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Li Z, Chen S, Zhao M. An analysis of reported cases shoulder injury related to vaccine administration of after COVID-19 vaccination. Hum Vaccin Immunother 2024; 20:2321672. [PMID: 38439670 PMCID: PMC10936633 DOI: 10.1080/21645515.2024.2321672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/18/2024] [Indexed: 03/06/2024] Open
Abstract
To prevent COVID-19, the COVID-19 vaccine has been widely administered worldwide, but various complications accompany this vaccine. The aim of this study was to investigate the demographic patterns, clinical features, diagnostic findings, and treatment outcomes associated with shoulder injury related to vaccine administration (SIRVA). This study examined 22 patients with SIRVA following COVID-19 vaccination from the Web of Science (WOS) and PubMed databases. The patients were categorized based on sex, age, type of COVID-19 vaccine received, dose administered, latency of symptom onset, and the presence of specific clinical manifestations. Patients, evenly distributed by sex (12 females, 10 males), and aged 21 to 84 years (mean age 46.6), were analyzed. SIRVA cases were reported across all age groups. The Pfizer - BioNTech COVID-19 vaccine had the highest incidence (n = 8), followed by the Oxford/AstraZeneca COVID-19 vaccine (n = 4). Symptoms, primarily shoulder pain (n = 22) and shoulder mobility disorders (n = 18), occurred within three days post-vaccination. Some patients also reported shoulder swelling (n = 5) and fever (n = 2). Imaging revealed nonspecific X-ray findings, supraspinatus tendon calcification (n = 2), and shoulder edema and inflammation on MRI (n = 12). This study provides insights into the clinical aspects of SIRVA related to COVID-19 vaccination. Recognition and appropriate management of these complications are crucial for optimal patient outcomes.
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Affiliation(s)
- Zixin Li
- Department of Spine Surgery and Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shijie Chen
- Department of Spine Surgery and Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mingyi Zhao
- Department of Spine Surgery and Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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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 Rev Rep Tech 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Fortier LM, Smith KL, Ina JG, Sinkler MA, Calcei JG, Salata MJ, Gillespie R, Voos JE. Common characteristics of shoulder injury related to vaccine administration following COVID-19 vaccination: a comprehensive systematic review. J Shoulder Elbow Surg 2024; 33:202-209. [PMID: 37660886 DOI: 10.1016/j.jse.2023.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/18/2023] [Accepted: 07/29/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND The pathogenesis of shoulder injury related to vaccine administration (SIRVA) is incompletely understood, but it is postulated to be an immune-mediated inflammatory response to a vaccine antigen, leading to shoulder pain and dysfunction. The purpose of this investigation is to systematically review the literature related to SIRVA specifically after the COVID-19 vaccination by describing the diagnostic and clinical characteristics, diagnoses associated with SIRVA, and incidence between vaccine types. METHODS A systematic review was performed to identify level I to IV studies and case descriptions of shoulder pain occurring after COVID-19 vaccination. To confirm that no studies were missing from the systematic review, references of studies from the initial search were scanned for additional relevant studies. RESULTS A total of 22 studies, comprised of 81 patients, were identified meeting the inclusion/exclusion criteria. Reports were most commonly published from countries in Asia (53.1%; n = 43/81). The most commonly described vaccines were Oxford-AstraZeneca at 37.0% (n = 30/81) and Pfizer-BioNTech at 33.3% (n = 27/81). Symptoms occurred most commonly after at least 72 hours of administration (30.9%, n = 25/81). One hundred percent of patients (n = 81/81) described pain as an associated symptom and 90.1% of patients (n = 73/81) described multiple symptoms. The diagnostic modalities utilized to identify a specific pathology consisted of magnetic resonance imaging (55.6%; n = 45/81), ultrasound (28.4; n = 23/81), radiograph (25.9%; n = 21/81), and computed tomography (4.9%; 4/81). Nearly a third of patients (32.1%; n = 26/81) were diagnosed with bursitis, while 22 (27.2%) were diagnosed with adhesive capsulitis, 17 (21.0%) with either rotator cuff tear or tendinopathy, and 14 (17.3%) with polymyalgia rheumatica or polymyalgia rheumatica-like syndrome. The 2 most common treatment options were physical therapy (34.6%; n = 28/81) and nonsteroidal anti-inflammatory medications (33.3%; 27/81). The majority of SIRVA cases (52.1%; n = 38/73) completely resolved within a few weeks to months. CONCLUSION Despite the limited quality and lack of large-scale studies, it is important for providers to recognize SIRVA as a potential risk factor as the number of patients receiving COVID-19 vaccinations and boosters continues to rise.
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Affiliation(s)
- Luc M Fortier
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - Kira L Smith
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jason G Ina
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Margaret A Sinkler
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jacob G Calcei
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Michael J Salata
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Robert Gillespie
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - James E Voos
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Alshehri M, Alsalman M, Alsebayel FM. Adhesive capsulitis following COVID-19 vaccination: a case report and review of literature. J Surg Case Rep 2023; 2023:rjad611. [PMID: 37965532 PMCID: PMC10642426 DOI: 10.1093/jscr/rjad611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/15/2023] [Indexed: 11/16/2023] Open
Abstract
Shoulder injury related to vaccine administration (SIRVA) has been frequently reported adverse event following COVID-19 vaccination. Multiple studies have reported various injuries including subacromial bursitis, rotator cuff tears, nerve injury, and most commonly, adhesive capsulitis. Adhesive capsulitis is defined as an inflammatory disease of the joint capsule characterized by pain and stiffness. Herein, we present a case of a 38-year-old female, known to have uncontrolled diabetes mellites and asthma, presented to upper extremity orthopedic clinic complaining of 6 months history of left shoulder pain and limited range of motion following COVID-19 vaccination administration. Clinical examination and radiological studies were consistent with adhesive capsulitis, the patient was then referred for intensive rehabilitation program that provided adequate response. In conclusion, the main etiology of SIRVA has been attributed to suboptimal injection technique, a standardized definition, implementation of safe vaccines injection protocols, and further education and awareness of SIRVA is needed to healthcare practitioners to allow better understanding and prevention.
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Affiliation(s)
- Mohammed Alshehri
- Department of Orthopedic Surgery, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed Alsalman
- Department of Medical Radiology, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Firas M Alsebayel
- Department of Orthopedic Surgery, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lyman K, Kelley T, Walthall J, Lang SD, Gilmer BB, Guttmann D. Refractory shoulder injury related to vaccine administration: correlation with culture presence of Cutibacterium acnes. JSES Rev Rep Tech 2023; 3:350-355. [PMID: 37588495 PMCID: PMC10426568 DOI: 10.1016/j.xrrt.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Shoulder pain following intramuscular administration of vaccine is common. However, a small number of patients experience prolonged pain and dysfunction atypical to normal transient postvaccination shoulder pain. Shoulder Injury Related to Vaccine Administration (SIRVA) remains incompletely understood, whether a robust immune response to vaccine antigen or inappropriate injection technique with needle placement in synovial or bursal tissue, or some combination of the two. Symptoms overlap with those of Cutibacterium acnes (C. acnes) infection but the relationship between the two, if any, has not been evaluated. Methods Clinical case files were reviewed for 3 cases of SIRVA with positive cultures for C. acnes were reviewed. Presentation, treatment, and clinical outcomes were compared. Results In all cases, patients were thin (body mass index < 23), females, who had high injection placement of a vaccine, all patients had positive magnetic resonance imaging findings of increased signal in the subacromial bursa, and/or greater tuberosity. All patients underwent arthroscopic débridement and culture harvest and cultures were positive for C. acnes. A combination of oral and intravenous antibiotics was used, and all patients demonstrated clinical improvement from the preoperative state. Discussion This case series presents 3 patients with refractory SIRVA who ultimately underwent arthroscopic irrigation and débridement with culture biopsy. Each case had culture results positive for C. acnes and all responded, at least partially, to arthroscopic débridement and intravenous antibiotic therapy. The purpose of this manuscript is to raise awareness of potential coexistence of SIRVA and C. acnes which may be of assistance to surgeons treating refractory cases of SIRVA.
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Affiliation(s)
- Kade Lyman
- Taos Orthopaedic Institute, Taos, NM, USA
| | - Tim Kelley
- Taos Orthopaedic Institute, Taos, NM, USA
| | | | - Sarah D. Lang
- Mammoth Orthopedic Institute, Mammoth Hospital, Mammoth Lakes, CA, USA
| | - Brian B. Gilmer
- Mammoth Orthopedic Institute, Mammoth Hospital, Mammoth Lakes, CA, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mackenzie LJ, Bousie JA, Bushell MJA, Newman P. Shoulder Injury Related to Vaccine Administration ( SIRVA) Is Real: A Case Report. Vaccines (Basel) 2023; 11:1164. [PMID: 37514980 PMCID: PMC10386640 DOI: 10.3390/vaccines11071164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/19/2023] [Accepted: 06/24/2023] [Indexed: 07/30/2023] Open
Abstract
This study presents a case of SIRVA-induced adhesive capsulitis and the subsequent physiotherapy intervention. It details the patient's journey using CARE guidelines. The main symptoms included persistent pain and a reduced range of motion for flexion, abduction, and internal and external rotation of the shoulder. Interventions included active and passive mobilisation via capsular stretching, and home exercise programs. At more than two years post-injury, the patient has ongoing pain, restricted shoulder movement, and disability. This highlights the importance of healthcare practitioners' knowledge of SIRVA. Vaccinating practitioners should be aware of the mechanism of injury of SIRVA for preventing such injuries. First-contact practitioners should be aware of SIRVA-induced conditions to ensure timely and correct diagnosis and management of SIRVA-induced conditions.
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Affiliation(s)
- Laura Jane Mackenzie
- Faculty of Health (Physiotherapy), University of Canberra, Canberra 2617, Australia
| | - Jaquelin Anne Bousie
- Faculty of Health (Physiotherapy), University of Canberra, Canberra 2617, Australia
| | | | - Phillip Newman
- Faculty of Health (Physiotherapy), University of Canberra, Canberra 2617, Australia
- UC Research Institute for Sport and Exercise, Canberra 2617, Australia
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11
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Abbas AM, Damron TA. Shoulder Pseudo-Tumor from COVID-19 Vaccine. Vaccines (Basel) 2023; 11:vaccines11040793. [PMID: 37112705 PMCID: PMC10145291 DOI: 10.3390/vaccines11040793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
Hypersensitivity reactions to the COVID-19 mRNA vaccines were identified in the initial 2020 trials. Appearance of a soft tissue mass is a rare manifestation of this hypersensitivity reaction. In this patient, bilateral injections resulted in the appearance of shoulder masses. Magnetic resonance imaging showed localized pseudo-tumorous edema in both shoulders, one subcutaneous and the other intramuscular. This is only the second case of a mass-like reaction to the COVID-19 vaccine mimicking a possible soft tissue neoplasm. Improper vaccination administration technique may have contributed to this complication. The case is presented to increase awareness of this potential pseudotumor.
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Affiliation(s)
- Anas M Abbas
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY 13202, USA
| | - Timothy A Damron
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY 13057, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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14
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Hirai J, Yamaoka T, Takahashi T, Mikamo H. Shoulder Injury Related to Zoster Vaccine Administration. Intern Med 2022; 61:3631-3632. [PMID: 35491135 PMCID: PMC9790784 DOI: 10.2169/internalmedicine.9484-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Jun Hirai
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Takanari Yamaoka
- Department of Orthopedic Surgery, Aichi Medical University, Japan
| | - Tomoko Takahashi
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
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15
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Mackenzie LJ, Bousie JA, Newman P, Waghorn J, Cunningham JE, Bushell MJA. Healthcare Practitioners Knowledge of Shoulder Injury Related to Vaccine Administration ( SIRVA). Vaccines (Basel) 2022; 10:vaccines10121991. [PMID: 36560401 PMCID: PMC9787830 DOI: 10.3390/vaccines10121991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Vaccine pharmacovigilance is at the forefront of the public eye. Shoulder Injuries Related to Vaccine Administration (SIRVA) is a poorly understood Adverse Event Following Immunisation, with iatrogenic origins. Criteria for medicolegal diagnosis of SIRVA is conflicting, current literature and educational materials are lacking, and healthcare practitioner knowledge of the condition is unknown. Methods: A cross-sectional, convenience sampled survey, utilising a validated online questionnaire assessed practitioner knowledge of SIRVA, safe injecting, and upper limb anatomy, and preferred definition for SIRVA. Results: Mean scores were moderate for safe injecting knowledge (69%), and poor for knowledge of anatomy (42%) and SIRVA (55%). Non-immunising healthcare practitioners scored significantly (p = 0.01, and < 0.05, respectively) higher than immunising practitioners for anatomy (2.213 ± 1.52 vs. 3.12 ± 1.50), and safe injecting knowledge (6.70 ± 1.34 vs. 7.14 ± 1.27). Only 52% of authorised vaccinators accurately selected a 40 × 20 mm area recommended for safe injecting. Majority (91.7%) of respondents thought nerve injuries should be included in the diagnostic criteria for SIRVA. Discussion and conclusions: Greater education and awareness of SIRVA is needed in all healthcare disciplines. Consensus regarding SIRVA definition is paramount for accurate reporting and improved future understanding of all aspects of SIRVA.
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Affiliation(s)
- Laura Jane Mackenzie
- Faculty of Health (Physiotherapy), University of Canberra, Bruce, ACT 2617, Australia
- Correspondence: ; Tel.: +61-0408-392-281
| | - Jaquelin Anne Bousie
- Faculty of Health (Physiotherapy), University of Canberra, Bruce, ACT 2617, Australia
- UC Research Institute for Sport and Exercise, University of Canberra, Bruce, ACT 2617, Australia
| | - Phillip Newman
- Faculty of Health (Physiotherapy), University of Canberra, Bruce, ACT 2617, Australia
- UC Research Institute for Sport and Exercise, University of Canberra, Bruce, ACT 2617, Australia
| | - Janique Waghorn
- Department of Pharmacy, King’s College London, London WC2R 2LS, UK
| | - John Edward Cunningham
- Royal Melbourne Hospital, University of Melbourne, Parkville, VIC 3050, Australia
- Epworth Richmond, Richmond, VIC 3121, Australia
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16
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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17
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Sahu D. Shoulder Pain and Injury after COVID-19 Vaccination. Yale J Biol Med 2022; 95:217-220. [PMID: 35782477 PMCID: PMC9235265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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18
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Affiliation(s)
- Benjamin R Wharton
- University of Colorado School of Medicine, Department of Orthopedics, University of Colorado, Aurora CO, USA
| | - Kent C Doan
- University of Colorado School of Medicine, Department of Orthopedics, University of Colorado, Aurora CO, USA
| | - Michelle L Wolcott
- University of Colorado School of Medicine, Department of Orthopedics, University of Colorado, Aurora CO, USA
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19
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Yuen WLP, Loh SYJ, Wang DB. SIRVA (Shoulder Injury Related to Vaccine Administration) following mRNA COVID-19 Vaccination: Case discussion and literature review. Vaccine 2022; 40:2546-2550. [PMID: 35339304 PMCID: PMC8934720 DOI: 10.1016/j.vaccine.2022.03.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 03/06/2022] [Accepted: 03/16/2022] [Indexed: 01/17/2023]
Abstract
Shoulder injury related to vaccine administration (SIRVA) is an increasingly recognised complication after vaccination and presents with significant shoulder pain and stiffness. SIRVA is thought to occur as a result of improper administration of vaccine into the subdeltoid bursa or shoulder joint. This results in an inflammatory cascade that damages the structures in the shoulder region. The incidence of SIRVA is relatively higher for influenza vaccination due its widespread administration. We present a reported case of SIRVA following a mRNA COVID-19 vaccination and review the current literature. As we embark on a worldwide scale of COVID-19 vaccination, it is of utmost important that we use proper vaccination techniques and screen patients at risk of SIRVA. This would improve the efficacy of the vaccine and improve the outcomes of the vaccination programme.
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20
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Honarmand AR, Mackey J, Hayeri R. Shoulder injury related to vaccine administration ( SIRVA) following mRNA COVID-19 vaccination: Report of 2 cases of subacromial-subdeltoid bursitis. Radiol Case Rep 2021; 16:3631-3634. [PMID: 34611469 PMCID: PMC8484890 DOI: 10.1016/j.radcr.2021.08.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/08/2021] [Accepted: 08/10/2021] [Indexed: 11/26/2022] Open
Abstract
Shoulder pain has been reported as a common side-effect after COVID-19 vaccination particularly after administration of mRNA vaccines. Although it is usually mild and self-limiting, occasionally it can become more extensive causing severe pain and marked limited range of motion. Shoulder injury related to vaccine administration has been reported following injection of other routine vaccines. In this case report, we describe 2 cases of shoulder injury related to vaccine administration due to subacromial-subdeltoid bursitis after administration of mRNA COVID-19 vaccines.
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Affiliation(s)
- Amir Reza Honarmand
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Justin Mackey
- Department of Radiology, Mercy Catholic Medical Center, Darby, PA, USA
| | - Reza Hayeri
- Department of Radiology, Mercy Catholic Medical Center, Darby, PA, USA
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21
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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22
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Cantarelli Rodrigues T, Hidalgo PF, Skaf AY, Serfaty A. Subacromial-subdeltoid bursitis following COVID-19 vaccination: a case of shoulder injury related to vaccine administration ( SIRVA). Skeletal Radiol 2021; 50:2293-7. [PMID: 33944967 DOI: 10.1007/s00256-021-03803-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 02/02/2023]
Abstract
Vaccination injection site adverse reactions are usually mild and transient, and post-vaccination musculoskeletal symptoms, such as myalgia and arthralgia, are very common. Shoulder injury related to vaccine administration (SIRVA), defined as shoulder pain and limited range of motion occurring after the administration of a vaccine intended for intramuscular administration in the upper arm, is a well-established condition in the medical literature, yet underreported. In such cases, subacromial-subdeltoid bursitis may occur, leading to shoulder dysfunction and ongoing pain. Millions of doses of vaccines for the prevention of COVID-19 have been administered to adults worldwide during the pandemic. We report a case of subacromial-subdeltoid bursitis after COVID-19 vaccination, related to the unintentional injection of vaccine solution into the bursa resulting in a robust immune-mediated inflammatory reaction.
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23
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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24
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Abstract
Transient shoulder pain is a common complaint following intramuscular vaccine administration into the deltoid. More severe vaccination-associated shoulder complications comprising of weakness and decreased range of motion are categorized under the construct "shoulder injury related to vaccine administration" (SIRVA) that subsumes both subjective and objective findings consistent with injury. We describe the presentation and management of a case of SIRVA in a health care worker following seasonal influenza vaccine administration as part of a hospital-based employee health program and review the relevant biomedical literature. We present a case from a single medical center. All data were collected by professionals in occupational health by interviewing, performing physical examinations, and reviewing medical records associated with the injured worker. Severe pain and limited range of shoulder motion developed following an influenza vaccination that was administered using a poorly positioned, larger than recommended needle. Magnetic resonance imaging (MRI) demonstrated moderate glenohumeral joint effusion and synovitis, with fluid accumulating in the subscapularis recess within 1 week of injury. At 8 months after initial injury, MRI showed persistent mild tenosynovitis of the long head of the biceps tendon, interval accumulation of a large glenohumeral joint effusion, and infraspinatus tendinitis with subjacent reactive bone marrow edema. The affected worker experienced work restrictions but had no complete lost workdays to date due to the injury. Occupationally related SIRVA is a preventable adverse event that should be considered in workplace vaccine administration programs, and appropriate education and training provided to vaccine administrators to address this.
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Affiliation(s)
| | - Paul D Blanc
- University of California, San Francisco.,San Francisco VA Health Care System
| | - Sandra J Domeracki
- University of California, San Francisco.,San Francisco VA Health Care System
| | - Sandeep Guntur
- University of California, San Francisco.,San Francisco VA Health Care System
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