Shoulder injuries related to vaccine administration (SIRVA) can occur following a vaccination into the upper arm. Pain usually occurs within 48 hours of the vaccination and can range from mild to severe. It is also common to have decreased range of motion, in addition to pain. 

The consensus theory of causation is that the vaccine is injected in an area (usually high on the shoulder instead of in the belly of the deltoid muscle) of the shoulder that is in close proximity to the subacromial bursa. The antigen from the vaccine causes a strong inflammatory response which in turn causes shoulder pain. Sometimes, previously asymptomatic conditions in the shoulder will become painful, as well. 

Some of the more common symptoms are pain with elevation of the arm overhead or sleeping on the arm (impingement) and decreased range of motion caused by pain or stiffness (capsulitis).

To evaluate for this type of injury, our team will perform a physical examination. Some common findings are those that support impingement syndrome (Neer and Hawkins Tests), tenderness to touch near the subacromial bursa, shoulder stiffness and painful arc of motion. We may order tests such as an x-ray or MRI if there is concern for additional injuries in the shoulder. 

Treatment is focused on reduction of inflammation. Depending on what your exam findings are, we may offer oral anti-inflammatory medications (NSAIDs, oral steroid pill pack), or a steroid (cortisone) injection. In the majority of patients, we have found that steroid injections are the most beneficial and effective at reducing symptoms quickly so that you may return to your normal life. In some cases, surgery may be needed in order to remove the inflammation and stiffness in the joint capsule.