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Li Z, Chen S, Zhao M. An analysis of reported cases shoulder injury related to vaccine administration of after COVID-19 vaccination. Hum Vaccin Immunother 2024; 20:2321672. [PMID: 38439670 PMCID: PMC10936633 DOI: 10.1080/21645515.2024.2321672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/18/2024] [Indexed: 03/06/2024] Open
Abstract
To prevent COVID-19, the COVID-19 vaccine has been widely administered worldwide, but various complications accompany this vaccine. The aim of this study was to investigate the demographic patterns, clinical features, diagnostic findings, and treatment outcomes associated with shoulder injury related to vaccine administration (SIRVA). This study examined 22 patients with SIRVA following COVID-19 vaccination from the Web of Science (WOS) and PubMed databases. The patients were categorized based on sex, age, type of COVID-19 vaccine received, dose administered, latency of symptom onset, and the presence of specific clinical manifestations. Patients, evenly distributed by sex (12 females, 10 males), and aged 21 to 84 years (mean age 46.6), were analyzed. SIRVA cases were reported across all age groups. The Pfizer - BioNTech COVID-19 vaccine had the highest incidence (n = 8), followed by the Oxford/AstraZeneca COVID-19 vaccine (n = 4). Symptoms, primarily shoulder pain (n = 22) and shoulder mobility disorders (n = 18), occurred within three days post-vaccination. Some patients also reported shoulder swelling (n = 5) and fever (n = 2). Imaging revealed nonspecific X-ray findings, supraspinatus tendon calcification (n = 2), and shoulder edema and inflammation on MRI (n = 12). This study provides insights into the clinical aspects of SIRVA related to COVID-19 vaccination. Recognition and appropriate management of these complications are crucial for optimal patient outcomes.
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Affiliation(s)
- Zixin Li
- Department of Spine Surgery and Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shijie Chen
- Department of Spine Surgery and Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mingyi Zhao
- Department of Spine Surgery and Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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Fortier LM, Smith KL, Ina JG, Sinkler MA, Calcei JG, Salata MJ, Gillespie R, Voos JE. Common characteristics of shoulder injury related to vaccine administration following COVID-19 vaccination: a comprehensive systematic review. J Shoulder Elbow Surg 2024; 33:202-209. [PMID: 37660886 DOI: 10.1016/j.jse.2023.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/18/2023] [Accepted: 07/29/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND The pathogenesis of shoulder injury related to vaccine administration (SIRVA) is incompletely understood, but it is postulated to be an immune-mediated inflammatory response to a vaccine antigen, leading to shoulder pain and dysfunction. The purpose of this investigation is to systematically review the literature related to SIRVA specifically after the COVID-19 vaccination by describing the diagnostic and clinical characteristics, diagnoses associated with SIRVA, and incidence between vaccine types. METHODS A systematic review was performed to identify level I to IV studies and case descriptions of shoulder pain occurring after COVID-19 vaccination. To confirm that no studies were missing from the systematic review, references of studies from the initial search were scanned for additional relevant studies. RESULTS A total of 22 studies, comprised of 81 patients, were identified meeting the inclusion/exclusion criteria. Reports were most commonly published from countries in Asia (53.1%; n = 43/81). The most commonly described vaccines were Oxford-AstraZeneca at 37.0% (n = 30/81) and Pfizer-BioNTech at 33.3% (n = 27/81). Symptoms occurred most commonly after at least 72 hours of administration (30.9%, n = 25/81). One hundred percent of patients (n = 81/81) described pain as an associated symptom and 90.1% of patients (n = 73/81) described multiple symptoms. The diagnostic modalities utilized to identify a specific pathology consisted of magnetic resonance imaging (55.6%; n = 45/81), ultrasound (28.4; n = 23/81), radiograph (25.9%; n = 21/81), and computed tomography (4.9%; 4/81). Nearly a third of patients (32.1%; n = 26/81) were diagnosed with bursitis, while 22 (27.2%) were diagnosed with adhesive capsulitis, 17 (21.0%) with either rotator cuff tear or tendinopathy, and 14 (17.3%) with polymyalgia rheumatica or polymyalgia rheumatica-like syndrome. The 2 most common treatment options were physical therapy (34.6%; n = 28/81) and nonsteroidal anti-inflammatory medications (33.3%; 27/81). The majority of SIRVA cases (52.1%; n = 38/73) completely resolved within a few weeks to months. CONCLUSION Despite the limited quality and lack of large-scale studies, it is important for providers to recognize SIRVA as a potential risk factor as the number of patients receiving COVID-19 vaccinations and boosters continues to rise.
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Affiliation(s)
- Luc M Fortier
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - Kira L Smith
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jason G Ina
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Margaret A Sinkler
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jacob G Calcei
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Michael J Salata
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Robert Gillespie
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - James E Voos
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Sahu D. Authors' response-how are vaccines related to frozen shoulder development? JSES Int 2024; 8:237-238. [PMID: 38312280 PMCID: PMC10837685 DOI: 10.1016/j.jseint.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Affiliation(s)
- Dipit Sahu
- Mumbai Shoulder Institute, Mumbai, India
- Jupiter Hospital Thane, Thane, India
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da Silva LNM, Filho AGO, Guimarães JB. Musculoskeletal manifestations of COVID-19. Skeletal Radiol 2023:10.1007/s00256-023-04549-4. [PMID: 38117308 DOI: 10.1007/s00256-023-04549-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/15/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023]
Abstract
During the COVID-19 pandemic, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected millions of people worldwide, with acute respiratory distress syndrome (ARDS) being the most common severe condition of pulmonary involvement. Despite its involvement in the lungs, SARS-CoV-2 causes multiple extrapulmonary manifestations, including manifestations in the musculoskeletal system. Several cases involving bone, joint, muscle, neurovascular and soft tissues were reported shortly after pandemic onset. Even after the acute infection has resolved, many patients experience persistent symptoms and a decrease in quality of life, a condition known as post-COVID syndrome or long COVID. COVID-19 vaccines have been widely available since December 2020, preventing millions of deaths during the pandemic. However, adverse reactions, including those involving the musculoskeletal system, have been reported in the literature. Therefore, the primary goal of this article is to review the main imaging findings of SARS-CoV-2 involvement in the musculoskeletal system, including acute, subacute, chronic and postvaccination manifestations.
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Affiliation(s)
- Lucas N M da Silva
- Department of Musculoskeletal Radiology, Grupo Fleury, Sao Paulo, Brazil
| | | | - Júlio Brandão Guimarães
- Department of Musculoskeletal Radiology, Grupo Fleury, Sao Paulo, Brazil.
- Department of Radiology, Universidade Federal de Sao Paulo, UNIFESP-EPM, Sao Paulo, Brazil.
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA.
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Mülkoğlu C, Tiftik T, Deniz AB, Taka İ, Genç H. Analysis of patients with adhesive capsulitis after COVID-19 vaccination: An observational study. Turk J Phys Med Rehabil 2023; 69:520-525. [PMID: 38766580 PMCID: PMC11099864 DOI: 10.5606/tftrd.2023.12660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/03/2023] [Indexed: 05/22/2024] Open
Abstract
Objectives This study aimed to increase the awareness of clinicians about shoulder injury related to vaccine administration (SIRVA) by analyzing 21 patients with adhesive capsulitis that developed after COVID-19 (coronavirus disease 2019) vaccination. Patients and methods In this observational study, 21 patients (11 males, 10 females; mean age: 60.7±7.3 years; range, 45 to 70 years) with incipient shoulder pain and limitation diagnosed with adhesive capsulitis due to SIRVA were evaluated between June 2021 and December 2022. Demographic and clinical data of the patients were recorded. Pain was evaluated with the Visual Analog Scale (VAS). The passive range of motion (ROM) of the affected shoulder was measured by a goniometer. The applied treatment methods (medical treatment, physical therapy, intraarticular steroid injection, hydrodilatation, and suprascapular nerve block) were recorded. The patients were called in for control two months later. Visual Analog Scale scores and passive shoulder ROMs were reevaluated. Results Symptoms started after the second dose in nine (42.9%) patients. The mean time between vaccination and onset of complaints was 8.0±6.4 days. Sinovac vaccine was administered to eight patients, BioNTech vaccine was administered to five patients, and Sinovac+BioNTech vaccine was administered to eight patients. Baseline to control ROM angle changes were 128.8±30.4º to 155.0±20.6° for flexion, 117.1±37.8° to 147.1±26.4° for abduction, 45.9±17.8° to 61.9±12.6° for internal rotation, and 43.4±21.9° to 56.3±18.3° for external rotation, respectively. The mean VAS scores were 7.0±1.2 (5-9) at baseline and 2.7±1.0 (1-5) at the control. There was a statistically significant difference between the baseline and control (two months after treatment) in terms of VAS scores and ROM angles (p<0.001). Conclusion Clinicians should be aware of adhesive capsulitis following vaccine administration since a significant improvement can be obtained by proper treatment for SIRVA.
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Affiliation(s)
- Cevriye Mülkoğlu
- Department of Physical Medicine and Rehabilitation, Health Sciences University, Ankara Training and Research Hospital, Ankara, Türkiye
| | - Tülay Tiftik
- Department of Physical Medicine and Rehabilitation, Health Sciences University, Ankara Training and Research Hospital, Ankara, Türkiye
| | - Ayşegül Berna Deniz
- Department of Physical Medicine and Rehabilitation, Health Sciences University, Ankara Training and Research Hospital, Ankara, Türkiye
| | - İbrahim Taka
- Department of Physical Medicine and Rehabilitation, Health Sciences University, Ankara Training and Research Hospital, Ankara, Türkiye
| | - Hakan Genç
- Department of Physical Medicine and Rehabilitation, Health Sciences University, Ankara Training and Research Hospital, Ankara, Türkiye
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Alshehri M, Alsalman M, Alsebayel FM. Adhesive capsulitis following COVID-19 vaccination: a case report and review of literature. J Surg Case Rep 2023; 2023:rjad611. [PMID: 37965532 PMCID: PMC10642426 DOI: 10.1093/jscr/rjad611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/15/2023] [Indexed: 11/16/2023] Open
Abstract
Shoulder injury related to vaccine administration (SIRVA) has been frequently reported adverse event following COVID-19 vaccination. Multiple studies have reported various injuries including subacromial bursitis, rotator cuff tears, nerve injury, and most commonly, adhesive capsulitis. Adhesive capsulitis is defined as an inflammatory disease of the joint capsule characterized by pain and stiffness. Herein, we present a case of a 38-year-old female, known to have uncontrolled diabetes mellites and asthma, presented to upper extremity orthopedic clinic complaining of 6 months history of left shoulder pain and limited range of motion following COVID-19 vaccination administration. Clinical examination and radiological studies were consistent with adhesive capsulitis, the patient was then referred for intensive rehabilitation program that provided adequate response. In conclusion, the main etiology of SIRVA has been attributed to suboptimal injection technique, a standardized definition, implementation of safe vaccines injection protocols, and further education and awareness of SIRVA is needed to healthcare practitioners to allow better understanding and prevention.
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Affiliation(s)
- Mohammed Alshehri
- Department of Orthopedic Surgery, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed Alsalman
- Department of Medical Radiology, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Firas M Alsebayel
- Department of Orthopedic Surgery, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Miyano M, Tsukuda Y, Hiratsuka S, Hamasaki M, Iwasaki N. Chronic shoulder injury related to vaccine administration following coronavirus disease 2019 vaccination: a case report. J Med Case Rep 2023; 17:456. [PMID: 37845692 PMCID: PMC10580499 DOI: 10.1186/s13256-023-04198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 10/02/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Shoulder injury related to vaccine administration, defined as shoulder pain and limited range of motion occurring after administration in the upper arm, has been previously reported. The symptom resolved completely after treatment with oral nonsteroidal anti-inflammatory drugs or an intraarticular steroid injection, however there have been few reports of long-term symptoms following coronavirus disease 2019 vaccination. This case report describes a healthy, middle-aged, healthcare worker who developed post-vaccination subacromial-subdeltoid bursitis that lasted for more than 6 months after Pfizer-BioNTech coronavirus disease 2019 vaccination. CASE PRESENTATION A 55-year-old Japanese woman with no significant medical history was vaccinated in the standard site, with the needle direction perpendicular to the skin. Within a few hours after the second vaccination, severe shoulder pain and limited range of motion appeared. Although shoulder range of motion improved, her shoulder pain did not improved for several months, and she consulted an orthopedic doctor 5 months later. Radiographs of her left shoulder did not provide helpful diagnostic information. High intensity in the subacromial-subdeltoid space was seen on short TI inversion recovery of magnetic resonance imaging, showing subacromial-subdeltoid bursitis. She was diagnosed with a shoulder injury related to vaccine administration. The patient was started on an oral anti-inflammatory drug, and the left subacromial space was injected with 2.5 mg of betamethasone with 3 ml of 1% lidocaine without epinephrine every 2 weeks. One month after starting this treatment, since her shoulder pain had not improved, the oral anti-inflammatory drug was switched to tramadol hydrochloride acetaminophen. However, 3 months after switching medication, the shoulder pain continued, and she worked so as to have minimal impact on her shoulder. CONCLUSION A case of subacromial-subdeltoid bursitis following a second dose of the Pfizer-BioNTech coronavirus disease 2019 vaccine that lasted many months is reported. Injection technique is a modifiable risk factor, the adverse effects of which could potentially be mitigated with appropriate and relevant training of healthcare providers. To prevent this type of case, the appropriate landmark, needle length, and direction should be confirmed.
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Affiliation(s)
- Masahiro Miyano
- Department of Orthopaedic Surgery, Otaru General Hospital, Wakamatsu 1-1-1, Otaru, Hokkaido, 047-8550, Japan
| | - Yukinori Tsukuda
- Department of Orthopaedic Surgery, Otaru General Hospital, Wakamatsu 1-1-1, Otaru, Hokkaido, 047-8550, Japan.
| | - Shigeto Hiratsuka
- Department of Orthopaedic Surgery, Otaru General Hospital, Wakamatsu 1-1-1, Otaru, Hokkaido, 047-8550, Japan
| | - Masanari Hamasaki
- Department of Orthopaedic Surgery, Otaru General Hospital, Wakamatsu 1-1-1, Otaru, Hokkaido, 047-8550, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Janssen ERC, van Montfoort AZ, Hollman F, Lambers Heerspink FO. The prevalence and clinical course of shoulder injury related to vaccine administration (SIRVA) after COVID-19 vaccines in Dutch hospital workers. Vaccine 2023; 41:6042-6047. [PMID: 37635003 DOI: 10.1016/j.vaccine.2023.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION Shoulder Injury Related to Vaccine Administration (SIRVA) is a rare disorder characterized by persistent shoulder pain and limited range of motion presenting within 48 h after vaccine administration. With the widespread distribution of the COVID-19 vaccine, the incidence of SIRVA is expected to rise. This sudden rise in vaccine administration presents an ideal opportunity to estimate the prevalence of SIRVA and to better characterize SIRVA. OBJECTIVE This study aims to investigate the prevalence of SIRVA following COVID-19 vaccine administration among hospital workers in the Netherlands. METHODS A questionnaire was sent to all hospital workers from a single non-academic hospital in the Netherlands. Respondents who had active SIRVA complaints were invited for an outpatient orthopaedic clinic assessment. Data was collected on participant characteristics and physical examination including assessment of active and passive range of motion (ROM). An ultrasound was performed to identify potential abnormalities. RESULTS 32 out of 981 (3.3%) respondents reported shoulder pain with limited ROM occurring within 48 h after vaccine administration lasting for at least 7 days. Of these 32 respondents with SIRVA, 18 (56.2%) still reported active symptoms at the time of the survey. Clinical examination of 13 (72.2%) respondents with active SIRVA complaints showed limited glenohumeral ROM, limitations in activities of daily living and injection site pain. Twelve out of thirteen (92.3%) respondents with active SIRVA complaints showed abnormalities of the soft-tissue of the shoulder on ultrasound. Physiotherapy was the most common treatment modality for persistent SIRVA complaints (38.9%). CONCLUSIONS The prevalence of SIRVA is estimated at 3% in the adult working population. Signs and symptoms of SIRVA are variable in severity, localization and timing. Soft-tissue abnormalities is the most common clinical sign. This study contributes to clinician's knowledge on SIRVA, aiding in early recognition and treatment, which are imperative for prevention of persistent and severe shoulder pathology.
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Affiliation(s)
- Esther R C Janssen
- Department of Orthopedic Surgery, VieCuri Medical Centre, Venlo, The Netherlands; Department of Orthopedics and Research School Caphri, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - Astrid Z van Montfoort
- Department of Orthopedic Surgery, VieCuri Medical Centre, Venlo, The Netherlands; Department of Orthopedics and Research School Caphri, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Freek Hollman
- Department of Orthopedic Surgery, VieCuri Medical Centre, Venlo, The Netherlands
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Kowatari R, Sasaki H, Murata K, Sato K, Sagawa K, Kudo M, Minakawa M. Establishment of prediction equations for subcutaneous tissue thickness in two representative intramuscular deltoid injections. Vaccine X 2023; 14:100316. [PMID: 37275271 PMCID: PMC10239006 DOI: 10.1016/j.jvacx.2023.100316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/07/2023] Open
Abstract
This study clarifies the predicted subcutaneous shoulder depth and investigates the safety of the conventional (three-finger breadth method) and new (axillary method) intramuscular injection methods. The anatomical features of 245 volunteers who received the COVID-19 vaccination via the conventional method were investigated at the injection site (T point) and the hypothetical injection site using the new method (A point) via ultrasonography. The body mass index (BMI) and subcutaneous thickness at the T point (men: r = 0.75; women: r = 0.45) and the A point (men: r = 0.81; women: r = 0.55) were positively correlated. The upper arm circumference and subcutaneous thickness at the T point (r = 0.51) and the A point (r = 0.58) were correlated in women. Formulas to predict subcutaneous thickness using BMI and upper arm circumference were established: predicted subcutaneous thickness at the A point = 0.62 × BMI - 7.7 mm (R2 = 0.66) in men and 0.658 × BMI - 5.5 mm (R2 = 0.31) in women. This study demonstrates safe intramuscular injection sites and their depth.
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Affiliation(s)
- Ryosuke Kowatari
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Japan
| | - Hanae Sasaki
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Japan
| | - Kenyu Murata
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Japan
| | - Ken Sato
- Hirosaki University Health Administration Center, Japan
| | - Koichi Sagawa
- Hirosaki University Graduate School of Science and Technology, Japan
| | - Masako Kudo
- Hirosaki University Hospital Nursing Department, Japan
| | - Masahito Minakawa
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Japan
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İğrek S, Ulusoy İ, Çeliksöz AH. Does COVID-19 vaccine exacerbate rotator cuff symptoms? A prospective study. BMC Musculoskelet Disord 2023; 24:551. [PMID: 37403025 DOI: 10.1186/s12891-023-06660-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/22/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Shoulder injury related to vaccine administration (SIRVA) is a rare but increasing complication after vaccination. The aim of this study was to increase awareness of post-vaccination shoulder pain and to investigate the effect of the clinical condition of the shoulder before vaccination on the loss of function that may occur after vaccination. METHODS This prospective study included 65 patients aged > 18 years who were diagnosed with unilateral shoulder impingement and/or bursitis. The first vaccination was performed on the shoulders with rotator cuff symptoms, then the second vaccination was performed on healthy shoulders of same patients as soon as the health system allowed. Pre-vaccination MRI of the symptomatic shoulders of the patients was performed and VAS, ASES and Constant scores were evaluated. At 2 weeks after vaccination of the symptomatic shoulder, scores were reassessed. For the patients with changes in the scores, MRI was performed again and the treatment of all patients was started. A second vaccination was given to asymptomatic shoulders and the patients were recalled two weeks later and their scores were evaluated. RESULTS After vaccination, the symptomatic shoulder of 14 patients was affected. No clinical changes were observed in the asymptomatic shoulders after vaccination. The VAS scores of the symptomatic shoulders evaluated after vaccination were significantly higher than the scores evaluated before vaccination (p = 0.001). The ASES and Constant scores of symptomatic shoulders evaluated after vaccination were significantly decreased compared to the scores evaluated before vaccination (p = 0.001). CONCLUSIONS Exacerbation of symptoms may occur if symptomatic shoulders are vaccinated. Before vaccination, a detailed anamnesis should be taken from the patients and vaccination should be performed to the asymptomatic side.
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Affiliation(s)
- Servet İğrek
- Department of Orthopaedics and Traumatology, Selahaddin Eyyubi State Hospital, Diyarbakır, Turkey.
| | - İbrahim Ulusoy
- Department of Orthopaedics and Traumatology, Selahaddin Eyyubi State Hospital, Diyarbakır, Turkey
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Foong B, Ho S, Tan L, Lee KT, Jegathesan T. Adhesive Capsulitis Secondary to COVID-19 Vaccination - A Case Series. Malays Orthop J 2023; 17:43-48. [PMID: 37583521 PMCID: PMC10425003 DOI: 10.5704/moj.2307.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 03/23/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction Shoulder injury related to vaccine administration (SIRVA) is a group of pathologies defined by pain and stiffness after intramuscular administration of vaccine to the upper arm and has been reported after COVID-19 vaccination. We aim to discuss its pathophysiology, clinical presentation, treatment and outcomes. Materials and methods We retrospectively identified patients presenting with adhesive capsulitis within four weeks of administration of COVID-19 vaccine to the affected arm at our tertiary institution from March 2021 to December 2022. Result Based on the above criteria, we identified seven cases of adhesive capsulitis, comprising one male and six female patients, with average age of 60 years. We present initial symptoms, signs and the duration from when the vaccine was administered. We have highlighted our treatment strategies as well as the clinical and functional outcomes reported by these patients after treatment. We have reported improvement in both Visual Analogue Scale (VAS) and range of motion (ROM) in all our patients after non-surgical management which included physiotherapy and, in some cases, hydrodilatation. Conclusion SIRVA related adhesive capsulitis is rare and under-reported with limited information in current literature. This study highlights that adhesive capsulitis is a potential complication arising from improper COVID-19 vaccine administration and reinforces traditional wisdom of administering vaccinations on the non-dominant arm. Conservative treatment strategies appear to be effective, particularly hydrodilatation combined with physiotherapy, and patients are expected to have a good return of function.
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Affiliation(s)
- Bcm Foong
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Swl Ho
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Ltj Tan
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - K T Lee
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - T Jegathesan
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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Quinodoz A, Luthi F, Revaz S, Konzelmann M. Acute myopericarditis and left shoulder capsulitis following second dose of mRNA SARS-CoV-2 Moderna vaccination. BMJ Case Rep 2023; 16:16/6/e254110. [PMID: 37263680 DOI: 10.1136/bcr-2022-254110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Vaccination against mRNA SARS-CoV-2 has been administered on a very large scale and various side effects have been described. The increased risk of myopericarditis is known, and only a few cases of shoulder capsulitis have been reported after vaccination. These two pathologies have never been reported in the same patient after vaccination. Our article presents the history of a man in his 40s who presented with myopericarditis a few days after vaccination against SARS-CoV-2 with mRNA(Messenger RNA) Moderna® vaccine and who at the same time developed shoulder capsulitis. His cardiovascular symptoms resolved rapidly, and his shoulder symptoms improved/resolved within 1 year. This case should make physicians aware of the possibility of several concomitant side effects following vaccination against SARS-CoV-2.
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Affiliation(s)
- Adrien Quinodoz
- Department of Musculoskeletal Rehabilitation, Clinique Romande de réadaptation, Sion, Switzerland
| | - Francois Luthi
- Department of Musculoskeletal Rehabilitation, Clinique Romande de réadaptation, Sion, Switzerland
- Department of Physical medicine and Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
| | - Sylvie Revaz
- Assessment and consultation service, Clinique Romande de réadaptation, Sion, Switzerland
| | - Michel Konzelmann
- Assessment and consultation service, Clinique Romande de réadaptation, Sion, Switzerland
- Research service, Clinique Romande de réadaptation, Sion, Switzerland
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Nakajima K, Miyata A, Kato S, Oshima Y, Tanaka S. Calcific tendinitis of the shoulder induced by an mRNA vaccine for COVID-19: A case report. Mod Rheumatol Case Rep 2023; 7:211-214. [PMID: 35134200 PMCID: PMC8903335 DOI: 10.1093/mrcr/rxac006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/05/2022] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
Coronavirus disease 2019 (COVID-19) vaccines have been widely used and have been shown to be effective in combating the pandemic. However, various side effects have been reported following vaccination. For instance, a condition called 'shoulder injury related to vaccine administration' (SIRVA) is characterized by shoulder pain and limited range of motion after intramuscular injection of a vaccine into the deltoid muscle of the shoulder. Despite an increase in SIRVA cases, the exact incidence of the disease is unclear, and there are a few reports of SIRVA about the COVID-19 vaccine. Here, we report a rare case of an 83-year-old woman who was diagnosed with calcification in her left shoulder 1 year ago and developed calcific tendinitis after receiving an mRNA vaccine for COVID-19 (Pfizer-BioNTech). Radiographs showed calcification of the supraspinatus tendon, and magnetic resonance images showed continuous inflammatory findings from the subdeltoid bursa to the subacromial bursa. We treated the patient with celecoxib and acetaminophen, and she recovered after about 2 months. In order to prevent SIRVA, the presence of shoulder joint disease should be carefully asked during a pre-vaccination assessment. The puncture point should be chosen with the median point of the deltoid muscle or the anterior-posterior axillary line as landmarks because the more cephalad the puncture position, the greater the chance of causing SIRVA.
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Affiliation(s)
- Koji Nakajima
- Corresponding author: Koji Nakajima, Department of Orthopaedic Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan, 113-8655. Tel: 81-3-3815-5411, E-mail:
| | - Akira Miyata
- Department of Orthopaedic Surgery, Tokatsu Hospital, Chiba, Japan
| | - So Kato
- Department of Orthopaedic Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
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14
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Izumi M, Morimoto T, Oda S, Ohishi D, Hayashi Y, Shimokawa T, Ozaki K, Nakamae A, Saito R, Fujii Y, Komatsu N, Seo H, Ikeuchi M. Assessment of multiple domains of pain following BNT162b2 mRNA COVID-19 vaccination. THE JOURNAL OF MEDICAL INVESTIGATION 2023; 70:355-360. [PMID: 37940519 DOI: 10.2152/jmi.70.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Pain at the injection site is the most frequent reaction among COVID-19 vaccine recipients, but its characteristics were not fully described yet. The purpose of this study was to investigate multiple domains of pain following BNT162b2 mRNA vaccination. We included 107 subjects undergoing primary shot of the vaccination twice into deltoid muscle with a 3-week interval. They completed 6 sessions of pain assessments, one before the first and second dose (1-0, 2-0), and 1st/7th day after the first and second dose (1-1/1-7, 2-1/2-7). Pain visual analog scale (VAS), pain distribution, and pressure pain threshold (PPT) on deltoid muscle were evaluated in each session. The mean VAS (at rest/shoulder motion) was 6.0/27.6 mm at 1-1, and 12.8/34.0 mm at 2-1. Approximately, 90% of recipients showed localized pain within the upper arm. Percentage change of PPTs at 1-1 and 2-1 was bilaterally (ipsilateral/contralateral) decreased to 87.4/89.4% and 80.6/91.0%, which was recovered to the baseline level at 1-7 and 2-7. Temporary, mild-to-moderate intensity, localized distribution, concomitant with bilateral mechanical hyperalgesia on the deltoid muscle, were typical pain characteristics following this vaccination. These findings provide a rationale that will be informative for future recipients. J. Med. Invest. 70 : 355-360, August, 2023.
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Affiliation(s)
- Masashi Izumi
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Kochi, Japan
- Department of Rehabilitation, Kochi Medical School Hospital, Kochi University, Kochi, Japan
| | - Toru Morimoto
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Kochi, Japan
| | - Shota Oda
- Department of Rehabilitation, Kochi Medical School Hospital, Kochi University, Kochi, Japan
| | - Dai Ohishi
- Department of Rehabilitation, Kochi Medical School Hospital, Kochi University, Kochi, Japan
| | - Yoshihiro Hayashi
- Department of Rehabilitation, Kochi Medical School Hospital, Kochi University, Kochi, Japan
| | - Takahiro Shimokawa
- Department of Rehabilitation, Kochi Medical School Hospital, Kochi University, Kochi, Japan
| | - Kazuki Ozaki
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Kochi, Japan
| | - Anzu Nakamae
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Kochi, Japan
| | - Ryota Saito
- Center for Innovative and Translational Medicine, Kochi Medical School, Kochi University, Kochi, Japan
| | - Yoshiki Fujii
- Center for Innovative and Translational Medicine, Kochi Medical School, Kochi University, Kochi, Japan
| | - Naoki Komatsu
- Department of General Medicine, Kochi Medical School Hospital, Kochi University, Kochi, Japan
| | - Hiromi Seo
- Department of General Medicine, Kochi Medical School Hospital, Kochi University, Kochi, Japan
| | - Masahiko Ikeuchi
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Kochi, Japan
- Department of Rehabilitation, Kochi Medical School Hospital, Kochi University, Kochi, Japan
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15
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Wright JO, Wiggins W, Smith MS, King JJ, Wright TW. Shoulder Pain and Dysfunction After Vaccination: A Systematic Review. JBJS Rev 2023; 11:01874474-202301000-00006. [PMID: 36722836 DOI: 10.2106/jbjs.rvw.22.00134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Persistent shoulder pain and dysfunction after vaccination are relatively rare but well-known complications after inoculations into the deltoid muscle. The term SIRVA (shoulder injury related to vaccine administration) is frequently used to encompass many of these occurrences; however, multiple distinct pathologies with similar presentations have been reported after vaccination. We performed a systematic review of the literature on vaccine-related shoulder injuries to help guide practitioners in appropriate workup and treatment based on specific diagnoses. METHODS PubMed was used to search for combinations of multiple keywords (including vaccine, immunization, SIRVA, injury, inflammation, bursitis, Parsonage-Turner syndrome, and neuritis), and all references of each potential article were reviewed. A total of 56 articles were included. Patient demographics, vaccine information, presentation, diagnostic studies, treatment, and outcomes were recorded. RESULTS Diagnoses were divided into 3 categories: (1) local inflammatory reaction (SIRVA), (2) brachial neuritis, and (3) direct nerve injury. The included articles reported on 57 cases of SIRVA, 18 of brachial neuritis, and 4 of direct nerve injury. The diagnoses reported for the SIRVA cases included frozen shoulder, pseudoseptic arthritis, subacromial bursitis, rotator cuff injury, and lytic lesions of the humeral head. Various treatments were used, and most patients had resolution of symptoms with conservative treatment including physical therapy, analgesics, and/or corticosteroid injections. Advanced imaging rarely provided information that affected treatment. The brachial neuritis and direct nerve injury cases were typically confirmed with electromyography/nerve conduction studies. Treatment of these 2 categories was nonoperative in all cases, typically with analgesics and/or corticosteroids, and most patients had symptomatic improvement after a few months, with most patients regaining strength. However, some (1 of 3 patients with brachial neuritis and >1 year of follow-up and 2 of 4 patients with direct injury) had residual weakness. CONCLUSIONS Medical professionals should be aware of the various pathologies that can lead to prolonged shoulder pain after vaccination. Fortunately, most of these conditions can be treated successfully with nonoperative modalities, although differentiating among the diagnoses can help guide treatment, as some likely benefit from systemic corticosteroids or localized corticosteroid injections. Outcomes for most patients have been good, with the majority recovering without residual pain or deficits. LEVEL OF EVIDENCE Prognostic Level IV.
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Affiliation(s)
- Jonathan O Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida
| | - Whitman Wiggins
- College of Medicine, University of Florida, Gainesville, Florida
| | - Michael Seth Smith
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida
| | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida
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16
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Hirai J, Yamaoka T, Takahashi T, Mikamo H. Shoulder Injury Related to Zoster Vaccine Administration. Intern Med 2022; 61:3631-3632. [PMID: 35491135 PMCID: PMC9790784 DOI: 10.2169/internalmedicine.9484-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Jun Hirai
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Takanari Yamaoka
- Department of Orthopedic Surgery, Aichi Medical University, Japan
| | - Tomoko Takahashi
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
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17
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Chen C, Chen C. New-onset inflammatory arthritis after COVID-19 vaccination: A systematic review. Int J Rheum Dis 2022; 26:267-277. [PMID: 36371629 PMCID: PMC9877737 DOI: 10.1111/1756-185x.14482] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/02/2022] [Accepted: 10/14/2022] [Indexed: 11/15/2022]
Abstract
AIM To analyze the clinical patterns of new-onset inflammatory arthritis after COVID-19 vaccination among patients without pre-existing rheumatic or autoimmune diseases. METHOD Case reports and series of new-onset inflammatory arthritis after COVID-19 vaccination were collected before April 2022. Clinical characteristics including diagnosis, age, gender, vaccine types, time interval between events, joint involvement (poly- or oligo-/monoarthritis), and laboratory data reflecting inflammatory status were sorted and P values between these parameters are calculated with independent sample Student's t test or 2 × 2 Fisher's exact test. RESULTS Among 39 cases with new-onset post-vaccination arthritis including 25 females and 13 males (1 unknown), the most common diagnosis is adult-onset Still's disease (AoSD, 10 cases), and the most common vaccine types are BNT162b2 (16 cases) and AZD-1222 (or ChAdOx1-nCoV19, 15 cases). Sub-analysis reveals that post-vaccination polyarthritis is more common among females (P = .016, by 2 × 2 Fisher's exact test, compared with male patients) and older patients (P = .006, by Student's t test). The C-reactive protein level is significantly higher in cases with post-vaccination inflammatory polyarthritis than oligoarthritis (P = .029), as well as in cases with AoSD than other causes of post-vaccination arthritis (P = .004). However, serum level of erythrocyte sedimentation rate in patients with post-vaccination AoSD are independent of other clinical variables in the analysis. CONCLUSION New-onset post-vaccination polyarthritis are more common in females and older patients. Although COVID-19 vaccines may lead to inflammatory arthritis, the benefits of vaccination substantially outweigh the potential risks of such serious adverse effects due to their rarity.
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Affiliation(s)
- Cheng‐Che Chen
- College of Chinese MedicineChina Medical UniversityTaichung CityTaiwan
| | - Chung‐Jen Chen
- Division of AllergyImmunology and Rheumatology, Kaohsiung Medical University Chung‐Ho Memorial HospitalKaohsiungTaiwan,Department of Traditional Chinese MedicineKaohsiung Medical University Chung‐Ho Memorial HospitalKaohsiungTaiwan
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18
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Moya D, Gómez D, Altamirano N, Alfano F, Pereira Corvalán JM, Dobkin F, Menon PH, Patinharayil G. Shoulder injury related to vaccine administration following SARS-CoV-2 inoculation: Case series and review of literature. J Orthop 2022; 35:79-84. [PMID: 36406160 PMCID: PMC9652104 DOI: 10.1016/j.jor.2022.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Shoulder Injuries Related to Vaccine Administration (SIRVA), describes those cases of shoulder severe post-inoculation complications, including pain and prolonged disability. Most of the reported cases have been secondary to influenza vaccination. This study retrospectively describes a series of 18 patients following SARS-CoV-2 inoculation and compares the findings with those previously reported for other vaccines. Materials and methods Inclusion criteria was onset of symptoms within 48 h after injection, symptoms duration of at least seven days, and restricted range of motion in absence of symptoms prior to vaccination. Average age was 59.4 years old (38-76), and 72.2% were women. Results In many cases (58%) the initial diagnosis was not clear, which lead to incorrect treatment. The most common pathological finding was subacromial-subdeltoid bursitis (66.6%). All patients who received depot corticosteroids followed by a gentle rehabilitation program showed strong clinical improvement but did not completely resolve the symptoms at 7.2 months average final follow-up. Surgical intervention was necessary in one of the patients due to the persistence of symptoms despite conservative treatment. Conclusions Shoulder injury related to vaccine administration is rare, but when present, its torpid evolution makes it difficult to treat. We have found in our case series a similar pattern to that already described for other vaccines. A high index of suspicion helps to pick up the condition promptly and early treatment can bring satisfactory outcome.
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Affiliation(s)
- Daniel Moya
- Hospital Británico de Buenos Aires, Orthopaedic Department Buenos Aires, Argentina,Corresponding author. Gabriela Mistral 2641, 8 A. C1419GFK, CABA, Argentina
| | - Diego Gómez
- Hospital Británico de Buenos Aires, Orthopaedic Department Buenos Aires, Argentina
| | - Nicolás Altamirano
- Hospital Británico de Buenos Aires, Orthopaedic Department Buenos Aires, Argentina
| | - Federico Alfano
- Hospital Español de Buenos Aires, Orthopaedic Department Buenos Aires, Argentina
| | | | - Fernando Dobkin
- Sanatorio Parque, Orthopaedic Department, Rosario, Santa Fe, Argentina
| | - Prem Haridas Menon
- Department of Orthopedics and Traumatology, Medical College, Trivandrum, Kerala University of Health Sciences, Kerala, India
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19
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Klabklay P, Chuaychoosakoon C. Septic arthritis of shoulder joint following a COVID-19 vaccination: A case report. Int J Surg Case Rep 2022; 99:107686. [PMID: 36160625 PMCID: PMC9484856 DOI: 10.1016/j.ijscr.2022.107686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/17/2022] [Accepted: 09/18/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Septic arthritis of the shoulder joint is a serious condition which requires early diagnosis and treatment. This condition usually presents with shoulder pain, limited range of motion and/or fever, and is diagnosed by shoulder arthrocentesis with significant synovial fluid leukocytosis or positive synovial fluid gram stain or culture. There are some risk factors for septic arthritis, notably bacteremia, pre-existing joint pathology and an immunocompromised host such as poorly controlled type II diabetes mellitus. Case presentation A 45-year-old Thai female developed left shoulder septic arthritis after an Astra-Zeneca COVID-19 vaccine administration. The clinical symptoms were left shoulder pain, limited range of motion and fever. The probable risk factors were underlying diabetes mellitus type II and vaccine administration technique. The joint fluid culture showed Staphylococcus aureus. This patient was treated with combined arthroscopic debridement and an intravenous antibiotic for 1 week which was then switched to an oral antibiotic for 5 weeks. Her clinical symptoms gradually improved over the 2 weeks following the initiation of treatment. Conclusion Septic arthritis is a rare complication after a vaccination. Doctors should be especially careful with immunocompromised patients, and always use a correct injection technique. Septic arthritis of the shoulder should not be missed in the patient with shoulder pain after vaccination. Even through the type II diabetes mellitus was well-controlled, the type II diabetes mellitus still placed her at extra risk of septic arthritis. The other possible cause was the injection technique of the vaccination.
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Affiliation(s)
- Prapakorn Klabklay
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla 90110, Thailand
| | - Chaiwat Chuaychoosakoon
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla 90110, Thailand.
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20
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Omar IM, Weaver JS, Samet JD, Serhal AM, Mar WA, Taljanovic MS. Musculoskeletal Manifestations of COVID-19: Currently Described Clinical Symptoms and Multimodality Imaging Findings. Radiographics 2022; 42:1415-1432. [PMID: 35867593 PMCID: PMC9341171 DOI: 10.1148/rg.220036] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
COVID-19, the clinical syndrome produced by infection with SARS-CoV-2, can result
in multisystem organ dysfunction, including respiratory failure and
hypercoagulability, which can lead to critical illness and death.
Musculoskeletal (MSK) manifestations of COVID-19 are common but have been
relatively underreported, possibly because of the severity of manifestations in
other organ systems. Additionally, patients who have undergone sedation and who
are critically ill are often unable to alert clinicians of their MSK symptoms.
Furthermore, some therapeutic measures such as medications and vaccinations can
worsen existing MSK symptoms or cause additional symptoms. Symptoms may persist
or occur months after the initial infection, known as post-COVID condition or
long COVID. As the global experience with COVID-19 and the vaccination effort
increases, certain patterns of MSK disease involving the bones, muscles,
peripheral nerves, blood vessels, and joints have emerged, many of which are
likely related to a hyperinflammatory host response, prothrombotic state, or
therapeutic efforts rather than direct viral toxicity. Imaging findings for
various COVID-19–related MSK pathologic conditions across a variety of
modalities are being recognized, which can be helpful for diagnosis, treatment
guidance, and follow-up. The online slide presentation from the RSNA Annual Meeting is
available for this article. ©RSNA, 2022
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Affiliation(s)
- Imran M Omar
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
| | - Jennifer S Weaver
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
| | - Jonathan D Samet
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
| | - Ali M Serhal
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
| | - Winnie A Mar
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
| | - Mihra S Taljanovic
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
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21
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Sahu D. Shoulder Pain and Injury after COVID-19 Vaccination. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2022; 95:217-220. [PMID: 35782477 PMCID: PMC9235265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Shoulder injury related to vaccine administration (SIRVA) is a term given to describe shoulder pain and dysfunction arising within 48 hours after vaccine administration and lasting for more than one week. While SIRVA is most commonly seen after influenza and tetanus vaccines, there have been a few recent case reports describing SIRVA-like symptoms after COVID-19 vaccine administration. Two patients presented to the shoulder surgeon's practice center with complaints of shoulder stiffness and pain following the COVID-19 vaccine. The first patient was a 33-year-old man; he presented within 2 days of onset of the pain and 14 days from the vaccine date. He had a complete restriction of shoulder motion (0° flexion, and no external or internal rotation) at presentation. This patient was treated with non-steroidal anti-inflammatory drugs (NSAID) and rested in a sling for a week. The second patient was a 53-year-old woman; she presented with a 6-week duration of mild restriction of active shoulder motion and shoulder pain. Her magnetic resonance imaging (MRI) revealed the presence of subacromial-subdeltoid bursitis. She was treated with subacromial steroid injection and range of motion shoulder exercises. Both patients recovered a near-normal range of motion recovery within a month, and their pain improved significantly. The main lessons from this case report were: (1) patients presenting with a recent increase in pain and acute loss of shoulder movements after vaccination may be managed conservatively with rest and NSAID medications and (2) in case of a subacromial-subdeltoid bursitis in the MRI, subacromial injection of steroid may provide good pain relief.
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Affiliation(s)
- Dipit Sahu
- Mumbai Shoulder Institute, Mumbai, India,Sir H.N. Reliance Foundation Hospital, Mumbai,
India,Jupiter Hospital, Thane, India,To whom all correspondence should be addressed:
Dipit Sahu, MS, Consultant Shoulder Surgeon, Mumbai Shoulder Institute, Mumbai,
India;
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22
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Bass JR, Poland GA. Shoulder Injury Related to Vaccine Administration (SIRVA) After COVID-19 Vaccination. Vaccine 2022; 40:4964-4971. [PMID: 35817645 PMCID: PMC9174179 DOI: 10.1016/j.vaccine.2022.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/13/2022] [Accepted: 06/02/2022] [Indexed: 01/16/2023]
Abstract
Objective The global fight against COVID-19 has required mass vaccination clinics as well as mass recruitment of personnel, including many who may not regularly administer intramuscular deltoid immunizations, potentially increasing the incidence of improper intramuscular injection. Shoulder injury related to vaccine administration (SIRVA) is a well-described, preventable injury resulting from improper injection into anatomic structures adjacent to the deltoid muscle leading to mechanical and chemical trauma augmented by an inflammatory immune response to the vaccine and/or adjuvants. SIRVA is best described in the setting of influenza vaccination, and little is known about it as it pertains to COVID-19 vaccination. This study aims to describe SIRVA in the current pandemic, increase clinician awareness, and offer considerations for prevention. Methods To identify clinical characteristics of patients with post-COVID-19-vaccination shoulder injuries, we performed a systematic review of the cases of vaccination-related shoulder injuries reported in the literature and conducted a review of the public Vaccine Adverse Event Reporting System (VAERS). Results We identified 305 cases of SIRVA in the VAERS database and 28 cases of SIRVA in the setting of COVID-19 vaccination from the literature (n = 333). Patients had a mean age of 51.8 years and a median of 51.5 (range: 19–90) years. Of these, 76.3% were female and 23.7% male. Most patients sought medical evaluation with 54 of the 305 VAERS cases reporting utilizing emergency services. Of patients with imaging-confirmed SIRVA (n = 95), the most common diagnoses were adhesive capsulitis and bursitis, and the most common symptoms were pain (97.7%) and limited range of motion (68.1%). Most patients reported requiring treatment with the majority receiving physical therapy (56.3%), followed by cortisone injection (34.4%). Other modalities used were non-steroidal anti-inflammatory drugs, oral steroids, and surgery. Only 5 patients from this group reported recovery while 60 stated they had not yet recovered. Of those, 23.3% reported disability. Conclusion SIRVA should be regarded as an under-reported, significant cause of post-vaccination morbidity. In the setting of COVID-19 mass vaccination, clinicians must be aware of signs and symptoms of SIRVA as well as appropriate diagnostic modalities and treatment options. Additionally, standardization and proper education regarding injection technique and appropriate needle length is imperative to reducing harm.
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Affiliation(s)
| | - Gregory A Poland
- Mayo Clinic Vaccine Research Group, Mayo Clinic, Rochester, MN, United States.
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23
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Aldosary AH. Prolonged shoulder dysfunction after coronavirus disease vaccination: A case of shoulder injury related to vaccine administration. SAGE Open Med Case Rep 2022; 10:2050313X221089494. [PMID: 35433003 PMCID: PMC9008811 DOI: 10.1177/2050313x221089494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/07/2022] [Indexed: 12/03/2022] Open
Abstract
Shoulder pain is a common symptom after intramuscular vaccination. However, only
a few cases of shoulder joint injury have been reported after coronavirus
disease 2019 vaccination. A 52-year-old woman experienced clinically significant
pain in the left shoulder joint after receiving the first dose of a coronavirus
disease 2019 vaccine. She neglected the shoulder pain, hoping that it would
spontaneously improve without medical attention. However, the pain continued
with obvious limitations in shoulder movement and function. After 8 months, she
presented to the outpatient clinic with a frozen left shoulder. Such rare
consequences of vaccinations, known as shoulder injury related to vaccine
administration, can be prevented by using an appropriate needle gauge and length
according to the patient’s sex and weight with the correct injection site away
from shoulder structures.
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Affiliation(s)
- Ahmad Hamad Aldosary
- Department of Family and Community Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
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Klatte-Schulz F, Thiele K, Scheibel M, Duda GN, Wildemann B. Subacromial Bursa: A Neglected Tissue Is Gaining More and More Attention in Clinical and Experimental Research. Cells 2022; 11:cells11040663. [PMID: 35203311 PMCID: PMC8870132 DOI: 10.3390/cells11040663] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 01/27/2023] Open
Abstract
The subacromial bursa has long been demolded as friction-reducing tissue, which is often linked to shoulder pain and, therefore, partially removed during shoulder surgery. Currently, the discovery of the stem cell potential of resident bursa-derived cells shed a new light on the subacromial bursa. In the meanwhile, this neglected tissue is gaining more attention as to how it can augment the regenerative properties of adjacent tissues such as rotator cuff tendons. Specifically, the tight fibrovascular network, a high growth factor content, and the large progenitor potential of bursa-derived cells could complement the deficits that a nearby rotator cuff injury might experience due to the fact of its low endogenous regeneration potential. This review deals with the question of whether bursal inflammation is only a pain generator or could also be an initiator of healing. Furthermore, several experimental models highlight potential therapeutic targets to overcome bursal inflammation and, thus, pain. More evidence is needed to fully elucidate a direct interplay between subacromial bursa and rotator cuff tendons. Increasing attention to tendon repair will help to guide future research and answer open questions such that novel treatment strategies could harvest the subacromial bursa's potential to support healing of nearby rotator cuff injuries.
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Affiliation(s)
- Franka Klatte-Schulz
- Julius Wolff Institute, Berlin Institute of Health at Charité-Universitaetsmedizin Berlin, 13353 Berlin, Germany; (G.N.D.); (B.W.)
- BIH-Center for Regenerative Therapies, Berlin Institute of Health, Charité-Universitaetsmedizin Berlin, 13353 Berlin, Germany
- Correspondence:
| | - Kathi Thiele
- Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, 13353 Berlin, Germany; (K.T.); (M.S.)
| | - Markus Scheibel
- Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, 13353 Berlin, Germany; (K.T.); (M.S.)
- Department Shoulder and Elbow Surgery, Schulthess Klinik, 8008 Zurich, Switzerland
| | - Georg N. Duda
- Julius Wolff Institute, Berlin Institute of Health at Charité-Universitaetsmedizin Berlin, 13353 Berlin, Germany; (G.N.D.); (B.W.)
- BIH-Center for Regenerative Therapies, Berlin Institute of Health, Charité-Universitaetsmedizin Berlin, 13353 Berlin, Germany
| | - Britt Wildemann
- Julius Wolff Institute, Berlin Institute of Health at Charité-Universitaetsmedizin Berlin, 13353 Berlin, Germany; (G.N.D.); (B.W.)
- Experimental Trauma Surgery, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany
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25
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Elasomeran/tozinameran. REACTIONS WEEKLY 2022. [PMCID: PMC8872907 DOI: 10.1007/s40278-022-10607-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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26
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Klabklay P, Boonsri P, Kanyakool P, Chuaychoosakoon C. A COVID-19 vaccination precipitating symptomatic calcific tendinitis: A case report. Ann Med Surg (Lond) 2022; 74:103347. [PMID: 35154699 PMCID: PMC8817452 DOI: 10.1016/j.amsu.2022.103347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Prapakorn Klabklay
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
| | - Pattira Boonsri
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
| | - Pathawin Kanyakool
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
| | - Chaiwat Chuaychoosakoon
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
- Corresponding author.
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