by Tyler Tice, PT, DPT, MS, ATC
I have seen multiple patients recently reporting they have developed shoulder pain and limited range of motion after receiving the flu or COVID vaccines. The cases that I have seen have varied in time of symptom onset from 2 days to 4+ weeks after receiving the vaccine and some reported developing pain and shoulder deficits in the opposite shoulder from the one they received the vaccine. This is questionable whether receiving a vaccine to shoulder musculature actually caused the pain and functional deficits, however it was worth looking into.
We are thankful to have vaccines readily available to help protect us from multiple different illnesses. During this time, a large amount of the population are receiving the COVID and flu vaccines and I wanted to highlight one possible specific orthopedic side effect from vaccine administration.
SIRVA, an acronym standing for Shoulder Injury Related to Vaccine Administration, is a potential reason for shoulder pain after injection. This occurs when a vaccine is injected into the shoulder capsule instead of the deltoid musculature, causing an inflammatory response to the shoulder. If this occurs, people may experience pain, decreased shoulder range of motion, and a temporary decrease in functional abilities. Patient diagnoses related to SIRVA may include shoulder bursitis, rotator cuff injury, and adhesive capsulitis. The only difference between SIRVA and other shoulder injuries not related to vaccines is the time of onset of pain and limited motion are usually within 48 hours after receiving a vaccine and do not improve with over the counter analgesic medications. There are no other known differences in the physical exam or with ultrasound imaging. Treatment for SIRVA is typically the same as treatment for routine inflammatory shoulder injuries.
Vaccines are intended to be administered in the deltoid muscle. When administering vaccines into the deltoid, the individual should outline the borders of the safe zone. The upper border is about 2-3 finger breadths below the acromion and the lower border is marked by the armpit. The thumb and index finger can make a “V” to outline the deltoid muscle in order to know the proper zone when injecting the needle at a 90 degree angle.
Prevalence of SIRVA is still being analyzed and there have been reports in the literature that SIRVA occurred due to multiple different types of intra-muscular vaccines. In a systematic review in 2020, 27 papers reported the accounts of SIRVA in the literature with the most common vaccine being the Influenza vaccine, most common symptoms were shoulder pain and loss of motion within 48 hours, and most common treatments were physical therapy or corticosteroid injection. Most cases reported had great outcomes. It is generally believed that SIRVA is under-reported, therefore there is likely more cases that have occurred, but it is still very uncommon.
Since this systematic review was published in 2020, there have been multiple more recent case studies reporting SIRVA in relation to the COVID vaccine. The COVID vaccine has been administered to a very large degree throughout the past year which makes sense that there will be some reported cases of SIRVA in relation to the COVID vaccine. Although this is a novel vaccine, SIRVA appears to occur due to inaccurate vaccine administration regardless of vaccine type.
SIRVA is preventable if using proper vaccine administration guidelines, however accidents do happen and there is always potential for this to occur.
In summary, incorrectly administered vaccines into shoulder musculature can cause shoulder pain and decreased shoulder functional abilities. These deficits typically present like other inflammatory shoulder conditions and people have great outcomes when seeking intervention and using physical therapy. It is encouraged that all people receive the necessary vaccines that are available to help protect against getting and spreading different illnesses.
Bancsi A, Houle SKD, Grindrod KA. Shoulder injury related to vaccine administration and other injection site events. Can Fam Physician. 2019;65(1):40-42.
Cagle PJ Jr. Shoulder Injury after Vaccination: A Systematic Review. Rev Bras Ortop (Sao Paulo). 2021;56(3):299-306. doi:10.1055/s-0040-1719086