CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2021; 56(03): 299-306
DOI: 10.1055/s-0040-1719086
Revisão Sistemática
Ombro e Cotovelo

Shoulder Injury after Vaccination: A Systematic Review

Article in several languages: português | English
1   Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, Nova York, Nova York, Estados Unidos
› Author Affiliations

Abstract

Adverse reactions to vaccine injections are usually mild and incredibly rare in nature, but multiple cases of shoulder events including bursitis, generalized pain or decreased range of motion have been reported following routine vaccine administrations. These events are known as Shoulder Injury Related to Vaccine Administration or SIRVA.

A systematic review of literature was performed to identify all published accounts of SIRVA. Twenty-seven papers reporting one or more accounts of SIRVA were identified. The most common vaccination involved was the Influenza vaccine. The most common symptoms were pain that began in 48 hours or less and loss of shoulder range of motion. The most common treatment modalities were physical therapy, corticosteroid injections and anti-inflammatory medication; but in some patients, surgery was required. Regardless of intervention, the vast majority of outcomes demonstrated improved pain and functional except in the occasions of nerve injury.

The etiology of SIRVA injuries has multiple possibilities including needle length, mechanical injury from needle overpenetration and the possibility of an immune inflammatory response from the vaccine components, but a unique definitive test or quantifiably result does not yet exist.



Publication History

Received: 20 May 2020

Accepted: 16 September 2020

Article published online:
16 December 2020

© 2020. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 
  • Referências

  • 1 Cunningham LS, Kelsey JL. Epidemiology of musculoskeletal impairments and associated disability. Am J Public Health 1984; 74 (06) 574-579
  • 2 Luime JJ, Koes BW, Hendriksen IJM. et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol 2004; 33 (02) 73-81
  • 3 Current Trends Vaccine Adverse Event Reporting System–United States. Accessed March 1, 2019 at: https://www.cdc.gov/mmwr/preview/mmwrhtml/00001804.htm
  • 4 The National Childhood Vaccine Injury Act of 1986. Public Health Service Act *** 2125. (42 U.S.C. *** 300aa-25 (Supp. 1987))
  • 5 Ryan T. 2011 Institute of Medicine (IOM) Report generated Proposals for Updates to the Vaccine Injury Table
  • 6 Vaccine Injury Table. [Accessed March 1, 2019] at: https://www.hrsa.gov/sites/default/files/hrsa/vaccine-compensation/vaccine-injury-table.pdf
  • 7 Atanasoff S, Ryan T, Lightfoot R, Johann-Liang R. Shoulder injury related to vaccine administration (SIRVA). Vaccine 2010; 28 (51) 8049-8052
  • 8 Salmon JH, Geoffroy M, Eschard JP, Ohl X. Bone erosion and subacromial bursitis caused by diphtheria-tetanus-poliomyelitis vaccine. Vaccine 2015; 33 (46) 6152-6155
  • 9 Terreri MT, Yamada AF. Osteitis caused by BCG vaccination. Pediatr Radiol 2008; 38 (04) 481
  • 10 Barnes MG, Ledford C, Hogan K. A “needling” problem: shoulder injury related to vaccine administration. J Am Board Fam Med 2012; 25 (06) 919-922
  • 11 Shaikh MF, Baqai TJ, Tahir H. Acute brachial neuritis following influenza vaccination. BMJ Case Rep 2012; 2012: 1-2
  • 12 Messerschmitt PJ, Abdul-Karim FW, Iannotti JP, Gobezie RG. Progressive osteolysis and surface chondrolysis of the proximal humerus following influenza vaccination. Orthopedics 2012; 35 (02) e283-e286
  • 13 Kuether G, Dietrich B, Smith T, Peter C, Gruessner S. Atraumatic osteonecrosis of the humeral head after influenza A-(H1N1) v-2009 vaccination. Vaccine 2011; 29 (40) 6830-6833
  • 14 Bodor M, Montalvo E. Vaccination-related shoulder dysfunction. Vaccine 2007; 25 (04) 585-587
  • 15 Cook IF. Subdeltoid/subacromial bursitis associated with influenza vaccination. Hum Vaccin Immunother 2014; 10 (03) 605-606
  • 16 Saleh ZM, Faruqui S, Foad A. Onset of frozen shoulder following pneumococcal and influenza vaccinations. J Chiropr Med 2015; 14 (04) 285-289
  • 17 Hexter AT, Gee E, Sandher D. Management of glenohumeral synovitis secondary to influenza vaccination. Shoulder Elbow 2015; 7 (02) 100-103
  • 18 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; 35 (37) 4870-4876
  • 19 Floyd MW, Boyce BM, Castellan RM, McDonough EB. Pseudoseptic arthritis of the shoulder following pneumococcal vaccination. Orthopedics 2012; 35 (01) e101-e103
  • 20 Cross GB, Moghaddas J, Buttery J, Ayoub S, Korman TM. Don't aim too high: Avoiding shoulder injury related to vaccine administration. Aust Fam Physician 2016; 45 (05) 303-306
  • 21 Okur G, Chaney KA, Lomasney LM. Magnetic resonance imaging of abnormal shoulder pain following influenza vaccination. Skeletal Radiol 2014; 43 (09) 1325-1331
  • 22 Degreef I, Debeer P. Post-vaccination frozen shoulder syndrome. Report of 3 cases. Acta Chir Belg 2012; 112 (06) 447-449
  • 23 McColgan BP, Borschke FA. Pseudoseptic arthritis after accidental intra-articular deposition of the pneumococcal polyvalent vaccine: a case report. Am J Emerg Med 2007; 25 (07) 864.e1-864.e3
  • 24 Bathia NA, Stitik T. “Influenza vaccine shoulder”–vaccination related traumatic injury to the infraspinatus: a case report [Poster presentation]. Assoc Acad Physiat Ann Meet 2010;. PM R 2009; 1: S118
  • 25 Shafer B, Burroughs K. Shoulder pain in a 25-year-old female following an influenza vaccination. Am Med Soc Sport Med 2010. Available at: https://www.amssm.org/shoulder_pain_in_a_25_year-csa
  • 26 Uchida S, Sakai A, Nakamura T. Subacromial bursitis following human papilloma virus vaccine misinjection. Vaccine 2012; 31 (01) 27-30
  • 27 DeRogatis MJ, Parameswaran L, Lee P, Mayer TG, Issack PS. Septic Shoulder Joint After Pneumococcal Vaccination Requiring Surgical Debridement. HSS J 2018; 14 (03) 299-301
  • 28 Jotwani V, Narducci DM. Pain in right shoulder · recent influenza vaccination · history of hypertension and myocardial infarction · Dx?. J Fam Pract 2019; 68 (01) 44-46
  • 29 Imran M, Hayley D. Injection-induced axillary nerve injury after a drive- through Flu shot. Clin Geriatr 2013;21(12):
  • 30 Meirelles H, Filho GRM. Axillary nerve injury caused by deltoid muscle intramuscular injection: case report. Rev Bras Ortop 2004; 39 (10) 615-619
  • 31 Erickson BJ, DiCarlo EF, Brause B, Callahan L, Hannafin J. Lytic Lesion in the Proximal Humerus After a Flu Shot: A Case Report. JBJS Case Connect 2019; 9 (03) e0248
  • 32 Shahbaz M, Blanc PD, Domeracki SJ, Guntur S. Shoulder Injury Related to Vaccine Administration (SIRVA): An Occupational Case Report. Workplace Health Saf 2019; 67 (10) 501-505
  • 33 Macomb CV, Evans MO, Dockstader JE, Montgomery JR, Beakes DE. Treating SIRVA Early With Corticosteroid Injections: A Case Series. Mil Med 2020; 185 (1-2): e298-e300
  • 34 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (07) e1000097
  • 35 Obremskey WT, Pappas N, Attallah-Wasif E, Tornetta 3rd. P, Bhandari M. Level of evidence in orthopaedic journals. J Bone Joint Surg Am 2005; 87 (12) 2632-2638
  • 36 Bilgili SG, Karadag AS, Ceylan MF, Calka O, Turktas U, Bulut G. The development of giant lipoma on the BCG vaccine caused scar. Cutan Ocul Toxicol 2012; 31 (01) 70-73
  • 37 Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg 1999; 8 (04) 296-299
  • 38 Minagawa H, Yamamoto N, Abe H. et al. Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village. J Orthop 2013; 10 (01) 8-12
  • 39 Yamaguchi K, Tetro AM, Blam O, Evanoff BA, Teefey SA, Middleton WD. Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically. J Shoulder Elbow Surg 2001; 10 (03) 199-203
  • 40 Centers for Disease Control and Prevention. Dose, route, site, and needle size. [Accessed March 22, 2019] at: www.immunize.org/catg.d/p3085.pdf
  • 41 Poland GA, Borrud A, Jacobson RM. et al. Determination of deltoid fat pad thickness. Implications for needle length in adult immunization. JAMA 1997; 277 (21) 1709-1711
  • 42 Lippert WC, Wall EJ. Optimal intramuscular needle-penetration depth. Pediatrics 2008; 122 (03) e556-e563
  • 43 Cook IF, Williamson M, Pond D. Definition of needle length required for intramuscular deltoid injection in elderly adults: an ultrasonographic study. Vaccine 2006; 24 (07) 937-940
  • 44 Zuckerman JN. The importance of injecting vaccines into muscle. Different patients need different needle sizes. BMJ 2000; 321 (7271): 1237-1238
  • 45 Beals TC, Harryman 2nd DT, Lazarus MD. Useful boundaries of the subacromial bursa. Arthroscopy 1998; 14 (05) 465-470
  • 46 How to Administer Intramuscular and Subcutaneous Vaccine Injections to Adults. [Accessed March 15, 2019] at. http://www.immunize.org/catg.d/p2020A.pdf
  • 47 Dumonde DC, Glynn LE. The production of arthritis in rabbits by an immunological reaction to fibrin. Br J Exp Pathol 1962; 43 (04) 373-383
  • 48 Cooke TD, Jasin HE. The pathogenesis of chronic inflammation in experimental antigen-induced arthritis. I. The role of antigen on the local immune response. Arthritis Rheum 1972; 15 (04) 327-337
  • 49 Cooke TD, Hurd ER, Ziff M, Jasin HE. The pathogenesis of chronic inflammation in experimental antigen-induced arthritis. II. Preferential localization of antigen-antibody complexes to collagenous tissues. J Exp Med 1972; 135 (02) 323-338
  • 50 Jasin HE. Mechanism of trapping of immune complexes in joint collagenous tissues. Clin Exp Immunol 1975; 22 (03) 473-485
  • 51 Trollmo C, Carlsten H, Tarkowski A. Intra-articular immunization induces strong systemic immune response in humans. Clin Exp Immunol 1990; 82 (02) 384-389