep
It’s a very rare side effect associated with a shot being administered incorrectly.
If you have been inoculated with a vaccine, you might have encountered typical aftereffects such as mild arm discomfort or a low-grade fever. Nevertheless, you might not be acquainted with an infrequent and potential side effect referred to as shoulder injury related to vaccine administration (SIRVA). Despite the possibility of SIRVA causing some discomfort, it’s important to note that the tremendous life-saving advantages of vaccines far overshadow the remote risk of encountering this uncommon complication. Gaining insight into SIRVA can empower you to take measures for its prevention. In the event that you suspect its presence, consulting a healthcare professional is advisable for proper symptom management and guidance.
What Is SIRVA?
Ken Donohue, MD, an esteemed orthopedic surgeon and shoulder specialist at Yale Medicine, has elucidated to Health magazine that Shoulder Injury Related to Vaccine Administration (SIRVA) is an infrequent condition characterized by pain and reduced shoulder functionality following a vaccination.
The rarity of this condition is underscored by Dr. Donohue’s professional experience. As a practitioner who specializes in shoulder issues, he affirms having encountered very few instances of SIRVA among his patients. Owing to its scarcity, the body of knowledge about SIRVA remains limited, and some medical experts even contest its existence.
In a comprehensive literature review published in the Clinical Orthopaedics and Related Research journal in 2022, researchers highlighted the stance of the National Academy of Medicine’s Committee on the Adverse Effects of Vaccines. This committee unequivocally acknowledges the link between injectable vaccines and deltoid (shoulder muscle) bursitis as evidence-supported. However, the American Academy of Orthopaedic Surgeons (AAOS) presents a contradictory perspective. Their positions, initially stated in 2017 and reiterated in 2020, assert that there is no substantiated evidence connecting vaccines to shoulder injuries.
Subsequent evaluations tend to align more closely with the National Academy of Medicine’s viewpoint. In a parallel literature review published in the same Clinical Orthopaedics and Related Research journal in 2022, the authors cautiously state that while SIRVA is exceptionally rare, it transpires in approximately one out of 130,000 vaccinations.
Further support for SIRVA’s recognition comes from another literature review, this time published in the Vaccine Journal in 2022. This review accentuates that SIRVA is gaining increasing acknowledgment as a post-vaccination complication. Moreover, it proposes that certain risk factors for SIRVA include being female, having a slender physique, possessing a smaller deltoid muscle, and encountering improper injection techniques.
Causes
According to Dr. Donohue, the precision of healthcare professionals trained in needle length selection and accurate injection site determination sometimes falls short. Despite proper training, there are instances where the injection isn’t administered at the intended location in the arm.
Dr. Donohue elaborates that when a needle is inserted too deeply, it can breach the boundaries of the deltoid muscle, leading to potential harm to critical shoulder structures like the rotator cuff or joint capsule. He also notes that in exceedingly rare cases, the axillary or radial nerves in the upper arm could sustain injury.
A study conducted in 2018 and documented in the Canadian Pharmacists Journal explicitly outlines the mechanics of SIRVA. It describes SIRVA as arising from injections placed too high in the arm, causing the vaccine to be deposited into the shoulder capsule instead of the intended deltoid muscle.
Furthermore, these researchers highlight that such misplaced injections trigger an inflammatory response that can inflict damage upon various shoulder structures, including tendons and bursa.
Symptoms and Treatment
According to Dr. Donohue, the precision of healthcare professionals trained in needle length Although experiencing mild muscle soreness following a vaccine shot is a common occurrence, it usually subsides naturally within a few days. In contrast, with SIRVA, an individual typically encounters pain within 48 hours of vaccination, and this discomfort doesn’t ameliorate over time.
For those grappling with SIRVA, months can transpire during which they report escalating pain, weakened strength, and compromised mobility in the vaccinated arm. Kelly Grindrod, PharmD, a respected professor at the School of Pharmacy at Waterloo and a contributor to the 2018 study, elucidates that even simple actions like raising one’s arm to brush their teeth can trigger pain.
According to the 2022 assessment published in the Clinical Orthopaedics and Related Research journal, the prevalent indicators of SIRVA encompass shoulder pain and diminished range of motion. Initial diagnoses often gravitate towards conditions such as shoulder bursitis, adhesive capsulitis (commonly known as frozen shoulder), and rotator cuff tears.
These complications can emerge, as highlighted by a 2022 review in the Journal of Hand Surgery Global Online when injections are inaccurately placed in specific shoulder locations. For instance, injections near the axillary nerve can result in nerve irritation, leading to sensations of numbness, tingling, or weakness.
Individuals grappling with these symptoms are encouraged to consult a healthcare professional. Grindrod underscores the importance of recognizing these SIRVA signs to facilitate timely and appropriate intervention.
In diagnosing SIRVA, ultrasound scans or MRI scans are requisite, as noted by a 2022 study in the Canadian Medical Association Journal. These imaging techniques not only diagnose SIRVA but also provide insights into the extent and nature of the damage. Common approaches for managing SIRVA encompass lifestyle adjustments, non-steroidal anti-inflammatory drugs (NSAIDs), and physical therapy.
If these conservative measures prove insufficient, corticosteroid injections might offer relief, and in more severe instances, surgical intervention could be recommended.
Prevention of SIRVA
Above all, adhering to accurate vaccination landmarking methods is crucial for healthcare providers who administer vaccines, as emphasized by Grindrod. On the recipient’s end, however, several precautions can be undertaken.
Dr. Donohue underscores the significance of affording vaccination administrators a full view of the shoulder area to facilitate referencing essential landmarks for precise injection. He recommends wearing a sleeveless or easily removable shirt to ensure the entire shoulder is visible. Rolling up the sleeve, he notes, might hinder the administrator from accessing all the vital landmarks needed for accurate administration.
Summary
Preventing SIRVA involves collaborative efforts between the person administering the injection and the recipient. To contribute, ensure that your arm is clearly visible, allowing for accurate landmarking during the injection process. It’s essential to maintain perspective on the broader context: vaccines are instrumental in saving lives, and the likelihood of encountering SIRVA is exceedingly low.
Dr. Donohue strongly emphasizes the disparity in risk between not receiving vaccinations and the remote chance of SIRVA. He stresses that the benefits of vaccination far outweigh the potential for SIRVA. His recommendation is to adhere to your regular vaccination schedule and engage in a dialogue with your primary care doctor if any concerns arise.
