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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(02): 279-283
DOI: 10.1055/s-0042-1751022
Artigo Original
Ombro e Cotovelo

Shoulder Injury Related to Vaccine Administration: Case Series

Article in several languages: português | English
Paul J. Cagle 
1   Departamento de Cirurgia Ortopédica, Escola de Medicina Icahn de Monte Sinai, Nova York, Nova York, Estados Unidos
,
Christopher A. White 
1   Departamento de Cirurgia Ortopédica, Escola de Medicina Icahn de Monte Sinai, Nova York, Nova York, Estados Unidos
,
Akshar V. Patel 
1   Departamento de Cirurgia Ortopédica, Escola de Medicina Icahn de Monte Sinai, Nova York, Nova York, Estados Unidos
› Author Affiliations Financial Support This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Abstract

Objective Shoulder pain is a common presentation in the primary care setting, and shoulder pain after vaccination has a growing body of literature. The present study sought to understand how a standardized treatment protocol would aid patients experiencing shoulder injury related to vaccine administration (SIRVA).

Methods Patients experiencing SIRVA were retrospectively recruited between February 2017 and February 2021. All patients were treated with physical therapy and offered a cortisone injection. Post-treatment range of motion (i.e., forward elevation, external rotation, internal rotation) and patients' reported outcomes were collected with the visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES), simple shoulder test (SST), and single assessment numeric evaluation (SANE) scores.

Results A total of 9 patients were retrospectively examined. Among them, 6 patients presented within one month of a recent vaccination event, while 3 patients presented 67, 87, and 120 days after vaccination. Furthermore, 8 of the patients completed physical therapy, and 6 of them underwent a cortisone injection. The follow-up time averaged 8 months. At final follow-up, the mean external rotation was 61° (standard deviation, SD ± 3°) and the mean forward elevation was 179° (SD ± 45°). Internal rotation ranged between L3 and T10. The VAS pain scores were 3.5/10.0 (SD ± 2.4), the mean ASES score was 63.5/100.0 (SD ± 26.3), and the SST scores were 8.5/12.0 (SD ± 3.9). Finally, the SANE scores were 75.7/100.0 (SD ± 24.7) and 95.7/100.0 (SD ± 6.1) in the injured and contralateral shoulders respectively.

Conclusion Shoulder pain after a vaccination treated with physical therapy and cortisone injection ultimately resulted in favorable shoulder range of motion and functional score outcomes.

Level of Evidence IV.

Keywords

bursitis - pain management - rotator cuff injuries - shoulder injuries - vaccination

Work developed at the Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.




Publication History

Received: 24 November 2021

Accepted: 16 May 2022

Article published online:
11 July 2022

© 2022. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referências

  • 1 Cunningham LS, Kelsey JL. Epidemiology of musculoskeletal impairments and associated disability. Am J Public Health 1984; 74 (06) 574-579
    Google Scholar
  • 2 Luime JJ, Koes BW, Hendriksen IJ. et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol 2004; 33 (02) 73-81
    Google Scholar
  • 3 Bodor M, Montalvo E. Vaccination-related shoulder dysfunction. Vaccine 2007; 25 (04) 585-587
    Google Scholar
  • 4 Atanasoff S, Ryan T, Lightfoot R, Johann-Liang R. Shoulder injury related to vaccine administration (SIRVA). Vaccine 2010; 28 (51) 8049-8052
    Google Scholar
  • 5 Salmon JH, Geoffroy M, Eschard JP, Ohl X. Bone erosion and subacromial bursitis caused by diphtheria-tetanus-poliomyelitis vaccine. Vaccine 2015; 33 (46) 6152-6155
    Google Scholar
  • 6 Barnes MG, Ledford C, Hogan K. A “needling” problem: shoulder injury related to vaccine administration. J Am Board Fam Med 2012; 25 (06) 919-922
    Google Scholar
  • 7 Shaikh MF, Baqai TJ, Tahir H. Acute brachial neuritis following influenza vaccination. BMJ Case Rep 2012; 2012: bcr2012007673
    Google Scholar
  • 8 Messerschmitt PJ, Abdul-Karim FW, Iannotti JP, Gobezie RG. Progressive osteolysis and surface chondrolysis of the proximal humerus following influenza vaccination. Orthopedics 2012; 35 (02) e283-e286
    Google Scholar
  • 9 Kuether G, Dietrich B, Smith T, Peter C, Gruessner S. Atraumatic osteonecrosis of the humeral head after influenza A-(H1N1) v-2009 vaccination. Vaccine 2011; 29 (40) 6830-6833
    Google Scholar
  • 10 Cook IF. Subdeltoid/subacromial bursitis associated with influenza vaccination. Hum Vaccin Immunother 2014; 10 (03) 605-606
    Google Scholar
  • 11 Saleh ZM, Faruqui S, Foad A. Onset of Frozen Shoulder Following Pneumococcal and Influenza Vaccinations. J Chiropr Med 2015; 14 (04) 285-289
    Google Scholar
  • 12 Hexter AT, Gee E, Sandher D. Management of glenohumeral synovitis secondary to influenza vaccination. Shoulder Elbow 2015; 7 (02) 100-103
    Google Scholar
  • 13 Martín Arias LH, Sanz Fadrique R, Sáinz Gil M, Salgueiro-Vazquez ME. Risk of bursitis and other injuries and dysfunctions of the shoulder following vaccinations. Vaccine 2017; 35 (37) 4870-4876
    Google Scholar
  • 14 Floyd MW, Boyce BM, Castellan RM, McDonough EB. Pseudoseptic arthritis of the shoulder following pneumococcal vaccination. Orthopedics 2012; 35 (01) e101-e103
    Google Scholar
  • 15 Okur G, Chaney KA, Lomasney LM. Magnetic resonance imaging of abnormal shoulder pain following influenza vaccination. Skeletal Radiol 2014; 43 (09) 1325-1331
    Google Scholar
  • 16 Degreef I, Debeer P. Post-vaccination frozen shoulder syndrome. Report of 3 cases. Acta Chir Belg 2012; 112 (06) 447-449
    Google Scholar
  • 17 Bathia NA, Stitik T. “Influenza vaccine shoulder”–vaccination related traumatic injury to the infraspinatus: a case report. [poster presentation] PM R 2009; 1: S118
    Google Scholar
  • 18 Uchida S, Sakai A, Nakamura T. Subacromial bursitis following human papilloma virus vaccine misinjection. Vaccine 2012; 31 (01) 27-30
    Google Scholar
  • 19 DeRogatis MJ, Parameswaran L, Lee P, Mayer TG, Issack PS. Septic Shoulder Joint After Pneumococcal Vaccination Requiring Surgical Debridement. HSS J 2018; 14 (03) 299-301
    Google Scholar
  • 20 Imran M, Hayley D. Injection-induced axillary nerve injury after a drive- through Flu shot. Clin Geriatr 2013;21(12):
    Google Scholar
  • 21 Erickson BJ, DiCarlo EF, Brause B, Callahan L, Hannafin J. Lytic Lesion in the Proximal Humerus After a Flu Shot: A Case Report. JBJS Case Connect 2019; 9 (03) e0248
    Google Scholar
  • 22 Shahbaz M, Blanc PD, Domeracki SJ, Guntur S. Shoulder Injury Related to Vaccine Administration (SIRVA): An Occupational Case Report. Workplace Health Saf 2019; 67 (10) 501-505
    Google Scholar
  • 23 Current Trends Vaccine Adverse Event Reporting System–United States. [Accessed March 25, 2021] at: https://www.cdc.gov/mmwr/preview/mmwrhtml/00001804.htm
  • 24 The National Childhood Vaccine Injury Act of 1986. Public Health Service Act 2125. (42 U.S.C. 300aa-25 (Supp. 1987)).
    Google Scholar
  • 25 Ryan T. Institute of Medicine (IOM) Report generated Proposals for Updates to the Vaccine Injury Table. 2011
    Google Scholar
  • 26 Myles PS, Myles DB, Galagher W. et al. Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. Br J Anaesth 2017; 118 (03) 424-429
    Google Scholar
  • 27 Sciascia AD, Morris BJ, Jacobs CA, Edwards TB. Responsiveness and Internal Validity of Common Patient-Reported Outcome Measures Following Total Shoulder Arthroplasty. Orthopedics 2017; 40 (03) e513-e519
    Google Scholar
  • 28 Godfrey J, Hamman R, Lowenstein S, Briggs K, Kocher M. Reliability, validity, and responsiveness of the simple shoulder test: psychometric properties by age and injury type. J Shoulder Elbow Surg 2007; 16 (03) 260-267
    Google Scholar
  • 29 Cagle Jr PJ. Shoulder Injury after Vaccination: A Systematic Review. Rev Bras Ortop (Sao Paulo) 2021; 56 (03) 299-306
    Google Scholar