Shoulder Injury Related to Vaccine Administration (SIRVA)

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 SIRVA or 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 injury cases are caused by the seasonal flu shot because it is the most commonly administered vaccine to adults, but it can also 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, claims may satisfy the criteria outlined in the Vaccine Injury Table.

How is SIRVA diagnosed?

Patients diagnosed with SIRVA 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 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 to reduce the risks of SIRVA?

Intramuscular vaccinations should be injected into the deltoid muscle of the arm, not into the shoulder joint.  Vaccines that are administered too high, too low, or too far to one side can cause damage.  To help the doctor or pharmacist locate a proper injection site, aim to expose the shoulder completely.  Do not pull your shirt down from the neck.  Instead, roll your sleeve up as far as it will go.  You may consider wearing a sleeveless shirt when getting vaccinated.

Also, when possible, avoid being injected by a person who is standing while you are sitting down, as the height difference can lead to an improperly administered vaccination.  A rule of thumb is to inject the vaccine 2 to 3 finger-widths below the shoulder joint or acromion.

The length of the needle is also important.  A needle that is too long can hit a bone or nerve, and one that is too short can result in the contents of the vaccine being administered into subcutaneous tissue rather than into the muscle.  With some pharmacies now offering curbside or drive-thru vaccinations, being aware of these simple practices will ensure that your next vaccination is as safe as possible.

How is SIRVA treated?

Treatment plans for SIRVA often include physical therapy to aid in improving the range of motion and muscle strength in the shoulder.

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.

Recent Shoulder Injury Related to Vaccine Administration (SIRVA) Case Results