Shoulder injury related to vaccine administration (SIRVA) introduction Shoulder injury related to vaccine administration, or SIRVA, is an uncommon but emerging phenomenon caused by an improper technique or landmarking...
Shoulder injury related to vaccine administration (SIRVA) introduction Shoulder injury related to vaccine administration, or SIRVA, is an uncommon but emerging phenomenon caused by an improper technique or landmarking for intramuscular deltoid injections. It has likely been more common over the past one to two years secondary to more vaccinations being administered and is likely something that you will encounter in a sports medicine practice. In 2010, shoulder injury related to vaccine administration (SIRVA) was described by Atanasoff and colleagues as the rapid onset of shoulder pain and dysfunction persisting as a complication of deltoid muscle vaccination in a case series of 13 patients.
Influenza vaccine–based studies showed an incidence of 1 to 2 per million and SIRVA is expected to become more prevalent as vaccination numbers grow worldwide. One recent study documenting fifty two cases showed seventy percent women with seventy percent caucasian. The median age was 43 years old with ten different vaccinations identified with no injury pattern associated with any particular vaccine.
The mean duration was 143 days and surgical referral was required for 7.6%. In 2017, SIRVA was included in the Vaccine Injury Compensation Program (VICP), a federal program that can provide compensation to individuals injured by certain vaccines. A diagnosis of SIRVA can be considered in patients who experience pain within 48 hours of vaccination, have no prior history of pain or dysfunction of the affected shoulder prior to vaccine administration, and have symptoms limited to the shoulder in which the vaccine was administered where no other abnormality is present to explain these symptoms (eg, brachial neuritis, other neuropathy).
Currently, patients with back pain or musculoskeletal complaints that do not include the shoulder following deltoid vaccination do not meet the reporting criteria for SIRVA in the VICP. Cook and colleagues used anthropomorphic data to evaluate the potential for injury to the subdeltoid/subacromial bursa and/or the axillary nerve. Based on these data, they recommended safe IM vaccine administration can be assured by using the midpoint of the deltoid muscle located midway between the acromion and deltoid tuberosity with the arm abducted to 60°.
In 46% of SIRVA cases described by Atanasoff and colleagues, patients reported that the vaccine was administered “too high.” The study also recommended that the clinician and the patient be in the seated position to ensure proper needle angle and location of administration. For most adults, a 1-inch needle is appropriate for vaccine administration in the deltoid; however, in females weighing < 70 kg and males < 75 kg, a 5/8-inch needle is recommended to avoid injury. There is no standardized approach for the evaluation of SIRVA.
If you are experiencing symptoms that may be related to shoulder injury related to vaccine administration (sirva), it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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