Shoulder Injury Related to Vaccine Administration

Abstract

Background: Shoulder injury related to vaccine administration (SIRVA) is a recognized complication and possible source of morbidity associated with incorrectly administered intramuscular deltoid vaccinations. As this site is commonly used for intramuscular injection, both clinicians and vaccine administrators should be familiar with SIRVA to minimize risk and monitor for its clinical presentation. Case Report: A 49-year-old male presented with shoulder pain that began 1 day after intramuscular administration of an influenza vaccine and point tenderness near the site of injection. Magnetic resonance imaging of the shoulder demonstrated focal osseous edema in the humeral head related to suboptimal needle placement. Conclusion: Based on the combination of history, physical examination findings, and imaging findings, the diagnosis of SIRVA was made with confidence in this clinical scenario.

Keywords: COVID-19 vaccines; influenza vaccines; injections–intramuscular; shoulder injuries.

Figure 1.

Conventional radiograph of the left shoulder demonstrated no acute pathology.

Figure 2.

Coronal T2-weighted magnetic resonance imaging of the left shoulder with fat saturation shows focal osseous edema within the humerus at the level of the infraspinatus muscle insertion on the greater tubercle (arrow). A complex paralabral cyst can also be partially seen near the posterosuperior glenoid (dashed arrow).

Figure 3.

Axial proton density weighted magnetic resonance imaging of the left shoulder with fat saturation again demonstrates edema signal within the greater tubercle (arrow). Edema is also deep in the deltoid muscle and within the teres minor tendinous insertion (dashed arrow).