SIRVA (Shoulder Injury as a Result of Vaccine Administration)

Typically, immunization as, for example, against diphtheria, tetanus, pertussis is given by an intramuscular injection. Usually the vaccine is given into the deltoid muscle. To deliver medications into muscle, proper procedures should be followed. This includes the person administering the vaccine should wash one’s hands to reduce transfer of microorganisms. It also includes such procedures as cleaning the site with alcohol to prevent infection. Additionally, the needle should be inserted at the appropriate angle and the needle should then be removed at the same angle as the angle of insertion. This prevents needless tearing of tissue. The goal is to prevent redness, swelling or pain at the site of injection. If however, the placement of the needle is not inserted into the deltoid muscle, and it is however, incorrectly placed, it may go into the shoulder joint or bursar of the shoulder.

Shoulder Joint

The shoulder joint is a ball and socket joint. It is to be noted that the structures are near to one another. Important structures include tendons which are fibrous tissue securing a muscle to its attachment. There are ligaments which extend between the bones, forming the joint. The bursa are spaces between joints and they act by supporting ligaments and tendons that are presumed to act as gliding surfaces. The synovial membrane secretes a lubricating fluid. The ligaments of the shoulder include the articular capsule which completely encircles the joint. The brachial plexus supplies nerves to the upper limb.

Pathology

The subacromial bursa lies beneath the deltoid muscle. If a needle is improperly placed during, for instance, the administration of a vaccine, the injection could go into the bursa causing bursitis which is an inflammation of the bursa. Additionally, if there is bacterial invasion, there will also be an infection. If a tendon is injured, inflammation of the tendon could occur causing tendinitis. As in any inflammation, there can, therefore, be redness, warmth, swelling, pain and loss of function.

Symptoms of bursitis are similar to those in tendinitis. In acute calcific bursitis there is the formation of calcium salts causing severe pain, occasional warmth, and redness of the skin. Although one tendon or structure may be the cause of symptoms, it is not unusual that several tissues near to each other become involved, particularly in adhesive capsulitis. Acutely painful conditions of the shoulder and arm area are usually tendinitis, either bicipital tendinitis or supraspinatus tendinitis. Additionally, an acutely painful shoulder may be caused be a tear in the rotator cuff. Tears usually result from trauma, and these tears may produce the same symptoms as supraspinatus tendinitis. The patient, at times, may hear a “snap”. Rotator cuff tears could be, by error, diagnosed as tendinitis or bursitis. When conservative treatment does not cure the condition after several weeks, one must consider the possibility of a rotator cuff tear.

Chronic Symptoms of Stiffness and Pain in the Shoulder

Symptoms that develop gradually and thereafter persist for weeks or months, and then gradually resolve over several years indicate adhesive capsulitis which is frozen shoulder. In this condition, the capsule thickens and restricts movement. There may be adhesions that form in the joint capsule during a period of immobility. It also seems to occur more frequently in people who have diabetes. Increased risk factors also include thyroid disease as well as disease of the cardiovascular system or Parkinson’s disease. Diagnosis is usually clinical, however at times x-rays or an MRI are done.

Treatment

Treatment for tendinitis includes anti-inflammatory medications and steroids. In acute calcific bursitis, sometimes the doctor may aspirate the calcium and instill steroids into the bursa. Thereafter an exercise program is conducted.

For the treatment of frozen shoulder, anti-inflammatory medication can help reduce pain. Also, physical therapy may be conducted. And if these treatments are not successful, steroids may be injected. Lastly, if all else fails, surgery could be recommended.

Brachial Plexus Neuropathy – Parsonage-Turner Syndrome Etiology (Cause)

This may be an autoimmune reaction which is precipitated by events such as immunization, infection or surgery.

Symptoms

There is acute, severe pain in the shoulder after an acute injury to the brachial plexus or individual nerves of the upper extremity. Thereafter, the pain in the arm is severe with weakness and sensory changes. The pain may persist for several days to a few weeks and, additionally, a dull ache may last for years.

Testing

Several tests could be conducted including an MRI.

Treatment

Steroids may be tried. Additionally, physical therapy may be conducted.

References
  • Gray’s Anatomy, 28th edition, 1966
  • Mayo Clinic, March 10, 2015
  • Robbins Pathology, 3rd edition 1967
  • Office Practice of Medicine, 1982
  • Hankey’s Clinical Neurology, 2nd edition, 2014
  • Manual of Acute Orthopaedic Therapeutics, 1st edition, 1977
  • Outline of Orthopaedics, 7th edition, 1971
  • Nurses’ Guide to Clinical Procedures, 2nd edition, 1994
  • Physicians’ Desk Reference, 2016