Many people feel some pain or discomfort for a day or two after receiving an injection–that is normal. However, in rare cases, some people experience severe shoulder pain after vaccination, which persists for weeks or months, and interferes with daily life. This type of pain may be a condition called SIRVA, shoulder injury related to vaccine administration.
Although SIRVA is uncommon, it is important that patients and healthcare providers understand what it is and how it is caused, to help with both prevention and treatment.
This blog post will define SIRVA, the associated risks, and how to minimize or prevent potential injury.
Defining SIRVA (Shoulder Injury Related to Vaccine
Administration)
Shoulder injury related to vaccine administration (SIRVA) is a rare but serious condition that can occur after receiving a vaccine. A person with SIRVA experiences severe, persistent shoulder pain and prolonged restriction of function.
Possible Causes of SIRVA
SIRVA is believed to be caused by improper administration of a vaccine, not by the vaccine itself.
If the shot is injected too high in the arm, the vaccine can be delivered to the shoulder joint capsule instead of the deltoid muscle, causing inflammation, pain, and decreased range of motion.
If the needle is injected too deep, parts of the shoulder such as the rotator cuff can be damaged. In very rare cases the axillary or radial nerves in the upper arm can be injured.
While vaccines are safe and effective, a perfectly safe vaccine can cause SIRVA if it is improperly administered.
Symptoms of SIRVA
Patients experiencing SIRVA have severe shoulder pain, and less range of motion. SIRVA can also result in weakness, stiffness or nerve inflammation. In very rare cases, it can result in nerve injury.
These symptoms appear within 48 hours of having a vaccine injection. This pain is great enough to interfere with daily activities, and over-the-counter pain medicine does not help.
Diagnosis and Treatment of SIRVA
Patients often wait weeks or even months, living with serious pain, before visiting their doctor for this type of pain. Doctors often misdiagnose these patients with a more common shoulder injury like bursitis or a rotator cuff tear, because those injuries present in a similar way as SIRVA.
To rule out other conditions with similar symptoms, a doctor will likely do a physical exam and conduct tests. They may recommend an ultrasound or MRI.
The key distinguishing factors of SIRVA are symptoms starting within a few days of being vaccinated that don’t improve with over-the-counter pain medication.
If you are diagnosed with SIRVA, your doctor may recommend:
- Physical therapy
- Anti-inflammatory medication
- Steroid injections
- Surgery
Is SIRVA Permanent?
We do not have a lot of research about SIRVA. One study suggests that most people with SIRVA experience symptoms for at least six months, and less than a third make full recoveries.
Other research suggests that patients who are treated for SIRVA make modest improvements, but some have symptoms that never fully resolve.
More research is needed to learn more about SIRVA, both how it is initiated and how to treat it effectively.
How to Minimize/Prevent a Shoulder Injury from Vaccines
The good news about SIRVA is it is preventable. A properly trained vaccinator should be able to safely inject all patients with vaccines without causing SIRVA.
Recommendations for safe administration include:
- Both the patient and the vaccinator should be seated to avoid delivering the infection too
high on the arm. - The patient should completely expose their arm.
- Vaccinators should be trained on how to locate the site for the injection.
Vaccine Injury Compensation Program and SIRVA
The U.S. government created the National Vaccine Injury Compensation Program (VICP) for people who have suffered a serious injury or illness caused by a vaccine. SIRVA is one of the injuries that may qualify for compensation from the VICP.
If you or a family member has suffered from persistent shoulder pain following vaccination, you may be eligible for assistance from the VICP.
Congress established VICP in 1986 to compensate those who may have been injured by a vaccine, with the goal of compensating victims while encouraging pharmaceutical companies and doctors to continue to design, manufacture and deliver vaccines without fear of being sued for the rare bad outcome.
Vaccine Injury Table and SIRVA
The Vaccine Injury Table lists vaccines and associated injuries that are covered by the National Vaccine Injury Compensation Program (VICP). The Table lists and explains injuries and/or conditions that are presumed to be caused by vaccines unless another cause is proven.
Resources: Links to useful resources about SIRVA
National Vaccine Injury Compensation Program (VICP)
SIRVA description from the College of Family Physicians of Canada
SIRVA description from the National Center for Biotechnical Information
SIRVA description from Verywell Health
Are you eligible for compensation for a vaccine injury?
Answer a few questions here to see if you may be eligible for compensation for your vaccine injury. You can also contact us for a free consultation by phone or email anytime at 215-575-2997 or at lcohan@smbb.com or lamen@smbb.com.