What is SIRVA?
SIRVA, or Shoulder Injury Related to Vaccine Administration, manifests as shoulder pain and limited range of motion occurring as a result of the administration of an injected vaccine. While some degree of pain may be expected from any shoulder injection, the improper administration of a vaccine can cause injury to the shoulder, often resulting in debilitating, pain, which can lead to complications.
SIRVA may encompass a variety of diagnoses, including, but not limited to, bursitis, adhesive capsulitis or frozen shoulder, tendonitis, impingement syndrome, and rotator cuff tear.
How is it caused?
The majority of SIRVA cases are caused by the seasonal flu shot because it is the most commonly administered vaccine to adults, but SIRVA can occur with any vaccination.
Bodor and Montalvo, in their 2006 study, hypothesized that weakness and pain in the shoulder following influenza and pneumococcal vaccinations were administered too high in the deltoid muscle, causing an inflammatory reaction. They concluded that, in order to avoid vaccine-related shoulder dysfunction, the upper third of the deltoid muscle should not be used for vaccine injections.
In some circumstances, SIRVA claims may satisfy the criteria outlined in the Vaccine Injury Table.
How is SIRVA diagnosed?
Patients diagnosed with Shoulder Injury Related to Vaccine Administration experience acute shoulder pain, typically within 48 hours of vaccine administration. Shoulder pain increases over time, limiting range of motion, function of the arm and shoulder, and arm strength. Some SIRVA cases present as or can occur concurrently with tendonitis, rotator cuff tears, frozen shoulder, bone erosion, and brachial nerve damage.
SIRVA is not limited to one specific diagnosis. Physical examination and imaging are important in assessing and diagnosing SIRVA.
How is it treated?
Treatment plans often include physical therapy to aid in improving range of motion and muscle strength.
If pain persists, steroid injections and/or surgery may be options as well. Coupled with physical therapy, surgery may help alleviate the pain many individuals experience.