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Sahu D, Gupta S, Shetty G, Choudhury HS. Frozen shoulder after COVID-19 vaccination versus idiopathic frozen shoulder: similar clinical features and functional improvement at 1-year follow-up. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:41-47. [PMID: 38323207 PMCID: PMC10840564 DOI: 10.1016/j.xrrt.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Background Frozen shoulder after COVID-19 vaccination is sparsely discussed in the medical literature. We aimed to evaluate: (1) the differences in the baseline clinical features and functional outcomes of conservatively treated frozen shoulder following COVID-19 vaccination compared to idiopathic frozen shoulder (2) the improvements in pain scores, functional outcomes, and range of motion (ROM) at 6-10 months and at 1 year of follow-up in patients with frozen shoulder after COVID-19 vaccination treated by conservative therapy. Methods Between June 2021 and December 2021, 12 patients (13 shoulders) that were diagnosed with frozen shoulder after COVID-19 vaccination (vaccine related frozen shoulder [VRF] group) (final follow-up of 12.4 months ± 0.8 months) were compared with 20 patients that were diagnosed as idiopathic frozen shoulder unrelated to vaccination (unvaccinated frozen shoulder [UFS] group) (average follow-up of 13.4 ± 3.1 months). All patients were treated with home-based stretching exercises. Four (33%) patients in the VRF group and 15 (75%) patients in the UFS group underwent steroid injection in the suprascapular notch by an experienced radiologist. Results The left side was affected more frequently in the VRF group [n = 10 (83.3%)] than in the UFS group [n = 8 (40%), P = .03]. The VRF and the UFS groups were similar in the rest of the baseline clinical features, such as the age distribution, men/women ratio, baseline Oxford Shoulder Scores (OSS), ROM deficit, and pain visual analogue scale (VAS) scores. The OSS, VAS pain scores, and the ROM deficit significantly improved in the VRF group at the 6-10-month follow-up and then at the final (12.4 ± 0.8 months) follow-up compared to the baseline values. At the final follow-up, there were no significant differences in the average external rotation, external rotation deficit, elevation, elevation deficit, internal rotation, pain VAS scores, and OSS between the VRF and the UFS group. Conclusion To conclude, frozen shoulder following COVID-19 vaccination may present with clinical features similar to those of the idiopathic frozen shoulder. Furthermore, the patients with frozen shoulder following COVID-19 vaccination may continue to improve over one year with conservative treatment; the final improvements in function and ROM are similar to those with idiopathic frozen shoulder.
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Affiliation(s)
- Dipit Sahu
- Sir H.N. Reliance Foundation Hospital, Mumbai, India
- Mumbai Shoulder Institute, Mumbai, India
- Jupiter Hospital, Thane, India
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Biglia A, Morandi V, Zanframundo G, Donati D, Maggiore F, Vita F, Sammarchi L, Pagani C, Cavagna L, Galletti S, Montecucco C. Adhesive capsulitis after COVID-19 vaccine injection: a peculiar case treated with combined bursa distention and glenohumeral capsular hydrodilatation. J Ultrasound 2023; 26:909-911. [PMID: 36595199 PMCID: PMC9809505 DOI: 10.1007/s40477-022-00739-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/01/2022] [Indexed: 01/04/2023] Open
Abstract
Frozen shoulder is a common and self-limiting condition affecting the soft tissues of the shoulders, characterized by severe pain, impaired range of motion (ROM) and limitation of daily activities. Its prevalence is 5% and it occurs most commonly in the fifth and sixth decades of life; women are more affected [DePalma in Clin Orthop Relat Res 466:552-560, 2008]. It can be idiopathic or associated with other conditions such as metabolic disorders, diabetes, thyroid diseases, prolonged immobilization, trauma [DePalma in Clin Orthop Relat Res 466:552-560, 2008], or complications after vaccine administration known as SIRVA (Shoulder injury related to vaccine administration). SIRVA is not caused by the vaccine itself but by inappropriate vaccination techniques [Martín Arias et al. in Vaccine 35:4870-4876, 2017]. The natural history of the frozen shoulder is a progression through three stages based on clinical and arthroscopic presentations: freezing, frozen and thawing [DePalma in Clin Orthop Relat Res 466:552-560, 2008; Do et al. in Orthop J Sport Med 9:232596712110036, 2021]. The onset is characterized by disabling pain, that worsens at night; it is induced by inflammation and hypervascularity and lasts from 10 to 36 weeks [Do et al. in Orthop J Sport Med 9:232596712110036, 2021]. The second stage is predominated by stiffness and severe reduction of ROM. This phase typically lasts from 9 to 12 months [Do et al. in Orthop J Sport Med 9:232596712110036, 2021]. Eventually, a recovery phase occurs, with a gradual recovery of the ROM that can last between 12 and 42 months. Ultrasound is an emerging diagnostic tool that contributes to differential diagnosis and treatment [Zappia et al. in Insights Imaging 7:365-371, 2016; Ricci et al. in J Ultrasound Med 39:633-635, 2020]: signs of adhesive capsulitis consist of thickening of the inferior recess of the glenohumeral joint capsule, thickening of the coracohumeral ligament and soft tissue structures in the rotator cuff interval, with hypervascularity. An unspecific sign is increased fluid in the tendon sheath of the long head of the biceps [Martín Arias et al. in Vaccine 35:4870-4876, 2017; Tandon et al. in J Ultrasound 20:227-236, 2017].
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Affiliation(s)
- Alessandro Biglia
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, V. le Golgi 19, 27100, Pavia, Italy
| | - Valentina Morandi
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy.
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, V. le Golgi 19, 27100, Pavia, Italy.
| | - Giovanni Zanframundo
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, V. le Golgi 19, 27100, Pavia, Italy
| | - Danilo Donati
- Physical Medicine and Rehabilitation Unit, IRCCS-Istituto Ortopedico Rizzoli, Bologna, BO, Italy
| | - Francesco Maggiore
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, V. le Golgi 19, 27100, Pavia, Italy
| | - Fabio Vita
- Department of Orthopedic and Traumatological Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luigi Sammarchi
- Department of Diagnostic and Interventional Radiology and Neuroradiology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy
| | - Chiara Pagani
- Department of Diagnostic and Interventional Radiology and Neuroradiology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy
| | - Lorenzo Cavagna
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, V. le Golgi 19, 27100, Pavia, Italy
| | - Stefano Galletti
- Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology, Bologna, Italy
| | - Carlomaurizio Montecucco
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, V. le Golgi 19, 27100, Pavia, Italy
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Yuen WLP, Chong YKK, How CH, Loh SYJ. Vaccine administration during COVID-19 pandemic: an overview of safe injection technique and local complications. Singapore Med J 2023; 64:690-694. [PMID: 38037789 PMCID: PMC10754365 DOI: 10.4103/singaporemedj.smj-2022-059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 06/20/2022] [Indexed: 12/02/2023]
Affiliation(s)
| | | | - Choon How How
- Care and Health Integration, Changi General Hospital, Singapore
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4
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Zeldin ER, Boyette DM, Norbury JW. Shoulder Pain After Influenza Vaccine Administration: A Clinical Vignette. Am J Phys Med Rehabil 2023; 102:e141-e143. [PMID: 37026846 DOI: 10.1097/phm.0000000000002242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- Evan R Zeldin
- From the Department of Physical Medicine and Rehabilitation, Brody School of Medicine at East Carolina University, Greenville, North Carolina (ERZ); Boyette Orthopedics and Sports Medicine, Greenville, North Carolina (DB); and Division of Physical Medicine and Rehabilitation, Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas (JWN)
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5
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Mayer EN, Gajewski CR, Bernthal NM, Jensen AR. Arthroscopic debridement for acute hemorrhagic subacromial bursitis following COVID-19 vaccine administration: A case report. Shoulder Elbow 2023; 15:527-533. [PMID: 37811386 PMCID: PMC8977431 DOI: 10.1177/17585732221090821] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 10/10/2023]
Abstract
The rapid rollout of vaccinations in response to the COVID-19 pandemic has led to their widespread distribution and administration throughout the world. The benefit of these vaccinations in preventing the spread of the disease and diminishing symptoms in patients who contract COVID-19 has been fervently studied and reported. While vaccinations remain an effective and generally safe method of limiting disease transmission and virus-related mortality, vaccine administration is not completely without risk. Shoulder injuries related to vaccine administration (SIRVA) have been described with previously available vaccines but have yet to be widely reported in the COVID-19 vaccination population. We present a case report of a young, high-functioning patient who presented with acute subacromial bursitis after COVID-19 vaccine administration due to improper vaccination technique. The patient was treated with arthroscopic shoulder surgery and had near immediate relief of shoulder symptoms.
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Affiliation(s)
- Erik N Mayer
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Christopher R Gajewski
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Nicholas M Bernthal
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Andrew R Jensen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
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6
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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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Hacker E, Baker B, Lake T, Ross C, Cox M, Davies C, Skinner SR, Booy R, Forster A. Vaccine microarray patch self-administration: An innovative approach to improve pandemic and routine vaccination rates. Vaccine 2023; 41:5925-5930. [PMID: 37643926 DOI: 10.1016/j.vaccine.2023.08.027] [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: 02/16/2023] [Revised: 07/20/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Abstract
The high-density microprojection array patch (HD-MAP) is a novel vaccine delivery system with potential for self-administered vaccination. HD-MAPs provide an alternative to needle and syringe (N&S) vaccination. Additional advantages could include reduced cold-chain requirements, reduced vaccine dose, reduced vaccine wastage, an alternative for needle phobic patients and elimination of needlestick injuries. The drivers and potential benefits of vaccination by self-administering HD-MAPs are high patient acceptance and preference, higher vaccination rates, speed of roll-out, cost-savings, and reduced sharps and environmental waste. The HD-MAP presents a unique approach in pandemic preparedness and routine vaccination of adults. It could alleviate strain on the healthcare workforce and allows vaccine administration by minimally-trained workers, guardian or subjects themselves. Self-vaccination using HD-MAPs could occur in vaccination hubs with supervision, at home after purchasing at the pharmacy, or direct distribution to in-home settings. As a result, it has the potential to increase vaccine coverage and expand the reach of vaccines, while also reducing labor costs associated with vaccination. Key challenges remain around shifting the paradigm from medical professionals administrating vaccines using N&S to a future of self-administration using HD-MAPs. Greater awareness of HD-MAP technology and improving our understanding of the implementation processes required for adopting this technology, are critical factors underpinning HD-MAP uptake by the public.
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Affiliation(s)
- E Hacker
- Vaxxas Pty Ltd, Translational Research Institute, Woolloongabba, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, QLD 4222, Australia
| | - B Baker
- Vaxxas Pty Ltd, Translational Research Institute, Woolloongabba, Australia
| | - T Lake
- Vaxxas Pty Ltd, Translational Research Institute, Woolloongabba, Australia
| | - C Ross
- Vaxxas Pty Ltd, Translational Research Institute, Woolloongabba, Australia
| | - M Cox
- NextWaveBio, East Haven, CT, United States
| | - C Davies
- Specialty of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia; Sydney Institute of Infectious Diseases, University of Sydney, Sydney, Australia
| | - S R Skinner
- Specialty of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia; Sydney Institute of Infectious Diseases, University of Sydney, Sydney, Australia
| | - R Booy
- Specialty of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia; Sydney Institute of Infectious Diseases, University of Sydney, Sydney, Australia
| | - A Forster
- Vaxxas Pty Ltd, Translational Research Institute, Woolloongabba, Australia.
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8
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Jenkins PJ, Duckworth AD. SIRVA: Shoulder injury related to vaccine administration. Bone Joint J 2023; 105-B:839-842. [PMID: 37524358 DOI: 10.1302/0301-620x.105b8.bjj-2023-0435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Shoulder injury related to vaccine administration (SIRVA) is a prolonged episode of shoulder dysfunction that commences within 24 to 48 hours of a vaccination. Symptoms include a combination of shoulder pain, stiffness, and weakness. There has been a recent rapid increase in reported cases of SIRVA within the literature, particularly in adults, and is likely related to the mass vaccination programmes associated with COVID-19 and influenza. The pathophysiology is not certain, but placement of the vaccination in the subdeltoid bursa or other pericapsular tissue has been suggested to result in an inflammatory capsular process. It has been hypothesized that this is associated with a vaccine injection site that is "too high" and predisposes to the development of SIRVA. Nerve conduction studies are routinely normal, but further imaging can reveal deep-deltoid collections, rotator cuff tendinopathy and tears, or subacromial subdeltoid bursitis. However, all of these are common findings within a general asymptomatic population. Medicolegal claims in the UK, based on an incorrect injection site, are unlikely to meet the legal threshold to determine liability.
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Affiliation(s)
- Paul J Jenkins
- Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
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9
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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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10
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Mardourian M, Hao KA, Wiggins W, Arias J, King JJ, Wright TW, Wright JO. Optimizing needle length and site choice for adult immunization. Vaccine 2023:S0264-410X(23)00697-7. [PMID: 37365058 DOI: 10.1016/j.vaccine.2023.06.031] [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: 10/04/2022] [Revised: 05/01/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Current recommendations for needle length and vaccination site for intramuscular deltoid vaccinations are backed by minimal data. AIM To determine the ideal needle length and vaccination site for intramuscular deltoid vaccine administration. METHODS 120 shoulder CT scans were evaluated and grouped by patient weight and sex as recommended by the United States CDC: Group 1, <60 kg, Group 2, 60-70 kg, Group 3, females 70-90 kg and males 70-118 kg, and Group 4, females > 90 kg and males > 118 kg. For each group, distance from skin to deltoid fascia and deltoid muscle width were measured at 2, 4, and 6 cm distal to the posterolateral corner of the acromion for 5 unique trajectories. Needle lengths of 0.625″, 1.0″, and 1.5″ were simulated at each site to determine inoculation location relative to the deltoid. RESULTS For Group 1, a 0.625″ needle in the mid-lateral (ML) trajectory 4 cm distal to the posterolateral corner provided a perfect rate of successful inoculations (100 %). For Groups 2-3, a 1″ needle in the posterolateral (PL) trajectory 4 cm distal provided high rates (>80 %) of successful intramuscular inoculations with low rates of overpenetration (<15 %) while minimizing risk to the axillary nerve. For Group 4, a 1.5″ needle using the same strategy provided the highest rate of successful inoculations (96 %) and minimal overpenetration (4 %). Overpenetration was associated with more anterior and superior injection sites (P < 0.001 for both) for all needle lengths. CONCLUSIONS The overall ideal injection site to maximize successful intramuscular vaccine administration, minimize overpenetration, and avoid axillary nerve injury is 4 cm distal to and in line with the posterolateral corner of the acromion, a site more posterior and inferior than current CDC recommendations. We caution against use of a 1.5″ needle for patients < 118 kg due to high predicted rates of overpenetration.
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Affiliation(s)
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Whitman Wiggins
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jonathan Arias
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Jonathan O Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA.
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Kagawa K, Kuroda H, Kaneko D, Imura M, Imaizumi U, Kido K, Tsukimoto S, Kurata S, Kishimoto N, Sanuki T. Safety of COVID-19 vaccine delivery by dentists: An observational cohort study. J Dent Sci 2023; 18:613-617. [PMID: 36068849 PMCID: PMC9437767 DOI: 10.1016/j.jds.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 08/19/2022] [Indexed: 12/02/2022] Open
Abstract
Background/purpose Although many coronavirus disease 2019 (COVID-19) vaccine injections have been administered worldwide, the safety of this practice remains unclear. This study aimed to compare the rates of complications associated with COVID-19 vaccines administered by dentists with those of vaccines administered by nurses. This study aimed to evaluate the safety of a vaccination program delivered by dentists. Materials and methods This observational cohort study included 537 recipients of the second dose of the Pfizer COVID-19 vaccine, delivered as an intramuscular injection to the upper arm deltoid muscle by dentists or nurses at the study site. Vaccine recipients were divided into two groups according to the vaccination administrator (dentist vs. nurse groups). The rates of complications associated with intramuscular injection technique (numbness in the hand or arm at the time of the injection, vasovagal reflex at the time of the injection, vaccine-related shoulder injury, and prolonged numbness) were examined. Results A total of 125 vaccine recipients were included (nurse group, n = 84; dentist group, n = 41). The overall incidence rate of complications was lower in the dentist group (2.4%; 1/41) than in the nurse group (8.3%; 7/84). However, this difference was not statistically significant (P = 0.3). Conclusion This study suggests that the safety of COVID-19 vaccine administration is comparable between dentists and nurses.
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Affiliation(s)
- Keita Kagawa
- Department of Dental Anesthesiology, Kanagawa Dental University, Yokosuka, Japan
- Department of Anesthesiology, Tokyo University, Tokyo, Japan
| | - Hidetaka Kuroda
- Department of Dental Anesthesiology, Kanagawa Dental University, Yokosuka, Japan
| | - Dai Kaneko
- Department of Dental Anesthesiology, Kanagawa Dental University, Yokosuka, Japan
| | - Miki Imura
- Department of Dental Anesthesiology, Kanagawa Dental University, Yokosuka, Japan
| | - Uno Imaizumi
- Department of Dental Anesthesiology, Kanagawa Dental University, Yokosuka, Japan
| | - Kanta Kido
- Department of Dental Anesthesiology, Kanagawa Dental University, Yokosuka, Japan
| | - Shota Tsukimoto
- Department of Dental Anesthesiology, Kanagawa Dental University, Yokosuka, Japan
- Department of Anesthesiology, Kindai University, Sayama, Japan
| | - Shinji Kurata
- Department of Dental Anesthesiology, Nagasaki University, Nagasaki, Japan
| | - Naotaka Kishimoto
- Department of Dental Anesthesiology, Niigata University, Niigata, Japan
| | - Takuro Sanuki
- Department of Dental Anesthesiology, Kanagawa Dental University, Yokosuka, Japan
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12
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Petrakis N, Addison M, Penak B, Schrader S, Mallard J, Clothier HJ, Buttery JP, Crawford NW, Cheng DR. Shoulder injury following COVID-19 vaccine administration: a case series and proposed diagnostic algorithm. Expert Rev Vaccines 2023; 22:299-306. [PMID: 36894495 DOI: 10.1080/14760584.2023.2189463] [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: 03/11/2023]
Abstract
BACKGROUND Shoulder Injury Related to Vaccine Administration (SIRVA) is a preventable adverse event following incorrect vaccine administration, which can result in significant long-term morbidity. There has been a notable surge in reported cases of SIRVA as a rapid national population-based COVID-19 immunization program has been rolled out across Australia. METHODS Surveillance of Adverse Events Following Vaccination in the Community (SAEFVIC) in Victoria identified 221 suspected cases of SIRVA following the commencement of the COVID-19 vaccination program, reported between February 2021 and February 2022. This review describes the clinical features and outcomes of SIRVA in this population. Additionally, a suggested diagnostic algorithm is proposed, in order to facilitate early recognition and management of SIRVA. RESULTS 151 cases were confirmed as SIRVA, with 49.0% having received vaccines at state vaccination centers. 75.5% were suspected incorrect administration site, with most patients experiencing shoulder pain and restricted movement within 24 hours of vaccination, lasting on average 3 months. CONCLUSION Improved awareness and education regarding SIRVA is imperative in a pandemic vaccine roll-out. The development of a structured framework for evaluating and managing suspected SIRVA will aid in timely diagnosis and treatment, essential to mitigate potential long-term complications.
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Affiliation(s)
- Nikki Petrakis
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Murdoch Children's Research Institute, Parkville, Australia
- The Royal Children's Hospital Melbourne, Parkville, Australia
| | - Mel Addison
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Murdoch Children's Research Institute, Parkville, Australia
- The Royal Children's Hospital Melbourne, Parkville, Australia
| | - Bianca Penak
- The Royal Children's Hospital Melbourne, Parkville, Australia
| | - Silja Schrader
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Murdoch Children's Research Institute, Parkville, Australia
| | - John Mallard
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Murdoch Children's Research Institute, Parkville, Australia
- Centre for Health Analytics, Melbourne Children's Campus, Parkville, Australia
| | - Hazel J Clothier
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Murdoch Children's Research Institute, Parkville, Australia
- Centre for Health Analytics, Melbourne Children's Campus, Parkville, Australia
- Melbourne School of Population & Global Health, University of Melbourne, Parkville, Australia
| | - Jim P Buttery
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Murdoch Children's Research Institute, Parkville, Australia
- Centre for Health Analytics, Melbourne Children's Campus, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Infectious Disease, The Royal Children's Hospital Melbourne, Parkville, Australia
| | - Nigel W Crawford
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Australia
| | - Daryl R Cheng
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Murdoch Children's Research Institute, Parkville, Australia
- Centre for Health Analytics, Melbourne Children's Campus, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Australia
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13
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Muacevic A, Adler JR, Baajajah LH, Alharthy SF, Alsalahi H, Mahjaa MA, Barakat MM, Badawy MI, Sultan I. Side Effects Associated With Homologous and Heterologous COVID-19 Vaccines: A Cross-Sectional Study in Saudi Arabia. Cureus 2023; 15:e34030. [PMID: 36814743 PMCID: PMC9940124 DOI: 10.7759/cureus.34030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Numerous studies on coronavirus disease 2019 (COVID-19) vaccination safety have been conducted in Saudi Arabia. Even though there is less evidence comparing the side effects of different vaccines and a few of them studied the side effects of mixing different platforms of vaccines. OBJECTIVES This study aimed to evaluate the type and severity of adverse effects following COVID-19 vaccination based on the type and platform of received vaccine and to determine factors that contribute to the occurrence of these side effects. METHODS This cross-sectional comparative study was conducted in Saudi Arabia from January to the end of February 2022 among COVID-19 vaccine recipients through an online survey. Based on the type of vaccines received, we categorized our participants into two groups - those who received two doses of either the Pfizer or the AstraZeneca COVID-19 vaccines, and those who received mixed vaccination regimen (one dose of Pfizer and one dose of AstraZeneca). RESULTS The study included 1,340 participants, of which 56.3% received two doses of the Pfizer vaccine while (7%) received two doses of the AstraZeneca vaccine, and 8.8% received mixed vaccines (one dose of the Pfizer vaccine and one dose of the AstraZeneca vaccine). Pain at the injection site was the most frequent local symptom (37.9%) followed by swelling±redness (27.6%). The local adverse reactions were nearly equal in AstraZeneca and Pfizer vaccines, whereas these were significantly lower in those who received mixed doses (p<0.001). Fever was significantly higher in mixed vaccination regimens compared to other types (p<0.001). The male gender who received the Pfizer vaccine were at higher risk of developing an adverse reaction following vaccination. Unusual side effects (sleep disorders, menstrual irregularities, and symptoms suggestive of diabetic neuropathy) were also reported. CONCLUSION The results suggest the overall safety of Pfizer and AstraZeneca vaccines as well as the mixed vaccination protocol. A heterologous regimen was associated with fewer side effects compared to homologous vaccines. Further studies are needed to assess the long-term side effects.
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14
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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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15
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Marshall T, Addison M, Crawford NW, Buttery JP, Cheng DR. Aiming too high: Shoulder injury related to vaccine administration (SIRVA): A case series. Vaccine 2022; 40:7505-7509. [PMID: 36357286 DOI: 10.1016/j.vaccine.2022.10.086] [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: 03/24/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE Shoulder injury directly related to vaccination (SIRVA) occurs when a vaccine is administered too high in the shoulder. The primary aim of this study was to accurately detail the occurrence, symptoms, diagnosis, management and long-term outcomes of SIRVA cases in Victoria, Australia. PRINCIPAL RESULTS The study identified 102 SIRVA cases from 2007 to 2020 from the Surveillance of Adverse Events Following Vaccination in the Community (SAEFVIC) database. The majority [73/85; (86 %)] of cases resolved completely with a median time to resolution of 8 weeks and no statistically significant difference in recovery by immunisation provider type or baseline imaging. MAJOR CONCLUSIONS This large case series includes long-term clinical progress in SIRVA, allowing accurate evaluation and analysis. Further evaluation is required to establish if other risk factors contribute to SIRVA, which may help with targeted, tailored education for providers on correct vaccine administration technique, including in large and rapid vaccine rollouts.
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Affiliation(s)
- Tessa Marshall
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia
| | - Mel Addison
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia
| | - Nigel W Crawford
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia; Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Jim P Buttery
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia; Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Centre for Health Analytics, Melbourne Children's Campus, Parkville, Australia
| | - Daryl R Cheng
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia; Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Centre for Health Analytics, Melbourne Children's Campus, Parkville, Australia.
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16
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Sahu D. What's Important: The Challenge in Diagnosing Frozen Shoulder After COVID-19 Vaccination. J Bone Joint Surg Am 2022; 104:2127-2128. [PMID: 35766418 DOI: 10.2106/jbjs.22.00420] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Dipit Sahu
- Mumbai Shoulder Institute, Mumbai, India.,Sir H.N. Reliance Foundation Hospital, Mumbai, India.,Jupiter Hospital Thane, Thane, India
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17
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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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KAPLANOĞLU H, KAPLANOĞLU V, TURAN A, ÜNLÜ AKYÜZ E. Kuduz aşısı uygulamasına bağlı omuz yaralanması: bir olgu sunumu. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1124528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Reactions at the vaccine injection site are usually mild and transient. Musculoskeletal symptoms, such as myalgia and arthralgia, are commonly seen following vaccination. Shoulder injury related to vaccine administration (SIRVA), defined as shoulder pain and limited range of motion in the shoulder after intramuscular vaccine administration into the upper arm, may occur due to incorrect vaccine administration. Using the appropriate injection technique in the intramuscular administration of vaccines will reduce the risk of SIRVA. In this paper, we report the clinical and magnetic resonance imaging findings of a 26-year-old female patient presenting with SIRVA after rabies vaccination and discuss this case in light of the current literature.
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Affiliation(s)
- Hatice KAPLANOĞLU
- Sağlık Bilimleri Üniversitesi Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi, Radyoloji Bölümü, Ankara, Turkiye
| | - Veysel KAPLANOĞLU
- Sağlık Bilimleri Üniversitesi Keçiören Eğitim ve Araştırma Hastanesi, Patoloji Bölümü, Ankara, Turkiye
| | - Aynur TURAN
- Sağlık Bilimleri Üniversitesi Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi, Patoloji Bölümü, Ankara, Turkiye
| | - Ece ÜNLÜ AKYÜZ
- Sağlık Bilimleri Üniversitesi Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi, Patoloji Bölümü, Ankara, Turkiye
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19
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Mackenzie LJ, Bushell MJA, Newman P, Bousie JA. Shoulder injury related to vaccine administration (SIRVA): What do we know about its incidence and impact? EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 8:100183. [PMID: 36268129 PMCID: PMC9576975 DOI: 10.1016/j.rcsop.2022.100183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 10/28/2022] Open
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20
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MacMahon A, Nayar SK, Srikumaran U. What Do We Know About Shoulder Injury Related to Vaccine Administration? An Updated Systematic Review. Clin Orthop Relat Res 2022; 480:1241-1250. [PMID: 35323136 PMCID: PMC9191332 DOI: 10.1097/corr.0000000000002181] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 02/28/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Shoulder injury related to vaccine administration (SIRVA) is postulated to be an immune-mediated inflammatory response to a vaccine antigen injected into or near the subacromial bursae or synovium, leading to shoulder pain and dysfunction. The number of studies on this topic is rapidly increasing. Recent comparative studies have reported conflicting conclusions, which suggests that a systematic review of the best-available evidence may be helpful. QUESTIONS/PURPOSES In this systematic review, we asked: What are the (1) clinical characteristics, (2) diagnoses, and (3) management approaches and outcomes reported in association with SIRVA? METHODS A search was performed on October 4, 2021, of the PubMed and Medline databases for studies related to SIRVA. Inclusion criteria were English-language comparative studies, case series, and case reports that involved shoulder pain occurring after vaccination. Studies of exclusively neurologic conditions after vaccination were excluded. Forty-two studies met the eligibility criteria, including three retrospective comparative studies (72 patients and 105 controls), five database case series (2273 patients), and 34 case reports (49 patients). Study quality was assessed for the database case series and retrospective comparative studies using the Methodological Index for Non-randomized Studies tool. RESULTS Among patients in the case reports, the median age was 51 years (range 15-90 years), and 73% (36 of 49) were women. BMI was reported for 24% of patients (12 of 49) in case reports, with a median of 23.5 kg/m2 (range 21-37.2 kg/m2). The most common symptoms were shoulder pain and reduced ROM. The most common diagnoses were shoulder bursitis, adhesive capsulitis, and rotator cuff tears. The most frequent management modalities included physical or occupational therapy, NSAIDs, and steroid injections, followed by surgery, which was generally used for patients whose symptoms persisted despite nonsurgical management. Full resolution of symptoms was reported in 2.9% to 56% of patients. CONCLUSION The association between inflammatory conditions of the shoulder (such as bursitis) and vaccination appears to be exceedingly rare, occurring after approximately 1:130,000 vaccination events according to the best-available comparative study. Currently, there is no confirmatory experimental evidence supporting the theory of an immune-mediated inflammatory response to vaccine antigens. Although the clinical evidence is limited, similar to any bursitis, typical treatments appear effective, and surgery should rarely be performed. Additional research is needed to determine the best injection technique or evaluate alternate injection sites such as the anterolateral thigh that do not involve positioning a needle close to the shoulder.
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Affiliation(s)
- Aoife MacMahon
- Department of Orthopaedic Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Suresh K. Nayar
- Department of Orthopaedic Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
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21
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Slette E, Rohrback M, Ring D. Persistent Shoulder Pain After Vaccine Administration Is Associated with Common Incidental Pathology: A Systematic Review. Clin Orthop Relat Res 2022; 480:1251-1258. [PMID: 35319515 PMCID: PMC9191317 DOI: 10.1097/corr.0000000000002191] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/07/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Claims of shoulder injury now account for half of all claims to the Vaccine Injury Compensation Program. Reports from databases of claims or potential adverse events note a relatively high mean age and high prevalences of rotator cuff tendinopathy and adhesive capsulitis-common shoulder problems that might be incidental to vaccination. Published case reports provide much more detail about individual patients than is available in databases. A review of published cases provides an opportunity for more detailed review of symptoms, diagnoses, pathology, treatment, and prognosis. Such a review can better assess the relative likelihood that pathologies associated with new persistent shoulder symptoms after vaccination are coincidental or unique to and caused by vaccine. QUESTIONS/PURPOSES Regarding published case reports addressing persistent shoulder pain after vaccination: (1) In what proportion of patients was a specific diagnosis made? (2) What diagnoses were most common? (3) Among patients treated nonsurgically, what proportion resolved, and over what time span did they resolve? METHODS In August 2020, we searched PubMed and Embase between 2006 and 2020 using the following search strategy: Search 1: (shoulder dysfunction OR shoulder pain OR shoulder bursitis OR rotator cuff tendonitis OR adhesive capsulitis OR glenohumeral arthritis AND [vaccine OR vaccination OR immunization]); Search 2: (shoulder injury related to vaccine administration or SIRVA). The search was supplemented by reviewing reference lists of identified studies. Inclusion criteria were any detailed report of three or fewer cases involving shoulder pain after vaccine administration. Twenty published reports of 29 patients were identified and assessed by two reviewers independently. One reported glenohumeral joint infection was excluded because the relationship between this type of relatively uncommon, discrete diagnosis and vaccination raises different considerations. We assumed a high risk of bias, although we are not aware of bias assessment tool for case reports. We recorded and summarized patient demographics, symptoms, examination and imaging findings, surgery findings, diagnoses, treatments, and outcomes. Seventy-five percent (21 of 28) of patients were women, with a mean age of 54 ± 19 years. In search of an underlying pathology, at least one diagnostic study was performed in 82% (23 of 28) of patients including radiographs in seven, ultrasound in seven, and MRI in 16 patients (some patients underwent more than one type of imaging). We distinguished specific pathophysiological diagnosis from shoulder pain and stiffness, counted the most common diagnoses among patients a specific diagnosis, and tracked symptom resolution among patients treated nonoperatively. RESULTS A specific diagnosis was made in 57% (16 of 28) of patients. Twelve patients had pain and limitation of motion due to pain but no specific pathological diagnosis. The most common specific diagnoses were rotator cuff tendinopathy (9 of 16) and adhesive capsulitis (4 of 16). Less common specific diagnoses included rotator cuff arthropathy (and rheumatoid arthritis) and suspected septic arthritis with nonspecific synovitis on arthroscopy. One patient had transient MRI signal change in the humeral head, which was interpreted as osteonecrosis that resolved in a manner not typical for that diagnosis. Of the 17 patients treated nonsurgically, 15 reported resolution, and two had incomplete symptom resolution with the mean 6-month evaluation period. CONCLUSION The observation that persistent shoulder pain after vaccination overlaps with common shoulder pathology-both in large databases as well as in more detailed reports of specific patients as analyzed in this review-establishes a high probability of a coincidental rather than a causal association. In the absence of high-quality experimental evidence of vaccine-specific shoulder pathology, in our opinion, it seems safest and healthiest to assume that perceived shoulder injury related to vaccine administration (SIRVA) is due to misinterpretation of new symptoms from established pathology rather than a new, vaccine-specific pathology. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Erik Slette
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Mitchell Rohrback
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
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22
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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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23
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Zheng C, Duffy J, Liu ILA, Sy LS, Chen W, Qian L, Navarro RA, Ryan DS, Kim SS, Mercado C, Jacobsen SJ. Risk for Shoulder Conditions After Vaccination: A Population-Based Study Using Real-World Data. Ann Intern Med 2022; 175:634-643. [PMID: 35313110 PMCID: PMC9117507 DOI: 10.7326/m21-3023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although shoulder conditions have been reported as an adverse event after intramuscular vaccination in the deltoid muscle, epidemiologic data on shoulder conditions after vaccination are limited. OBJECTIVE To estimate the risk for shoulder conditions after vaccination and assess possible risk factors. DESIGN Retrospective cohort study. SETTING Kaiser Permanente Southern California, a large integrated health care organization. PARTICIPANTS Kaiser Permanente Southern California members aged 3 years or older who had an intramuscular vaccination administered in the deltoid muscle between 1 April 2016 and 31 December 2017. MEASUREMENTS A natural language processing (NLP) algorithm was used to identify potential shoulder conditions among vaccinated persons with shoulder disorder diagnosis codes. All NLP-identified cases were manually chart confirmed on the basis of our case definition. The characteristics of vaccinated persons with and without shoulder conditions were compared. RESULTS Among 3 758 764 administered vaccinations, 371 cases of shoulder condition were identified, with an estimated incidence of 0.99 (95% CI, 0.89 to 1.09) per 10 000 vaccinations. The incidence was 1.22 (CI, 1.10 to 1.35) for the adult (aged ≥18 years) and 0.05 (CI, 0.02 to 0.14) for the pediatric (aged 3 to 17 years) vaccinated populations. In the adult vaccinated population, advanced age, female sex, an increased number of outpatient visits in the 6 months before vaccination, lower Charlson Comorbidity Index, and pneumococcal conjugate vaccine were associated with a higher risk for shoulder conditions. Among influenza vaccines, quadrivalent vaccines were associated with an increased risk for shoulder conditions. Simultaneous administration of vaccines was associated with a higher risk for shoulder conditions among elderly persons. LIMITATION Generalizability to other health care settings, use of administrative data, and residual confounding. CONCLUSION These population-based data suggest a small absolute risk for shoulder conditions after vaccination. Given the high burden of shoulder conditions, clinicians should pay attention to any factors that may further increase risks. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Chengyi Zheng
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California (C.Z., I.A.L., L.S.S., W.C., L.Q., D.S.R., S.S.K., C.M., S.J.J.)
| | - Jonathan Duffy
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia (J.D.)
| | - In-Lu Amy Liu
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California (C.Z., I.A.L., L.S.S., W.C., L.Q., D.S.R., S.S.K., C.M., S.J.J.)
| | - Lina S Sy
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California (C.Z., I.A.L., L.S.S., W.C., L.Q., D.S.R., S.S.K., C.M., S.J.J.)
| | - Wansu Chen
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California (C.Z., I.A.L., L.S.S., W.C., L.Q., D.S.R., S.S.K., C.M., S.J.J.)
| | - Lei Qian
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California (C.Z., I.A.L., L.S.S., W.C., L.Q., D.S.R., S.S.K., C.M., S.J.J.)
| | - Ronald A Navarro
- Kaiser Permanente South Bay Medical Center, Harbor City, California (R.A.N.)
| | - Denison S Ryan
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California (C.Z., I.A.L., L.S.S., W.C., L.Q., D.S.R., S.S.K., C.M., S.J.J.)
| | - Sunhea S Kim
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California (C.Z., I.A.L., L.S.S., W.C., L.Q., D.S.R., S.S.K., C.M., S.J.J.)
| | - Cheryl Mercado
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California (C.Z., I.A.L., L.S.S., W.C., L.Q., D.S.R., S.S.K., C.M., S.J.J.)
| | - Steven J Jacobsen
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California (C.Z., I.A.L., L.S.S., W.C., L.Q., D.S.R., S.S.K., C.M., S.J.J.)
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Shoulder Injury Related to COVID-19 Vaccine Administration: A Case Series. Vaccines (Basel) 2022; 10:vaccines10040588. [PMID: 35455337 PMCID: PMC9027408 DOI: 10.3390/vaccines10040588] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/08/2022] [Accepted: 04/10/2022] [Indexed: 02/06/2023] Open
Abstract
Background: A shoulder injury related to vaccine administration (SIRVA) is a vaccination complication that can affect daily life activities. To date, there have been no case series of patients diagnosed as SIRVA following a COVID-19 vaccination. We offer a series of seven SIRVA cases including clinical presentations, investigations and treatment outcomes. Methods: A retrospective chart review was performed for seven patients who developed SIRVA following a COVID-19 vaccination between April 2021 and October 2021. All patients had no prior shoulder pain before their vaccination and then developed shoulder pain within a few days following the vaccination, which did not spontaneously improve within 1 week. Results: Four of the seven patients were male, and the average age was 62.29 ± 7.76 years. The average body mass index was 25.1 ± 2.2 kg/m2. In all cases, the cause of the SIRVA was from an incorrect COVID-19 vaccine administration technique. Two patients developed shoulder pain immediately following the injection, one patient about 3 h after the injection, and the other four patients within the next few days. Two of the seven patients visited the orthopedic clinic after the persistent shoulder pain for 3 and 4 days and the other five patients 1–9 weeks following their injections. One of the seven patients was treated with combined intravenous antibiotic and oral non-steroidal anti-inflammatory drug (NSAID) because septic arthritis of the shoulder could not initially be ruled out, and recovered within 2 weeks. The other six patients had shoulder pain without acute fever, and five of them were treated with only oral prednisolone 30 mg/day for 5–10 days, following which the pain improved and they all could return to normal activities within 14 days, with no side effects from the prednisolone such as stomachache, nausea, vomiting, headache, or dizziness. Discussion and conclusion: In our series, the most common cause of SIRVA was an incorrect vaccination technique. Most patients responded well to oral NSAIDs or oral prednisolone. Clinical relevance: All SIRVAs were from an incorrect injection technique and not actually the vaccination, so our series highlights the importance of ensuring all vaccinators understand the importance of taking proper care with the injection technique. Additionally, most of our patients with SIRVA from a COVID-19 injection responded well to oral prednisolone (30 mg/day). If there are no contraindications, we suggest this as the first line treatment for COVID-19-related SIRVA.
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Local Response and Barrier Recovery in Elderly Skin Following the Application of High-Density Microarray Patches. Vaccines (Basel) 2022; 10:vaccines10040583. [PMID: 35455332 PMCID: PMC9031416 DOI: 10.3390/vaccines10040583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 02/01/2023] Open
Abstract
The high-density microneedle array patch (HD-MAP) is a promising alternative vaccine delivery system device with broad application in disease, including SARS-CoV-2. Skin reactivity to HD-MAP applications has been extensively studied in young individuals, but not in the >65 years population, a risk group often requiring higher dose vaccines to produce protective immune responses. The primary aims of the present study were to characterise local inflammatory responses and barrier recovery to HD-MAPs in elderly skin. In twelve volunteers aged 69−84 years, HD-MAPs were applied to the forearm and deltoid regions. Measurements of transepidermal water loss (TEWL), dielectric permittivity and erythema were performed before and after HD-MAP application at t = 10 min, 30 min, 48 h, and 7 days. At all sites, TEWL (barrier damage), dielectric permittivity (superficial water);, and erythema measurements rapidly increased after HD-MAP application. After 7 days, the mean measures had recovered toward pre-application values. The fact that the degree and chronology of skin reactivity and recovery after HD-MAP was similar in elderly skin to that previously reported in younger adults suggests that the reactivity basis for physical immune enhancement observed in younger adults will also be achievable in the older population.
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Haaksman M, van Erp-van Boekel A, de Vries E, Robben Y. [Not Available]. HUISARTS EN WETENSCHAP 2022; 65:38-41. [PMID: 35291329 PMCID: PMC8916079 DOI: 10.1007/s12445-022-1422-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Shoulder injury related to vaccine administration(SIRVA) is een zeldzame en ondergerapporteerde complicatie van vaccinatie in de bovenarm. Patiënten met SIRVA hebben (soms heftige) schouderklachten die passen bij een subacromiaal pijnsyndroom of glenohumerale klachten. De klachten houden vaak weken tot maanden aan en beperken de patiënten in hun dagelijkse bezigheden. SIRVA ontstaat wanneer een intramusculaire injectie (deels) wordt toegediend in de onderliggende niet-musculaire weefsels. Dit veroorzaakt een ontstekingsreactie en kan leiden tot bursitis, tendinitis of een glenohumerale capsulitis. Vanwege de grote hoeveelheid vaccinaties in de huidige COVID-19-pandemie is het van belang dat huisartsen oog hebben voor deze complicatie.
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Affiliation(s)
- Michelle Haaksman
- Beoordelaar, farmakundige, Bijwerkingencentrum Lareb, ’s-Hertogenbosch, Nederland
| | | | - Esther de Vries
- Medisch specialist, lid klinische adviesraad Lareb, Jeroen Bosch Ziekenhuis, ’s-Hertogenbosch, Nederland
| | - Yvonne Robben
- Huisarts, Huisartsenpraktijk de Mierden, Reusel, Nederland
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27
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Pettyjohn EW, Clugston JR, Zaremski JL. Shoulder Injury Related to Vaccine Administration and a Growing Challenge: A Focused Review. Curr Sports Med Rep 2022; 21:78-83. [PMID: 35245242 DOI: 10.1249/jsr.0000000000000939] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Shoulder injury related to vaccine administration (SIRVA), an entity that causes acute shoulder pain and may limit range of motion (ROM) after vaccination, is a condition where a small but significant percentage of patients are experiencing in light of the current push for mass immunizations against SARS-CoV-2 worldwide. A search of literature related to SIRVA was performed across multiple electronic databases. Women, patients reporting vaccine injection location to be too high, and patients without prior history of shoulder pain were the most common historical factors in those experiencing SIRVA. Tenderness to palpation and limited shoulder ROM were the most associated physical examination findings. When using magnetic resonance imaging, tendinopathy, subacromial-subdeltoid bursitis, and rotator cuff tears (partial or complete) were the most common findings. Radiographic imaging rarely aided the diagnosis. SIRVA is an entity that health care providers should be aware of to improve the care of patients that may experience these symptoms after vaccine administration.
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Affiliation(s)
- Eric W Pettyjohn
- Department of Family Medicine and Community Health, University of Florida, Gainesville, FL
| | - James R Clugston
- Department of Family Medicine and Community Health, University of Florida, Gainesville, FL
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Abstract
Background The data on frozen shoulder and shoulder injury related to vaccine administration (SIRVA) after coronavirus disease 2019 (COVID-19) vaccination are absent from the literature. Hence, the purpose of this case series was to describe the clinical presentation and short-term follow-up of patients who developed frozen shoulder after COVID-19 vaccination. Methods In the present study, 10 patients (9 women and 1 man) with a mean age of 53 ± 8 years (range, 43-68 years) who presented to the shoulder surgeon’s practice center with painful stiffness of the shoulder after COVID-19 vaccination between June 1 and September 30, 2021, were retrospectively evaluated. Results All 10 patients had normal radiographs and were diagnosed as frozen shoulder. Eight patients (80%) had a comorbidity during presentation (4 patients with hypothyroidism, 3 patients with diabetes mellitus, and 1 patient with prediabetes/hyperglycemia). Symptoms developed immediately after the vaccination in 6 patients (60%), at 48 hours in 1 patient (10%), and at 10 days in 3 patients (30%). The mean pain visual analog scale score was 6.5 ± 1.9 (range, 2.5-8), and both active and passive range of motion were limited in all the patients at the time of presentation. Conclusion The musculoskeletal specialists who will see such patients with painful shoulder stiffness should be aware of the frozen shoulder diagnosis, which can occur after COVID-19 vaccination, so that such patients can be identified and treated early.
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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
- Corresponding author: Dipit Sahu, MS, Mumbai Shoulder Institute, Central avenue, Hiranandani, Powai, Mumbai, Maharashtra 400072, India.
| | - Gautam Shetty
- Knee & Orthopaedic Clinic, Mumbai, India
- QI Spine Clinic, Mumbai, India
- AIMD Research, Mumbai, India
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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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30
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Perez-Vilar S, Dores GM, Marquez PL, Ng CS, Cano MV, Rastogi A, Lee L, Su JR, Duffy J. Safety surveillance of meningococcal group B vaccine (Bexsero®), Vaccine Adverse Event Reporting System, 2015-2018. Vaccine 2022; 40:247-254. [PMID: 34887130 PMCID: PMC9009159 DOI: 10.1016/j.vaccine.2021.11.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Bexsero® (GlaxoSmithKline) is a four-component Neisseria meningitidis serogroup B vaccine (MenB-4C). It was licensed in the United States in 2015 for use among individuals ages 10-25 years. We aimed to assess the post-licensure safety profile of MenB-4C by examining reports received in the Vaccine Adverse Event Reporting System (VAERS). METHODS VAERS is a national passive surveillance system for adverse events (AEs) following immunization that uses the Medical Dictionary for Regulatory Activities to code reported AEs and the Code of Federal Regulations to classify reports by seriousness. In this case series, we analyzed U.S. reports involving MenB-4C received between January 23, 2015 through December 31, 2018. We used Empirical Bayesian data mining to identify MenB-4C/AE combinations reported at least twice as often as expected. RESULTS VAERS received 1,867 reports following MenB-4C administration, representing 332 reports per million doses distributed. Most reports were for females (59%), with a median age of 17 years (interquartile range: 16-18 years); 40% of reports described simultaneous administration of other vaccines. The majority of reports were classified as non-serious (96%). The most commonly reported AEs were injection site pain (22%), pyrexia (16%), and headache (16%). Data mining identified disproportionate reporting for "injected limb mobility decreased" secondary to injection site reactions, including extensive swelling of the vaccinated limb and injection site pain. CONCLUSIONS Analysis of passive surveillance data from over 5.6 million doses of MenB-4C distributed in the United States did not reveal new safety concerns. The large majority of reports were classified as non-serious and the reported AEs were generally consistent with the safety experience described in clinical studies and the product's package insert. While our results are reassuring, continued post-marketing surveillance is warranted.
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Affiliation(s)
- Silvia Perez-Vilar
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD 20993, United States.
| | - Graça M Dores
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD 20993, United States.
| | - Paige L Marquez
- Immunization Safety Office, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, United States.
| | - Carmen S Ng
- Immunization Safety Office, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, United States.
| | - Maria V Cano
- Immunization Safety Office, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, United States.
| | - Anuja Rastogi
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD 20993, United States.
| | - Lucia Lee
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD 20993, United States.
| | - John R Su
- Immunization Safety Office, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, United States.
| | - Jonathan Duffy
- Immunization Safety Office, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, United States.
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Wood CT, Ilyas AM. Shoulder Injury Related to Vaccine Administration: Diagnosis and Management. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:111-117. [PMID: 35128359 PMCID: PMC8797178 DOI: 10.1016/j.jhsg.2021.12.009] [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: 08/08/2021] [Accepted: 12/21/2021] [Indexed: 11/05/2022] Open
Abstract
Shoulder injury related to vaccine administration (SIRVA) is a rare but potentially debilitating injury characterized by persistent shoulder pain, typically occurring within 48 hours of intramuscular deltoid vaccine administration. With over 150 million flu vaccines being administered in the United States each year, and the US Centers for Disease Control’s goal of immunizing greater than 70% of the population for the coronavirus disease 2019 virus, cases of SIRVA can be expected to rise. A search of current literature was done to identify published material corresponding to incidence, diagnosis, and treatment of SIRVA. Most events have been associated with poor needle placement and/or a local reaction to the delivered serum during vaccine administration. Shoulder injury related to vaccine administration events can lead to persistent and possibly permanent injury. Clinical evaluation involves a thorough history, physical examination, and often diagnostic studies including radiographs, magnetic resonance imaging, and nerve studies. Treatment is individually directed and should initially consist of observation and local symptom management. Recalcitrant cases or infections may warrant surgical intervention. Published outcomes vary widely, and our understanding of SIRVA remains limited. Large-scale studies are necessary to better understand the pathophysiology of SIRVA, its treatment, and its outcomes. Overall, the initial priority in managing SIRVA should be awareness and prevention.
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Bodor M, Uribe Y, Srikumaran U. Ultrasonic aspiration for vaccination-related shoulder dysfunction. Heliyon 2021; 7:e08442. [PMID: 34901499 PMCID: PMC8642614 DOI: 10.1016/j.heliyon.2021.e08442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/29/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background Chronic shoulder pain occurs rarely after a vaccination and is hypothesized to arise from the effects of unintentional vaccine injection into the subacromial bursa, rotator cuff, capsule or underlying bone. The avascular nature of the rotator cuff, as well as unknown genetic and environmental factors, may predispose to the persistence of pain and disability, referred to as vaccination-related shoulder dysfunction and shoulder injury related to vaccine administration (SIRVA). Methods Ultrasonography, sonopalpation and ultrasound-guided anesthetic injections were used to locate the anatomical source of chronic (mean 20, range 8–42 months) shoulder pain after a vaccination in a consecutive series of 5 patients. Subsequently ultrasound-guided ultrasonic aspiration and debridement was performed using a 2.1 mm outer cannula with an inner needle vibrating at 28 kHz. Outcomes were assessed using the Quick Disabilities of the Arm, Shoulder and Hand (QDASH) scale at 2, 4, 12, 24 weeks and 1 year. Results The distal infraspinatus and teres minor tendons, their insertions and or the adjacent bone were the source of pain in all 5 patients. The mean QDASH score improved from 65 points to 11 points at 2 weeks (P = 0.001), and to 1 point at 4 weeks after the procedures (P = 0.003). Improvements in pain and function remained stable at 1 year in 3 patients, for at least 24 weeks in 1 patient who died of unrelated causes, and 1 year in 1 patient for posterior shoulder pain who after a pain free interval developed anterior shoulder pain related to his previously asymptomatic osteoarthritis (P = 0.013). Conclusion The distal infraspinatus and teres minor tendons, their insertions and adjacent bone are a common source of chronic shoulder pain after a vaccination. Ultrasound-guided ultrasonic aspiration and debridement is a potentially effective treatment for resolving pain and restoring function.
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Affiliation(s)
- Marko Bodor
- Bodor Clinic, 3421 Villa Lane, Napa, CA, 94558, USA.,Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA.,Department of Physical Medicine and Rehabilitation, University of California Davis, 4860 Y Street, Sacramento, CA, 95817, USA.,Napa Medical Research Foundation, 3421 Villa Lane, Napa, CA, 94558, USA
| | - Yvette Uribe
- Napa Medical Research Foundation, 3421 Villa Lane, Napa, CA, 94558, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD, 21287, USA
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Sarasua SM, Floyd S, Bridges WC, Pill SG. The epidemiology and etiology of adhesive capsulitis in the U.S. Medicare population. BMC Musculoskelet Disord 2021; 22:828. [PMID: 34579697 PMCID: PMC8474744 DOI: 10.1186/s12891-021-04704-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022] Open
Abstract
Background Adhesive capsulitis (AC) of the shoulder, also known as frozen shoulder, causes substantial pain and disability. In cases of secondary AC, the inflammation and fibrosis of the synovial joint can be triggered by trauma or surgery to the joint followed by extended immobility. However, for primary AC the inciting trigger is unknown. The burden of the disorder among the elderly is also unknown leading to this age group being left out of therapeutic research studies, potentially receiving delayed diagnoses, and unknown financial costs to the Medicare system. The purpose of this analysis was to describe the epidemiology of AC in individuals over the age of 65, an age group little studied for this disorder. The second purpose was to investigate whether specific medications, co-morbidities, infections, and traumas are risk factors or triggers for primary AC in this population. Methods We used Medicare claims data from 2010–2012 to investigate the prevalence of AC and assess comorbid risk factors and seasonality. Selected medications, distal trauma, and classes of infections as potential inflammatory triggers for primary AC were investigated using a case–control study design with patients with rotator cuff tears as the comparison group. Medications were identified from National Drug codes and translated to World Health Organization ATC codes for analysis. Health conditions were identified using ICD9-CM codes. Results We found a one-year prevalence rate of AC of approximately 0.35% among adults aged 65 years and older which translates to approximately 142,000 older adults in the United States having frozen shoulder syndrome. Diabetes and Parkinson’s disease were significantly associated with the diagnosis of AC in the elderly. Cases were somewhat more common from August through December, although a clear seasonal trend was not observed. Medications, traumas, and infections were similar for cases and controls. Conclusions This investigation identified the burden of AC in the US elderly population and applied case–control methodology to identify triggers for its onset in this population. Efforts to reduce chronic health conditions such as diabetes may reduce seemingly unrelated conditions such as AC. The inciting trigger for this idiopathic condition remains elusive.
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Affiliation(s)
- Sara M Sarasua
- School of Nursing, Clemson University, 436 Edwards Hall, Clemson, SC, USA.
| | - Sarah Floyd
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA.,Center for Effectiveness Research in Orthopaedics, University of South Caro, Greenville, SC, USA
| | - William C Bridges
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, SC, USA
| | - Stephan G Pill
- Steadman Hawkins Clinic of the Carolinas, Prisma Health, Greenville, SC, USA
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Shoulder Injury Related to Vaccine Administration. J Am Acad Orthop Surg 2021; 29:732-739. [PMID: 34185028 DOI: 10.5435/jaaos-d-21-00021] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/03/2021] [Indexed: 02/01/2023] Open
Abstract
Shoulder injury related to vaccine administration (SIRVA) is a rare yet increasingly recognized complication of immunization. Although a medicolegal term rather than a true diagnosis, SIRVA was introduced in 2010 by the Vaccine Injury Compensation Program after an increase in claims filed for vaccine-related shoulder injury. Patients typically present with severe pain and limited range of motion within 48 hours of vaccination and may experience notable functional limitations. Although the underlying pathophysiology is incompletely understood, the existing literature suggests that SIRVA results from the inflammatory response produced when the vaccine is injected into tissues containing a preexisting antibody. Current treatment modalities include physical therapy, corticosteroid injections, and antiinflammatory medications. In some cases, surgery may be required to treat underlying pathology, such as rotator cuff or biceps tendinopathy. Although the available literature indicates modest improvement in patients with SIRVA undergoing treatment, current data are limited to case series. Larger, high-quality studies are needed to determine the natural history and optimal treatment of this increasingly prevalent condition.
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Hirsiger JR, Tamborrini G, Harder D, Bantug GR, Hoenger G, Recher M, Marx C, Li QZ, Martin I, Hess C, Scherberich A, Daikeler T, Berger CT. Chronic inflammation and extracellular matrix-specific autoimmunity following inadvertent periarticular influenza vaccination. J Autoimmun 2021; 124:102714. [PMID: 34403915 DOI: 10.1016/j.jaut.2021.102714] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/27/2021] [Accepted: 08/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Viral infections may trigger autoimmunity in genetically predisposed individuals. Immunizations mimic viral infections immunologically, but only in rare instances vaccinations coincide with the onset of autoimmunity. Inadvertent vaccine injection into periarticular shoulder tissue can cause inflammatory tissue damage ('shoulder injury related to vaccine administration, SIRVA). Thus, this accident provides a model to study if vaccine-induced pathogen-specific immunity accompanied by a robust inflammatory insult may trigger autoimmunity in specific genetic backgrounds. METHODS We studied 16 otherwise healthy adults with suspected SIRVA occurring following a single work-related influenza immunization campaign in 2017. We performed ultrasound, immunophenotypic analyses, HLA typing, and influenza- and self-reactivity functional immunoassays. Vaccine-related bone toxicity and T cell/osteoclast interactions were assessed in vitro. FINDINGS Twelve of the 16 subjects had evidence of inflammatory tissue damage on imaging, including bone erosions in six. Tissue damage was associated with a robust peripheral blood T and B cell activation signature and extracellular matrix-reactive autoantibodies. All subjects with erosions were HLA-DRB1*04 positive and showed extracellular matrix-reactive HLA-DRB1*04 restricted T cell responses targeting heparan sulfate proteoglycan (HSPG). Antigen-specific T cells potently activated osteoclasts via RANK/RANK-L, and the osteoclast activation marker Trap5b was high in sera of patients with an erosive shoulder injury. In vitro, the vaccine component alpha-tocopheryl succinate recapitulated bone toxicity and stimulated osteoclasts. Auto-reactivity was transient, with no evidence of progression to rheumatoid arthritis or overt autoimmune disease. CONCLUSION Vaccine misapplication, potentially a genetic predisposition, and vaccine components contribute to SIRVA. The association with autoimmunity risk allele HLA-DRB1*04 needs to be further investigated. Despite transient autoimmunity, SIRVA was not associated with progression to autoimmune disease during two years of follow-up.
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Affiliation(s)
- Julia R Hirsiger
- Translational Immunology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Giorgio Tamborrini
- Ultrasound Center for Rheumatology (UZR), Basel, Switzerland; Rheumatology Clinic, University Hospital Basel, Basel, Switzerland
| | - Dorothee Harder
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Glenn R Bantug
- Immunobiology Lab, Department Biomedicine, University of Basel, Basel, Switzerland
| | - Gideon Hoenger
- HLA-Diagnostics and Immunogenetics, Department of Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | - Mike Recher
- Immunodeficiency Lab, Department Biomedicine, University of Basel, Basel, Switzerland
| | | | - Quan-Zhen Li
- Department of Immunology & Internal Medicine, IIMT Microarray Core Facility, University of Texas Southwestern Medical Center, USA
| | - Ivan Martin
- Laboratory of Tissue Engineering, Departments of Surgery and Biomedicine, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Christoph Hess
- Immunobiology Lab, Department Biomedicine, University of Basel, Basel, Switzerland
| | - Arnaud Scherberich
- Laboratory of Tissue Engineering, Departments of Surgery and Biomedicine, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Thomas Daikeler
- Rheumatology Clinic, University Hospital Basel, Basel, Switzerland
| | - Christoph T Berger
- Translational Immunology, Department of Biomedicine, University of Basel, Basel, Switzerland; Interdisciplinary Center for Immunology, Departments of Dermatology, Internal Medicine, and Rheumatology, University Hospital Basel, Basel, Switzerland.
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36
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Abstract
ABSTRACT Shoulder injury related to vaccine administration (SIRVA) is a preventable complication caused by improper needle placement. It is associated with persistent shoulder pain and limited range of motion that occur within hours of vaccination and can last for months or longer. This article provides a brief overview of SIRVA and explains how vaccinators can prevent it by using proper injection technique.
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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; 30:e334-e337. [PMID: 33610727 DOI: 10.1016/j.jse.2021.01.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 01/18/2021] [Indexed: 02/01/2023]
Affiliation(s)
- Willis Wong
- Duke University School of Medicine, Durham, NC, USA.
| | | | - Elshaday Belay
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Christopher S Klifto
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Oke Anakwenze
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
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Zheng C, Duffy J, Liu ILA, Sy LS, Navarro RA, Kim SS, Ryan DS, Chen W, Qian L, Mercado C, Jacobsen SJ. Identifying Cases of Shoulder Injury Related to Vaccine Administration (SIRVA) in the United States: Development and Validation of a Natural Language Processing Method (Preprint). JMIR Public Health Surveill 2021; 8:e30426. [PMID: 35608886 PMCID: PMC9175103 DOI: 10.2196/30426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 02/22/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Shoulder injury related to vaccine administration (SIRVA) accounts for more than half of all claims received by the National Vaccine Injury Compensation Program. However, due to the difficulty of finding SIRVA cases in large health care databases, population-based studies are scarce. Objective The goal of the research was to develop a natural language processing (NLP) method to identify SIRVA cases from clinical notes. Methods We conducted the study among members of a large integrated health care organization who were vaccinated between April 1, 2016, and December 31, 2017, and had subsequent diagnosis codes indicative of shoulder injury. Based on a training data set with a chart review reference standard of 164 cases, we developed an NLP algorithm to extract shoulder disorder information, including prior vaccination, anatomic location, temporality and causality. The algorithm identified 3 groups of positive SIRVA cases (definite, probable, and possible) based on the strength of evidence. We compared NLP results to a chart review reference standard of 100 vaccinated cases. We then applied the final automated NLP algorithm to a broader cohort of vaccinated persons with a shoulder injury diagnosis code and performed manual chart confirmation on a random sample of NLP-identified definite cases and all NLP-identified probable and possible cases. Results In the validation sample, the NLP algorithm had 100% accuracy for identifying 4 SIRVA cases and 96 cases without SIRVA. In the broader cohort of 53,585 vaccinations, the NLP algorithm identified 291 definite, 124 probable, and 52 possible SIRVA cases. The chart-confirmation rates for these groups were 95.5% (278/291), 67.7% (84/124), and 17.3% (9/52), respectively. Conclusions The algorithm performed with high sensitivity and reasonable specificity in identifying positive SIRVA cases. The NLP algorithm can potentially be used in future population-based studies to identify this rare adverse event, avoiding labor-intensive chart review validation.
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Affiliation(s)
- Chengyi Zheng
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Jonathan Duffy
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - In-Lu Amy Liu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Lina S Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Ronald A Navarro
- Kaiser Permanente South Bay Medical Center, Harbor City, CA, United States
| | - Sunhea S Kim
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Denison S Ryan
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Wansu Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Lei Qian
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Cheryl Mercado
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
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Batra S, Page B. Shoulder Injury Related to Vaccine Administration: Case Series of an Emerging Occupational Health Concern. Workplace Health Saf 2020; 69:68-72. [PMID: 32967588 DOI: 10.1177/2165079920952765] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Shoulder injury related to vaccine administration (SIRVA) is an increasingly recognized complication of improper vaccine administration. Due to the growing number of mandatory workplace vaccination programs, especially for annual influenza vaccine, it is essential that occupational health providers are aware of this condition to improve prevention and/or treatment of this condition when it arises. Therefore, we describe the clinical presentation and course of treatment of five cases of SIRVA that were seen in an employer-based Occupational Health Services Clinic (OHS) after mandatory influenza vaccine administration. METHODS A retrospective chart review was performed for five cases of SIRVA from 2017 to 2019. FINDINGS Five cases met clinical definition of SIRVA as defined by the National Vaccine Injury Compensation Program. All cases were of similar characteristics including gender, age range, and body mass index (BMI). All were treated using multiple modalities including medication, physical therapy, and modified work with eventual resolution of symptoms and full return to work. CONCLUSIONS/APPLICATION TO PRACTICE Awareness of SIRVA is necessary in any occupational setting where vaccines are routinely administered. Avoidance of SIRVA by adhering to proper vaccination technique is crucial, as is awareness of how to recognize and manage the condition in affected employees to limit long-term impairment.
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Hesse EM, Navarro RA, Daley MF, Getahun D, Henninger ML, Jackson LA, Nordin J, Olson SC, Zerbo O, Zheng C, Duffy J. Risk for Subdeltoid Bursitis After Influenza Vaccination: A Population-Based Cohort Study. Ann Intern Med 2020; 173:253-261. [PMID: 32568572 DOI: 10.7326/m19-3176] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Subdeltoid bursitis has been reported as an adverse event after intramuscular vaccination in the deltoid muscle. Most published case reports involved influenza vaccine. OBJECTIVE To estimate the risk for subdeltoid bursitis after influenza vaccination. DESIGN Retrospective cohort study. SETTING The Vaccine Safety Datalink, which contains health encounter data for 10.2 million members of 7 U.S. health care organizations. PATIENTS Persons who received an inactivated influenza vaccine during the 2016-2017 influenza season. MEASUREMENTS Potential incident cases were identified by searching administrative data for persons with a shoulder bursitis diagnostic code within 180 days after receiving an injectable influenza vaccine in the same arm. The date of reported bursitis symptom onset was abstracted from the medical record. A self-controlled risk interval analysis was used to calculate the incidence rate ratio of bursitis in a risk interval of 0 to 2 days after vaccination versus a control interval of 30 to 60 days, which represents the background rate. The attributable risk was also estimated. RESULTS The cohort included 2 943 493 vaccinated persons. Sixteen cases of symptom onset in the risk interval and 51 cases of symptom onset in the control interval were identified. The median age of persons in the risk interval was 57.5 years (range, 24 to 98 years), and 69% were women. The incidence rate ratio was 3.24 (95% CI, 1.85 to 5.68). The attributable risk was 7.78 (CI, 2.19 to 13.38) additional cases of bursitis per 1 million persons vaccinated. LIMITATION The results may not be generalizable to vaccinations done in other types of health care settings. CONCLUSION Although an increased risk for bursitis after vaccination was present, the absolute risk was small. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Elisabeth M Hesse
- Epidemic Intelligence Service and Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia (E.M.H., J.D.)
| | - Ronald A Navarro
- Kaiser Permanente South Bay Medical Center, Harbor City, California (R.A.N.)
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado (M.F.D.)
| | | | | | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (L.A.J.)
| | - James Nordin
- HealthPartners Institute for Education and Research, Minneapolis, Minnesota (J.N.)
| | - Scott C Olson
- Marshfield Clinic Research Institute, Center for Clinical Epidemiology and Population Health, Marshfield, Wisconsin (S.C.O.)
| | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Oakland, California (O.Z.)
| | - Chengyi Zheng
- Kaiser Permanente, Pasadena, California (D.G., C.Z.)
| | - Jonathan Duffy
- Epidemic Intelligence Service and Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia (E.M.H., J.D.)
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Veera S, Chin J, Kleyn L, Spinelli S, Tafler L. Use of Osteopathic Manipulation for Treatment of Chronic Shoulder Injury Related to Vaccine Administration. Cureus 2020; 12:e9156. [PMID: 32789092 PMCID: PMC7417317 DOI: 10.7759/cureus.9156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Shoulder injury related to vaccine administration (SIRVA) is an increasingly reported phenomenon that causes inflammation of surrounding structures, along with pain and decreased range of motion of the affected shoulder. Current literature emphasizes proper injection techniques and locations to decrease incidence; however, there is limited information available on successful treatments. The aim of this report is to describe a case of SIRVA and review treatment options, specifically the role of osteopathic manipulative medicine (OMM) in the resolution of symptoms refractory to standard care. Here we present a case of chronic SIRVA in a 58-year-old female due to a poorly administered influenza vaccination with emphasis on a stepwise osteopathic therapy approach as a lasting treatment to decrease the effects of the inflammatory process and improve daily function of the shoulder. OMM, with the option of anesthesia, can be performed in outpatient family medicine practices as a noninvasive and safe adjunct treatment. Specifically, the Spencer technique has been shown to improve shoulder-related pathologies that include adhesions, capsulitis, and inflammation and was used in this case under anesthesia. The patient reported good improvement in her symptoms and increased range of motion. SIRVA is an underdiagnosed phenomenon that involves inflammation of surrounding structures after a vaccine administration. In chronic cases, such as in this patient, OMM may be enhanced with the use of anesthesia to optimize the treatment's effect on scar tissue and fibrosis.
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Affiliation(s)
- Simrat Veera
- Pediatrics, Goryeb Children's Hospital - Atlantic Health System, Morristown, USA
| | - Justin Chin
- Family Medicine, LifeLong Medical Care, Richmond, USA.,Medical Education, Lake Erie College of Osteopathic Medicine, Erie, USA
| | - Lina Kleyn
- Family Medicine, Morristown Medical Center - Atlantic Health System, Morristown, USA
| | | | - Leonid Tafler
- Primary Care, Touro College of Osteopathic Medicine, New York, USA
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Natanzi N, Hebroni F, Bodor M. Teres minor injury related to vaccine administration. Radiol Case Rep 2020; 15:552-555. [PMID: 32194884 PMCID: PMC7078120 DOI: 10.1016/j.radcr.2020.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 11/04/2022] Open
Abstract
Shoulder injury related to vaccine administration is a relatively rare disorder, which occurs as a result of vaccine being inadvertently injected into the subdeltoid/subacromial bursa, rotator cuff, and or underlying bone. We present 2 cases of shoulder injury related to vaccine administration in 2 women of ages 38 and 42 with injury to the teres minor tendon insertions on magnetic resonance imaging, a location not previously described. When faced with a patient with chronic shoulder pain following a vaccination, the possibility of vaccine deposition or injury to the teres minor tendon insertion should be considered.
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Affiliation(s)
- Naveed Natanzi
- The Regenerative Sports and Spine Institute, 14332 Ventura Blvd., Sherman Oaks, CA 91423, USA
| | - Frank Hebroni
- Department of Radiology, University of California, Los Angeles, CA 90024, USA
| | - Marko Bodor
- Bodor Clinic, 3421 Villa Lane Suite 2B, Napa, CA 94558, USA
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Thompson KM, Orenstein WA, Hinman AR. Performance of the United States Vaccine Injury Compensation Program (VICP): 1988-2019. Vaccine 2020; 38:2136-2143. [PMID: 31982259 DOI: 10.1016/j.vaccine.2020.01.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 11/28/2022]
Abstract
The United States (US) highly values the individual and societal benefits of vaccination and invests significantly in vaccine development and use as part of its national vaccine enterprise. In 1986, recognizing the small, but non-zero risks associated with vaccines, the US created a mechanism to collect excise taxes on each dose of vaccine to fund a national Vaccine Injury Compensation Program (VICP). The VICP includes a system for those claiming serious injuries from vaccines to seek compensation, and a process to pay individuals with legitimate claims and their legal counsel. Given the maturity of the VICP, we review experience with the vaccines and injuries covered, claims, and economics of the fund. Our review shows the excellent safety track record of vaccines, provides some evidence of injuries related specifically to vaccine delivery, and discusses the financial health of the fund.
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