synonyms: SIRVA (Shoulder Injury Related to Vaccine Administration)
SIRVA Etiology / Epidemiology / Natural History
- Likely related to improper administration of vaccine into the subdeltoid bursa or shoulder joint
- Reported after vaccinations for influenza, tetanus, pneumococcus, papillomavirus and COVID-19 vaccination.
- Risk factors: female gender, thin habitus, small deltoid muscle bulk and improper injection techniques.
SIRVA Clinical Evaluation
- Presents with significant shoulder pain and stiffness after vaccine administration.
SIRVA Xray / Diagnositc Tests
SIRVA Classification / Treatment
- Treatment: activity modifications, analgesia and PT focusing on progressive range of motion exercises.
- Vaccine injection technique recommendation: patients should be positioned with abduction of the vaccination arm at 60 degrees and placing the hand on the ipsilateral hip. The deltoid muscle is targeted at the midpoint between the acromion and the deltoid tuberosity. (Cook IF. An evidence based protocol for the prevention of upper arm injury related to vaccine administration (UAIRVA) Hum Vaccin. 2011;7:845–8.)
SIRVA Associated Injuries / Differential Diagnosis
- Subacromial impingement
- Rotator cuff tear
SIRVA Follow-up Care
- Generally resolves within 6 months.
SIRVA Review References
- Yuen, Vaccine. 2022 Apr 20; 40(18): 2546–2550.