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İğrek S, Ulusoy İ, Çeliksöz AH. Does COVID-19 vaccine exacerbate rotator cuff symptoms? A prospective study. BMC Musculoskelet Disord 2023; 24:551. [PMID: 37403025 DOI: 10.1186/s12891-023-06660-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/22/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Shoulder injury related to vaccine administration (SIRVA) is a rare but increasing complication after vaccination. The aim of this study was to increase awareness of post-vaccination shoulder pain and to investigate the effect of the clinical condition of the shoulder before vaccination on the loss of function that may occur after vaccination. METHODS This prospective study included 65 patients aged > 18 years who were diagnosed with unilateral shoulder impingement and/or bursitis. The first vaccination was performed on the shoulders with rotator cuff symptoms, then the second vaccination was performed on healthy shoulders of same patients as soon as the health system allowed. Pre-vaccination MRI of the symptomatic shoulders of the patients was performed and VAS, ASES and Constant scores were evaluated. At 2 weeks after vaccination of the symptomatic shoulder, scores were reassessed. For the patients with changes in the scores, MRI was performed again and the treatment of all patients was started. A second vaccination was given to asymptomatic shoulders and the patients were recalled two weeks later and their scores were evaluated. RESULTS After vaccination, the symptomatic shoulder of 14 patients was affected. No clinical changes were observed in the asymptomatic shoulders after vaccination. The VAS scores of the symptomatic shoulders evaluated after vaccination were significantly higher than the scores evaluated before vaccination (p = 0.001). The ASES and Constant scores of symptomatic shoulders evaluated after vaccination were significantly decreased compared to the scores evaluated before vaccination (p = 0.001). CONCLUSIONS Exacerbation of symptoms may occur if symptomatic shoulders are vaccinated. Before vaccination, a detailed anamnesis should be taken from the patients and vaccination should be performed to the asymptomatic side.
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Affiliation(s)
- Servet İğrek
- Department of Orthopaedics and Traumatology, Selahaddin Eyyubi State Hospital, Diyarbakır, Turkey.
| | - İbrahim Ulusoy
- Department of Orthopaedics and Traumatology, Selahaddin Eyyubi State Hospital, Diyarbakır, Turkey
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Wright JO, Wiggins W, Smith MS, King JJ, Wright TW. Shoulder Pain and Dysfunction After Vaccination: A Systematic Review. JBJS Rev 2023; 11:01874474-202301000-00006. [PMID: 36722836 DOI: 10.2106/jbjs.rvw.22.00134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Persistent shoulder pain and dysfunction after vaccination are relatively rare but well-known complications after inoculations into the deltoid muscle. The term SIRVA (shoulder injury related to vaccine administration) is frequently used to encompass many of these occurrences; however, multiple distinct pathologies with similar presentations have been reported after vaccination. We performed a systematic review of the literature on vaccine-related shoulder injuries to help guide practitioners in appropriate workup and treatment based on specific diagnoses. METHODS PubMed was used to search for combinations of multiple keywords (including vaccine, immunization, SIRVA, injury, inflammation, bursitis, Parsonage-Turner syndrome, and neuritis), and all references of each potential article were reviewed. A total of 56 articles were included. Patient demographics, vaccine information, presentation, diagnostic studies, treatment, and outcomes were recorded. RESULTS Diagnoses were divided into 3 categories: (1) local inflammatory reaction (SIRVA), (2) brachial neuritis, and (3) direct nerve injury. The included articles reported on 57 cases of SIRVA, 18 of brachial neuritis, and 4 of direct nerve injury. The diagnoses reported for the SIRVA cases included frozen shoulder, pseudoseptic arthritis, subacromial bursitis, rotator cuff injury, and lytic lesions of the humeral head. Various treatments were used, and most patients had resolution of symptoms with conservative treatment including physical therapy, analgesics, and/or corticosteroid injections. Advanced imaging rarely provided information that affected treatment. The brachial neuritis and direct nerve injury cases were typically confirmed with electromyography/nerve conduction studies. Treatment of these 2 categories was nonoperative in all cases, typically with analgesics and/or corticosteroids, and most patients had symptomatic improvement after a few months, with most patients regaining strength. However, some (1 of 3 patients with brachial neuritis and >1 year of follow-up and 2 of 4 patients with direct injury) had residual weakness. CONCLUSIONS Medical professionals should be aware of the various pathologies that can lead to prolonged shoulder pain after vaccination. Fortunately, most of these conditions can be treated successfully with nonoperative modalities, although differentiating among the diagnoses can help guide treatment, as some likely benefit from systemic corticosteroids or localized corticosteroid injections. Outcomes for most patients have been good, with the majority recovering without residual pain or deficits. LEVEL OF EVIDENCE Prognostic Level IV.
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Affiliation(s)
- Jonathan O Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida
| | - Whitman Wiggins
- College of Medicine, University of Florida, Gainesville, Florida
| | - Michael Seth Smith
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida
| | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida
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Cagle PJ, White CA, Patel AV. Lesão de ombro relacionada à administração de vacina: Série de casos. Rev Bras Ortop 2022; 58:279-283. [DOI: 10.1055/s-0042-1751022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/16/2022] [Indexed: 10/17/2022] Open
Abstract
Resumo
Objetivo A dor no ombro é um quadro comum na atenção primária e há cada vez mais relatos acerca de sua ocorrência após a vacinação. Este estudo buscou entender como um protocolo de tratamento padronizado ajudaria pacientes com lesão no ombro relacionada à administração de vacina (SIRVA).
Métodos Os pacientes com SIRVA foram recrutados de forma retrospectiva entre fevereiro de 2017 e fevereiro de 2021. Todos os pacientes foram submetidos à fisioterapia e receberam uma prescrição de cortisona injetável. A amplitude de movimento pós-tratamento (ou seja, elevação anterior, rotação externa, rotação interna) e os desfechos relatados pelo paciente foram analisados a partir das pontuações da escala visual análoga (EVA), da American Shoulder and Elbow Surgeons (ASES), do teste simples do ombro (SST) e da avaliação numérica única (SANE).
Resultados No total, 9 pacientes foram examinados de maneira retrospectiva. Entre eles, 6 pacientes foram atendidos no primeiro mês após a vacinação e os outros três, depois de 67, 87 e 120 dias. Ademais, 8 dos pacientes fizeram todo o tratamento fisioterápico e 6 receberam uma injeção de cortisona. O período médio de acompanhamento foi de 8 meses. À última consulta, a rotação externa média foi de 61° (desvio padrão, DP ± 3°) e a elevação anterior média foi de 179° (DP ± 45°). A rotação interna variou entre L3 e T10. As pontuações de dor à EVA foram de 3,5/10,0 (DP ± 2,4) e o escore médio ASES foi de 63,5/100,0 (DP ± 26,3); as pontuações de SST foram 8,5/12,0 (DP ± 3,9). Por fim, os escores de SANE foram de 75,7/100,0 (DP ± 24,7) e 95,7/100,0 (DP ± 6,1) nos ombros lesionados e contralaterais, respectivamente.
Conclusão A dor no ombro após a vacinação tratada com fisioterapia e injeção de cortisona melhorou a amplitude de movimento e os escores funcionais.
Nível de Evidência IV.
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Affiliation(s)
- Paul J. Cagle
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, New York City, Nova York, Estados Unidos
| | - Christopher A. White
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, New York City, Nova York, Estados Unidos
| | - Akshar V. Patel
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, New York City, Nova York, Estados Unidos
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MacMahon A, Nayar SK, Srikumaran U. What Do We Know About Shoulder Injury Related to Vaccine Administration? An Updated Systematic Review. Clin Orthop Relat Res 2022; 480:1241-1250. [PMID: 35323136 PMCID: PMC9191332 DOI: 10.1097/corr.0000000000002181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 02/28/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Shoulder injury related to vaccine administration (SIRVA) is postulated to be an immune-mediated inflammatory response to a vaccine antigen injected into or near the subacromial bursae or synovium, leading to shoulder pain and dysfunction. The number of studies on this topic is rapidly increasing. Recent comparative studies have reported conflicting conclusions, which suggests that a systematic review of the best-available evidence may be helpful. QUESTIONS/PURPOSES In this systematic review, we asked: What are the (1) clinical characteristics, (2) diagnoses, and (3) management approaches and outcomes reported in association with SIRVA? METHODS A search was performed on October 4, 2021, of the PubMed and Medline databases for studies related to SIRVA. Inclusion criteria were English-language comparative studies, case series, and case reports that involved shoulder pain occurring after vaccination. Studies of exclusively neurologic conditions after vaccination were excluded. Forty-two studies met the eligibility criteria, including three retrospective comparative studies (72 patients and 105 controls), five database case series (2273 patients), and 34 case reports (49 patients). Study quality was assessed for the database case series and retrospective comparative studies using the Methodological Index for Non-randomized Studies tool. RESULTS Among patients in the case reports, the median age was 51 years (range 15-90 years), and 73% (36 of 49) were women. BMI was reported for 24% of patients (12 of 49) in case reports, with a median of 23.5 kg/m2 (range 21-37.2 kg/m2). The most common symptoms were shoulder pain and reduced ROM. The most common diagnoses were shoulder bursitis, adhesive capsulitis, and rotator cuff tears. The most frequent management modalities included physical or occupational therapy, NSAIDs, and steroid injections, followed by surgery, which was generally used for patients whose symptoms persisted despite nonsurgical management. Full resolution of symptoms was reported in 2.9% to 56% of patients. CONCLUSION The association between inflammatory conditions of the shoulder (such as bursitis) and vaccination appears to be exceedingly rare, occurring after approximately 1:130,000 vaccination events according to the best-available comparative study. Currently, there is no confirmatory experimental evidence supporting the theory of an immune-mediated inflammatory response to vaccine antigens. Although the clinical evidence is limited, similar to any bursitis, typical treatments appear effective, and surgery should rarely be performed. Additional research is needed to determine the best injection technique or evaluate alternate injection sites such as the anterolateral thigh that do not involve positioning a needle close to the shoulder.
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Affiliation(s)
- Aoife MacMahon
- Department of Orthopaedic Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Suresh K. Nayar
- Department of Orthopaedic Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Slette E, Rohrback M, Ring D. Persistent Shoulder Pain After Vaccine Administration Is Associated with Common Incidental Pathology: A Systematic Review. Clin Orthop Relat Res 2022; 480:1251-1258. [PMID: 35319515 PMCID: PMC9191317 DOI: 10.1097/corr.0000000000002191] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/07/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Claims of shoulder injury now account for half of all claims to the Vaccine Injury Compensation Program. Reports from databases of claims or potential adverse events note a relatively high mean age and high prevalences of rotator cuff tendinopathy and adhesive capsulitis-common shoulder problems that might be incidental to vaccination. Published case reports provide much more detail about individual patients than is available in databases. A review of published cases provides an opportunity for more detailed review of symptoms, diagnoses, pathology, treatment, and prognosis. Such a review can better assess the relative likelihood that pathologies associated with new persistent shoulder symptoms after vaccination are coincidental or unique to and caused by vaccine. QUESTIONS/PURPOSES Regarding published case reports addressing persistent shoulder pain after vaccination: (1) In what proportion of patients was a specific diagnosis made? (2) What diagnoses were most common? (3) Among patients treated nonsurgically, what proportion resolved, and over what time span did they resolve? METHODS In August 2020, we searched PubMed and Embase between 2006 and 2020 using the following search strategy: Search 1: (shoulder dysfunction OR shoulder pain OR shoulder bursitis OR rotator cuff tendonitis OR adhesive capsulitis OR glenohumeral arthritis AND [vaccine OR vaccination OR immunization]); Search 2: (shoulder injury related to vaccine administration or SIRVA). The search was supplemented by reviewing reference lists of identified studies. Inclusion criteria were any detailed report of three or fewer cases involving shoulder pain after vaccine administration. Twenty published reports of 29 patients were identified and assessed by two reviewers independently. One reported glenohumeral joint infection was excluded because the relationship between this type of relatively uncommon, discrete diagnosis and vaccination raises different considerations. We assumed a high risk of bias, although we are not aware of bias assessment tool for case reports. We recorded and summarized patient demographics, symptoms, examination and imaging findings, surgery findings, diagnoses, treatments, and outcomes. Seventy-five percent (21 of 28) of patients were women, with a mean age of 54 ± 19 years. In search of an underlying pathology, at least one diagnostic study was performed in 82% (23 of 28) of patients including radiographs in seven, ultrasound in seven, and MRI in 16 patients (some patients underwent more than one type of imaging). We distinguished specific pathophysiological diagnosis from shoulder pain and stiffness, counted the most common diagnoses among patients a specific diagnosis, and tracked symptom resolution among patients treated nonoperatively. RESULTS A specific diagnosis was made in 57% (16 of 28) of patients. Twelve patients had pain and limitation of motion due to pain but no specific pathological diagnosis. The most common specific diagnoses were rotator cuff tendinopathy (9 of 16) and adhesive capsulitis (4 of 16). Less common specific diagnoses included rotator cuff arthropathy (and rheumatoid arthritis) and suspected septic arthritis with nonspecific synovitis on arthroscopy. One patient had transient MRI signal change in the humeral head, which was interpreted as osteonecrosis that resolved in a manner not typical for that diagnosis. Of the 17 patients treated nonsurgically, 15 reported resolution, and two had incomplete symptom resolution with the mean 6-month evaluation period. CONCLUSION The observation that persistent shoulder pain after vaccination overlaps with common shoulder pathology-both in large databases as well as in more detailed reports of specific patients as analyzed in this review-establishes a high probability of a coincidental rather than a causal association. In the absence of high-quality experimental evidence of vaccine-specific shoulder pathology, in our opinion, it seems safest and healthiest to assume that perceived shoulder injury related to vaccine administration (SIRVA) is due to misinterpretation of new symptoms from established pathology rather than a new, vaccine-specific pathology. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Erik Slette
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Mitchell Rohrback
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
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Zheng C, Duffy J, Liu ILA, Sy LS, Chen W, Qian L, Navarro RA, Ryan DS, Kim SS, Mercado C, Jacobsen SJ. Risk for Shoulder Conditions After Vaccination: A Population-Based Study Using Real-World Data. Ann Intern Med 2022; 175:634-643. [PMID: 35313110 PMCID: PMC9117507 DOI: 10.7326/m21-3023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although shoulder conditions have been reported as an adverse event after intramuscular vaccination in the deltoid muscle, epidemiologic data on shoulder conditions after vaccination are limited. OBJECTIVE To estimate the risk for shoulder conditions after vaccination and assess possible risk factors. DESIGN Retrospective cohort study. SETTING Kaiser Permanente Southern California, a large integrated health care organization. PARTICIPANTS Kaiser Permanente Southern California members aged 3 years or older who had an intramuscular vaccination administered in the deltoid muscle between 1 April 2016 and 31 December 2017. MEASUREMENTS A natural language processing (NLP) algorithm was used to identify potential shoulder conditions among vaccinated persons with shoulder disorder diagnosis codes. All NLP-identified cases were manually chart confirmed on the basis of our case definition. The characteristics of vaccinated persons with and without shoulder conditions were compared. RESULTS Among 3 758 764 administered vaccinations, 371 cases of shoulder condition were identified, with an estimated incidence of 0.99 (95% CI, 0.89 to 1.09) per 10 000 vaccinations. The incidence was 1.22 (CI, 1.10 to 1.35) for the adult (aged ≥18 years) and 0.05 (CI, 0.02 to 0.14) for the pediatric (aged 3 to 17 years) vaccinated populations. In the adult vaccinated population, advanced age, female sex, an increased number of outpatient visits in the 6 months before vaccination, lower Charlson Comorbidity Index, and pneumococcal conjugate vaccine were associated with a higher risk for shoulder conditions. Among influenza vaccines, quadrivalent vaccines were associated with an increased risk for shoulder conditions. Simultaneous administration of vaccines was associated with a higher risk for shoulder conditions among elderly persons. LIMITATION Generalizability to other health care settings, use of administrative data, and residual confounding. CONCLUSION These population-based data suggest a small absolute risk for shoulder conditions after vaccination. Given the high burden of shoulder conditions, clinicians should pay attention to any factors that may further increase risks. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Chengyi Zheng
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California (C.Z., I.A.L., L.S.S., W.C., L.Q., D.S.R., S.S.K., C.M., S.J.J.)
| | - Jonathan Duffy
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia (J.D.)
| | - In-Lu Amy Liu
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California (C.Z., I.A.L., L.S.S., W.C., L.Q., D.S.R., S.S.K., C.M., S.J.J.)
| | - Lina S Sy
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California (C.Z., I.A.L., L.S.S., W.C., L.Q., D.S.R., S.S.K., C.M., S.J.J.)
| | - Wansu Chen
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California (C.Z., I.A.L., L.S.S., W.C., L.Q., D.S.R., S.S.K., C.M., S.J.J.)
| | - Lei Qian
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California (C.Z., I.A.L., L.S.S., W.C., L.Q., D.S.R., S.S.K., C.M., S.J.J.)
| | - Ronald A Navarro
- Kaiser Permanente South Bay Medical Center, Harbor City, California (R.A.N.)
| | - Denison S Ryan
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California (C.Z., I.A.L., L.S.S., W.C., L.Q., D.S.R., S.S.K., C.M., S.J.J.)
| | - Sunhea S Kim
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California (C.Z., I.A.L., L.S.S., W.C., L.Q., D.S.R., S.S.K., C.M., S.J.J.)
| | - Cheryl Mercado
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California (C.Z., I.A.L., L.S.S., W.C., L.Q., D.S.R., S.S.K., C.M., S.J.J.)
| | - Steven J Jacobsen
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California (C.Z., I.A.L., L.S.S., W.C., L.Q., D.S.R., S.S.K., C.M., S.J.J.)
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Pettyjohn EW, Clugston JR, Zaremski JL. Shoulder Injury Related to Vaccine Administration and a Growing Challenge: A Focused Review. Curr Sports Med Rep 2022; 21:78-83. [PMID: 35245242 DOI: 10.1249/jsr.0000000000000939] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Shoulder injury related to vaccine administration (SIRVA), an entity that causes acute shoulder pain and may limit range of motion (ROM) after vaccination, is a condition where a small but significant percentage of patients are experiencing in light of the current push for mass immunizations against SARS-CoV-2 worldwide. A search of literature related to SIRVA was performed across multiple electronic databases. Women, patients reporting vaccine injection location to be too high, and patients without prior history of shoulder pain were the most common historical factors in those experiencing SIRVA. Tenderness to palpation and limited shoulder ROM were the most associated physical examination findings. When using magnetic resonance imaging, tendinopathy, subacromial-subdeltoid bursitis, and rotator cuff tears (partial or complete) were the most common findings. Radiographic imaging rarely aided the diagnosis. SIRVA is an entity that health care providers should be aware of to improve the care of patients that may experience these symptoms after vaccine administration.
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Affiliation(s)
- Eric W Pettyjohn
- Department of Family Medicine and Community Health, University of Florida, Gainesville, FL
| | - James R Clugston
- Department of Family Medicine and Community Health, University of Florida, Gainesville, FL
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Affiliation(s)
- Jacky C K Chow
- Department of Radiology (Chow, Koles), Section of Orthopaedic Surgery (Bois), Cumming School of Medicine University of Calgary; McCaig Institute for Bone and Joint Health (Koles, Bois), Calgary, Alta.
| | - Sarah L Koles
- Department of Radiology (Chow, Koles), Section of Orthopaedic Surgery (Bois), Cumming School of Medicine University of Calgary; McCaig Institute for Bone and Joint Health (Koles, Bois), Calgary, Alta
| | - Aaron J Bois
- Department of Radiology (Chow, Koles), Section of Orthopaedic Surgery (Bois), Cumming School of Medicine University of Calgary; McCaig Institute for Bone and Joint Health (Koles, Bois), Calgary, Alta
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9
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Bodor M, Uribe Y, Srikumaran U. Ultrasonic aspiration for vaccination-related shoulder dysfunction. Heliyon 2021; 7:e08442. [PMID: 34901499 PMCID: PMC8642614 DOI: 10.1016/j.heliyon.2021.e08442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/29/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background Chronic shoulder pain occurs rarely after a vaccination and is hypothesized to arise from the effects of unintentional vaccine injection into the subacromial bursa, rotator cuff, capsule or underlying bone. The avascular nature of the rotator cuff, as well as unknown genetic and environmental factors, may predispose to the persistence of pain and disability, referred to as vaccination-related shoulder dysfunction and shoulder injury related to vaccine administration (SIRVA). Methods Ultrasonography, sonopalpation and ultrasound-guided anesthetic injections were used to locate the anatomical source of chronic (mean 20, range 8–42 months) shoulder pain after a vaccination in a consecutive series of 5 patients. Subsequently ultrasound-guided ultrasonic aspiration and debridement was performed using a 2.1 mm outer cannula with an inner needle vibrating at 28 kHz. Outcomes were assessed using the Quick Disabilities of the Arm, Shoulder and Hand (QDASH) scale at 2, 4, 12, 24 weeks and 1 year. Results The distal infraspinatus and teres minor tendons, their insertions and or the adjacent bone were the source of pain in all 5 patients. The mean QDASH score improved from 65 points to 11 points at 2 weeks (P = 0.001), and to 1 point at 4 weeks after the procedures (P = 0.003). Improvements in pain and function remained stable at 1 year in 3 patients, for at least 24 weeks in 1 patient who died of unrelated causes, and 1 year in 1 patient for posterior shoulder pain who after a pain free interval developed anterior shoulder pain related to his previously asymptomatic osteoarthritis (P = 0.013). Conclusion The distal infraspinatus and teres minor tendons, their insertions and adjacent bone are a common source of chronic shoulder pain after a vaccination. Ultrasound-guided ultrasonic aspiration and debridement is a potentially effective treatment for resolving pain and restoring function.
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Affiliation(s)
- Marko Bodor
- Bodor Clinic, 3421 Villa Lane, Napa, CA, 94558, USA.,Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA.,Department of Physical Medicine and Rehabilitation, University of California Davis, 4860 Y Street, Sacramento, CA, 95817, USA.,Napa Medical Research Foundation, 3421 Villa Lane, Napa, CA, 94558, USA
| | - Yvette Uribe
- Napa Medical Research Foundation, 3421 Villa Lane, Napa, CA, 94558, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD, 21287, USA
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10
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Shoulder Injury Related to Vaccine Administration. J Am Acad Orthop Surg 2021; 29:732-739. [PMID: 34185028 DOI: 10.5435/jaaos-d-21-00021] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/03/2021] [Indexed: 02/01/2023] Open
Abstract
Shoulder injury related to vaccine administration (SIRVA) is a rare yet increasingly recognized complication of immunization. Although a medicolegal term rather than a true diagnosis, SIRVA was introduced in 2010 by the Vaccine Injury Compensation Program after an increase in claims filed for vaccine-related shoulder injury. Patients typically present with severe pain and limited range of motion within 48 hours of vaccination and may experience notable functional limitations. Although the underlying pathophysiology is incompletely understood, the existing literature suggests that SIRVA results from the inflammatory response produced when the vaccine is injected into tissues containing a preexisting antibody. Current treatment modalities include physical therapy, corticosteroid injections, and antiinflammatory medications. In some cases, surgery may be required to treat underlying pathology, such as rotator cuff or biceps tendinopathy. Although the available literature indicates modest improvement in patients with SIRVA undergoing treatment, current data are limited to case series. Larger, high-quality studies are needed to determine the natural history and optimal treatment of this increasingly prevalent condition.
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11
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Wong W, Okafor C, Belay E, Klifto CS, Anakwenze O. Arthroscopic surgical management of shoulder secondary to shoulder injury related to vaccine administration (SIRVA): a case report. J Shoulder Elbow Surg 2021; 30:e334-e337. [PMID: 33610727 DOI: 10.1016/j.jse.2021.01.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 01/18/2021] [Indexed: 02/01/2023]
Affiliation(s)
- Willis Wong
- Duke University School of Medicine, Durham, NC, USA.
| | | | - Elshaday Belay
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Christopher S Klifto
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Oke Anakwenze
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
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12
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Zheng C, Duffy J, Liu ILA, Sy LS, Navarro RA, Kim SS, Ryan DS, Chen W, Qian L, Mercado C, Jacobsen SJ. Identifying Cases of Shoulder Injury Related to Vaccine Administration (SIRVA) in the United States: Development and Validation of a Natural Language Processing Method (Preprint). JMIR Public Health Surveill 2021; 8:e30426. [PMID: 35608886 PMCID: PMC9175103 DOI: 10.2196/30426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 02/22/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Shoulder injury related to vaccine administration (SIRVA) accounts for more than half of all claims received by the National Vaccine Injury Compensation Program. However, due to the difficulty of finding SIRVA cases in large health care databases, population-based studies are scarce. Objective The goal of the research was to develop a natural language processing (NLP) method to identify SIRVA cases from clinical notes. Methods We conducted the study among members of a large integrated health care organization who were vaccinated between April 1, 2016, and December 31, 2017, and had subsequent diagnosis codes indicative of shoulder injury. Based on a training data set with a chart review reference standard of 164 cases, we developed an NLP algorithm to extract shoulder disorder information, including prior vaccination, anatomic location, temporality and causality. The algorithm identified 3 groups of positive SIRVA cases (definite, probable, and possible) based on the strength of evidence. We compared NLP results to a chart review reference standard of 100 vaccinated cases. We then applied the final automated NLP algorithm to a broader cohort of vaccinated persons with a shoulder injury diagnosis code and performed manual chart confirmation on a random sample of NLP-identified definite cases and all NLP-identified probable and possible cases. Results In the validation sample, the NLP algorithm had 100% accuracy for identifying 4 SIRVA cases and 96 cases without SIRVA. In the broader cohort of 53,585 vaccinations, the NLP algorithm identified 291 definite, 124 probable, and 52 possible SIRVA cases. The chart-confirmation rates for these groups were 95.5% (278/291), 67.7% (84/124), and 17.3% (9/52), respectively. Conclusions The algorithm performed with high sensitivity and reasonable specificity in identifying positive SIRVA cases. The NLP algorithm can potentially be used in future population-based studies to identify this rare adverse event, avoiding labor-intensive chart review validation.
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Affiliation(s)
- Chengyi Zheng
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Jonathan Duffy
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - In-Lu Amy Liu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Lina S Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Ronald A Navarro
- Kaiser Permanente South Bay Medical Center, Harbor City, CA, United States
| | - Sunhea S Kim
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Denison S Ryan
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Wansu Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Lei Qian
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Cheryl Mercado
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
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Littrell LA, Leslie DF, Bierle DM, Wenger DE. Progressive Monoarticular Inflammatory Arthritis Following Influenza Vaccination. Mayo Clin Proc Innov Qual Outcomes 2021; 5:204-209. [PMID: 33718794 PMCID: PMC7930781 DOI: 10.1016/j.mayocpiqo.2020.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Musculoskeletal injury is an uncommon but usually self-limited complication of vaccine administration. We present a case of progressive inflammatory monoarthritis of the shoulder characterized by bone erosion, bursitis, and severe synovitis caused by an influenza vaccine administered to the ipsilateral deltoid region. Clinical symptoms began within 2 hours of vaccination, with progressive decline in function over 6 weeks. Magnetic resonance imaging examinations performed 5 months apart demonstrated progressive erosive changes of the greater tuberosity, rotator cuff injury, and extensive enhancing synovitis of the glenohumeral joint and subacromial/subdeltoid bursa. After the exclusion of septic arthritis and osteomyelitis, the patient underwent nonoperative treatment and experienced near-complete recovery at 32 months. Although inflammatory arthritis of the shoulder following vaccination is rare, there have been previous reports of it. Clinicians and radiologists need to be aware of this potential complication to ensure an accurate diagnosis.
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Affiliation(s)
- Laurel A. Littrell
- Department of Radiology, Mayo Clinic, Rochester, MN
- Correspondence: Address to Laurel A. Littrell, MD, 200 1st St. SW, Rochester, MN 55905.
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14
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Cagle PJ. Shoulder Injury after Vaccination: A Systematic Review. Rev Bras Ortop 2020; 56:299-306. [PMID: 34239193 PMCID: PMC8249056 DOI: 10.1055/s-0040-1719086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/16/2020] [Indexed: 10/27/2022] Open
Abstract
Adverse reactions to vaccine injections are usually mild and incredibly rare in nature, but multiple cases of shoulder events including bursitis, generalized pain or decreased range of motion have been reported following routine vaccine administrations. These events are known as Shoulder Injury Related to Vaccine Administration or SIRVA. A systematic review of literature was performed to identify all published accounts of SIRVA. Twenty-seven papers reporting one or more accounts of SIRVA were identified. The most common vaccination involved was the Influenza vaccine. The most common symptoms were pain that began in 48 hours or less and loss of shoulder range of motion. The most common treatment modalities were physical therapy, corticosteroid injections and anti-inflammatory medication; but in some patients, surgery was required. Regardless of intervention, the vast majority of outcomes demonstrated improved pain and functional except in the occasions of nerve injury. The etiology of SIRVA injuries has multiple possibilities including needle length, mechanical injury from needle overpenetration and the possibility of an immune inflammatory response from the vaccine components, but a unique definitive test or quantifiably result does not yet exist.
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Affiliation(s)
- Paul J Cagle
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, Nova York, Nova York, Estados Unidos
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15
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Natanzi N, Hebroni F, Bodor M. Teres minor injury related to vaccine administration. Radiol Case Rep 2020; 15:552-555. [PMID: 32194884 PMCID: PMC7078120 DOI: 10.1016/j.radcr.2020.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 11/04/2022] Open
Abstract
Shoulder injury related to vaccine administration is a relatively rare disorder, which occurs as a result of vaccine being inadvertently injected into the subdeltoid/subacromial bursa, rotator cuff, and or underlying bone. We present 2 cases of shoulder injury related to vaccine administration in 2 women of ages 38 and 42 with injury to the teres minor tendon insertions on magnetic resonance imaging, a location not previously described. When faced with a patient with chronic shoulder pain following a vaccination, the possibility of vaccine deposition or injury to the teres minor tendon insertion should be considered.
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Affiliation(s)
- Naveed Natanzi
- The Regenerative Sports and Spine Institute, 14332 Ventura Blvd., Sherman Oaks, CA 91423, USA
| | - Frank Hebroni
- Department of Radiology, University of California, Los Angeles, CA 90024, USA
| | - Marko Bodor
- Bodor Clinic, 3421 Villa Lane Suite 2B, Napa, CA 94558, USA
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