Shoulder injury related to vaccine administration (SIRVA) is a relatively rare adverse effect of an improperly administered vaccination. It occurs when an injection is administered too high in the arm and the vaccine is delivered to the shoulder capsule instead of the deltoid muscle, according to a new study.

The report in the Canadian Pharmacists Journal urges pharmacists and other health professionals to take precautions to minimize SIRVA risk.

“With flu season underway and flu vaccinations widely available, both the public and health care providers should understand how to recognize and respond to SIRVA,” said Kelly Grindrod, BSCPharm, PharmD, MSC, a professor in the School of Pharmacy at the University of Waterloo. “There are strategies we can adopt to decrease the likelihood of experiencing SIRVA.”

Grindrod offered the following suggestions, which pharmacists can pass on to those being immunized:
• Wear a sleeveless shirt or a shirt with sleeves that can be easily rolled up.
• Do not pull the neck of the shirt down, as this can lead to a vaccine being injected into the shoulder instead of the arm.
• Putting a hand on the hip with the elbow out and away from the body will also help relax the deltoid muscle being injected.

The advice was based on a literature search of the PubMed, Embase, and Google Scholar databases, the study authors said.

Background information in the study noted that SIRVA is a rare sequela of the body’s immune response when a vaccine is injected into the shoulder capsule and that it can cause inflammation in the musculoskeletal structures of the shoulder, such as the bursae, tendons, and ligaments, resulting in shoulder pain and a limited range of motion that can persist for months without treatment.

The United States’ National Vaccine Injury Compensation Program added SIRVA to its list of recognized vaccine injuries early last year.

While a dull muscle ache is common after a vaccine injection, that pain typically disappears within a few days. With SIRVA, on the other hand, pain begins within 48 hours of vaccine administration and does not improve with OTC painkillers.

“In patients who experience SIRVA, months may pass by, and patients will still complain of increasing pain, weakness, and impaired mobility in the injected arm. Simple actions like lifting your arm to brush your teeth can cause pain,” said Grindrod. “It’s important that we learn to recognize these signs of SIRVA so that we can access appropriate treatment.”

She pointed out that an ultrasound scan is necessary to diagnose SIRVA and determine the level and type of damage. Treatment usually includes a corticosteroid injection to the shoulder or physiotherapy.

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