Increase in Vaccine-Related Shoulder Injuries

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December 12, 2017 | 23,034 views

Story at-a-glance

  • Shoulder injury related to vaccine administration, or SIRVA, causes chronic pain and loss of range of motion in the shoulder
  • Cases are on the rise, and 202 people were awarded compensation for SIRVA from the federally operated vaccine injury compensation program in 2016
  • If a vaccine is given too high on the shoulder, the vaccine may provoke the immune system to attack the bursa, a fluid-filled sac that protects shoulder tendons, leading to debilitating symptoms

By Dr. Mercola

Many people experience temporary soreness in their shoulder after receiving a vaccination in the area, but for some the soreness turns into chronic pain and limited range of motion. Some people are so badly affected that they become unable to move their shoulder altogether, known as frozen shoulder, or suffer from nerve damage and rotator cuff tear. The condition, known as shoulder injury related to vaccine administration, or SIRVA, is on the rise, according to data from the Vaccine Adverse Event Reporting System (VAERS).1

In fact, the condition is occurring often enough that it was recently added to the federally operated vaccine injury compensation program's (VICP) Vaccine Injury Table, which lists some, but not all, serious side effects that are known to be caused by vaccines.

In order to win federal compensation for a vaccine injury, a person must prove he or she developed certain clinical symptoms and health conditions listed on the Table within a certain timeframe of receiving a certain vaccine, and demonstrate that there is no more biologically plausible explanation for the vaccine-related injury or death.

In the case of SIRVA, 202 people were awarded compensation for SIRVA in 2016.2 According to Dr. H. Cody Meissner, professor of pediatrics at Floating Hospital for Children, Tufts Medical Center in Boston, Massachusetts, "Many instances of SIRVA may be avoided by proper vaccination technique and positioning."

A Vaccine Administered Too High Up on Your Shoulder May Lead to SIRVA

Many vaccine side effects are related to the ingredients in a vaccine. SIRVA is unique in that it's primarily caused by how the contents of the vaccine are injected into the arm. A vaccine given in your shoulder is intended to go into your muscle. If it is not administered correctly and goes into the bursa, a fluid-filled sac that protects your shoulder tendons, trouble can result. Specifically, the vaccine may provoke your immune system to attack the bursa, sometimes leading to debilitating symptoms. As The Washington Post reported:3

"These injection-caused injuries often make simple tasks — such as lifting your arm to change a light bulb or reaching behind you to put your arm through the sleeve of a jacket — painful, even impossible. Some victims cannot use their shoulder at all and must find ways to compensate using the other one."

The Washington Post interviewed Dr. G. Russell Huffman, an associate professor of orthopedic surgery at the Hospital of the University of Pennsylvania, who said when he first heard a patient complain of shoulder pain following an injury in 2009 or 2010, he "blew it off." But then the complaints started to become more common.

"Since then, I've seen more than a dozen patients who have suffered shoulder injuries after vaccinations. Almost universally, when I ask where the shot went, they point really high up on the arm," Huffman said.4 A patient, Barbara Steele, who spoke to Wired in 2015, similarly reported that doctors and nurses initially "kept brushing me off" after SIRVA from two vaccines left her unable to work.5

Yet, two case studies were published in 2007, highlighting vaccination-related shoulder dysfunction, including pain and weakness, that occurred following "influenza and pneumococcal vaccine injections provided high into the deltoid muscle." The researchers concluded, quite clearly, that improperly administered vaccines appeared responsible for the symptoms:6

"Based on ultrasound measurements, we hypothesize that vaccine injected into the subdeltoid bursa caused a periarticular inflammatory response, subacromial bursitis, bicipital tendonitis and adhesive capsulitis … We conclude that the upper third of the deltoid muscle should not be used for vaccine injections, and the diagnosis of vaccination-related shoulder dysfunction should be considered in patients presenting with shoulder pain following a vaccination."

Rapid Onset of Pain Is Common With SIRVA

In 2010, a series of 13 case studies were described in the journal Vaccine, which shed some light on the characteristics of the condition.7 In half of the cases, shoulder pain occurred immediately after vaccination, while 90 percent had pain within 24 hours. Close to half of the patients also said the vaccine was given "too high" in their arm.8 The symptoms, which included both pain and limited range of motion, continued for six months to several years.

"The proposed mechanism of injury is the unintentional injection of antigenic material into synovial tissues resulting in an immune-mediated inflammatory reaction," the researchers noted.9 Again in 2012, a case report of a 22-year-old woman who developed left shoulder pain and severe restrictions in range of motion following a seasonal influenza vaccine was published.10

MRI and ultrasound imaging, conducted eight and 9.5 weeks after the vaccination, respectively, showed "contusions on the humerus, injury of the supraspinatus, and effusion in the subacromial bursa," with researchers saying the case served as a catalyst for discussion regarding "the potential to prevent complications arising from vaccine overpenetration."

SIRVA Occurs More Often in Adults Than Children and Most Often After Certain Vaccines

Children receive more vaccinations than adults, yet SIRVA occurs more often in adults than children. This may be because children receive vaccinations in their thigh more often than adults do and, according to Meissner, "the bunching of the subcutaneous and deltoid tissue prior to vaccination may increase the distance to the shoulder." In addition, he noted that the subacromial bursa in children is still developing, and therefore smaller, which may be why it's less likely to be "hit" during a vaccination.11

Also noteworthy, in adults SIRVA occurs most often after flu shots and other vaccines that a person has already received, which may pave the way for a heightened inflammatory response. Meissner said:12

"Most cases in adults occur after administration of a vaccine to which some immunity already exists because of previous immunization such as influenza or tetanus-containing vaccines. This may result in a greater inflammatory response following inadvertent injection into the skeletal structures of the shoulder."

A 2017 systematic review of bursitis and other injuries of the shoulder following vaccination found 45 cases, all involving adults (and more than 70 percent female). In these cases, the dysfunction most often occurred following influenza and pneumococcal vaccines, respectively; followed by diphtheria-tetanus-pertussis, diphtheria-tetanus toxoid (Tdap), human papillomavirus and hepatitis A vaccines.13

There's even a case report, published in 2015, of a 26-year-old patient who was hospitalized with shoulder pain and impairment following a vaccine against diphtheria, tetanus and polio (dT-IPV). Bursitis was reported along with bone erosion, and MRI showed the vaccine was injected in contact with the bone, causing the erosion.14

Are Drug-Store Vaccines Responsible for Rising SIRVA Cases?

Improper technique appears to be the primary cause of SIRVA (inappropriate needle size could also be a contributor), which means that proper training among nurses, pharmacists and other health care practitioners should largely prevent it. However, many people now choose to get vaccines at workplace clinics or their local drugstore, grocery store or pharmacy, where standardized training may be nonexistent.

Not only that, but if you're sitting in the middle of a store, it's unlikely that you'll remove your entire arm from your sleeve to receive a shot. "You just pull your shirt down a little," physician Marko Bodor, who published the first SIRVA case report in 2007, told Wired.15 "That's only going to expose the top part of your shoulder." At this point, it's unknown just how often SIRVA cases appear after pharmacy versus physician's office vaccinations, but it's a valid theory.

That being said, SIRVA cases have occurred following vaccination at doctors' offices as well, and it's been suggested that, in addition to poor injection technique, practitioners' failing to take into account a person's individual characteristics, such as sex, body weight and physical constitution, could also increase the risk of injury.16

As for treatment, options for SIRVA include physical therapy, pain medication and cortisone injections. Up to 30 percent of patients in the 2010 case studies also required surgery,17which may be done to remove inflamed tissue. Platelet-rich plasma (PRP) therapy is another emerging option.

As the "first responders" to any site of an injury, they form a clot to stop bleeding. The process involves the platelets opening up and spilling out the growth factors held inside, which act as signaling molecules, issuing the instructions needed to call forth resources, including stem cells, to repair the damaged tissue. Dr. John Ferrell, director of sports medicine at Regenerative Orthopedics and Sports Medicine in Washington, D.C., says PRP has worked in 80 percent of his patients.18

Side Effects Following Vaccination Are Real

Although SIRVA is still described as rare, it's conditions like this that serve as an important reminder that every vaccine carries with it a risk of side effects, some of which you may not even be aware of.

For instance, in 2011, the U.S. Institute of Medicine (IOM) reviewed more than 1,000 vaccine studies and found convincing evidence of 14 health outcomes — including seizures, inflammation of the brain and fainting — that can be caused by certain vaccines.19 IOM reported that "injection of any vaccine in general can lead to … symptoms of deltoid bursitis, or shoulder inflammation," for instance.

They also noted that many people who experience an adverse reaction to vaccines have individual susceptibility that can make them at higher risk for experiencing acute and chronic health problems after vaccination due to biodiversity (genetic variations) within populations, age at the time of vaccination, immune deficiencies, coinciding infections/illnesses and other environmental exposures (such as toxins or traumas).

Further, for the majority of side effects and health conditions that have occurred in conjunction with vaccinations, IOM stated that there was inadequate evidence to determine whether the vaccine caused the problem. In other words, there is still so much medical science does not know about the risks of vaccination and who is at greater risk for suffering harm.

At the very basic level, if you choose to have a vaccine and it's going in your shoulder, be sure to expose your entire arm to discourage the vaccine provider from giving you a "too high" injection that could lead to debilitating shoulder injury. However, before making a choice to get vaccinated, make sure you fully understand what the vaccine contains and how to identify and report a vaccine reaction.

[+]Sources and References [-]Sources and References

  • 1, 2, 11, 12, 17 AAP News September 1, 2017
  • 3, 4, 8, 18 The Washington Post October 26, 2015
  • 5, 15 Wired September 3, 2015
  • 6 Vaccine. 2007 Jan 8;25(4):585-7. Epub 2006 Sep 8.
  • 7, 9 Vaccine. 2010 Nov 29;28(51):8049-52.
  • 10 J Am Board Fam Med. 2012 Nov-Dec;25(6):919-22.
  • 13, 16 Vaccine. 2017 Sep 5;35(37):4870-4876.
  • 14 Vaccine. 2015 Nov 17;33(46):6152-5.
  • 19 Institute of Medicine: Adverse Effects of Vaccines: Evidence and Causality August 25, 2011