Shoulder injury related to vaccine administration, or SIRVA, is a rare reaction to vaccine administration.

Local reactions at the site of a vaccine are common, and include soreness at the injection site, redness and swelling. In a 2018 study, 80% of vaccine administrations resulted in these local reactions (CDC 2015). These reactions are mild and tend to resolve with conservative treatment.

SIRVA is different. SIRVA presents as a rapid onset of shoulder pain and limited shoulder range of motion after administering a vaccine. Symptoms begin within 48 hours of vaccination and occur in the shoulder that was vaccinated. Most cases occur following the flu (influenza) vaccine (62% of cases), followed by the pneumococcal vaccine (13%) (Martin Arias, 2017).

SIRVA is rare and thought to be an immune response to the active agents within the vaccine. It occurs when the vaccine is administered deep to the deltoid muscle and into the subdeltoid or subcromial bursa, rotator cuff and/or underlying bone. The placement of the vaccine into these areas can result in inflammation, bursitis and damage to the tendons and bone.

An MRI can be helpful confirming the diagnosis as these features are often visible on MRI. Frozen shoulder is also sometimes associated with SIRVA.

Treatments for SIRVA

Treatment typically involves pain management with non-steroidal anti-inflammatory medications, physical therapy and intra-articular steroid injections. Surgical management has also been reported in one case report (Wong et al 2021).

Tenex for SIRVA

The Tenex device has been used in a similar way and may be an alternative to surgery. Tenex can be used to wash out subacromial and subdeltoid space, and remove portions of damaged tendon or bone. The Tenex device is minimally invasive and uses ultrasound guidance to visualize the painful tissue, and Tenex may be a good alternative to traditional orthopedic surgery.

Dr. Bodor and the Napa Medical Research Foundation were the first to report this novel use of the Tenex technology, with patient pain resolving within a month of the procedure (NMRF 2019). If you have symptoms of SIRVA call for a consultation at (781) 591-7855 or email at info@BSBortho.com.

Contact Dr. Sussman at:

20 Walnuts St. Suite 14

Wellesley MA 02481

(781) 591-7855

info@bsbortho.com

References

1. Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases. [Accessed June 3, 2019]. https://www.cdc.gov/vaccines/pubs/pinkbook/vac-admin.html. Published 2015.
2. Martín Arias LH, Sanz Fadrique R, Sáinz Gil M, Salgueiro-Vazquez ME. Risk of bursitis and other injuries and dysfunctions of the shoulder following vaccinations. Vaccine. 2017 Sep 5; 35(37):4870-4876.
3. Napa Medical Research Foundation. Shoulder recovery from vaccine injection. [Accessed March 12, 2021]. https://napamedicalresearch.org/shoulder-recovery-from-vaccine-injection/. Published 2019.
4. Wong W, Okafor C, Belay E, Klifto CS, Anakwenze O. Arthroscopic Surgical Management of Shoulder Secondary to Shoulder injury related to vaccine administration (SIRVA): A Case Report. J Shoulder Elbow Surg. 2021 Feb 18:S1058-2746(21)00108-7.