What is SIRVA?

Shoulder injury related to vaccine administration (SIRVA) is caused when a vaccine is injected too high up on the arm resulting in an injury to the musculoskeletal structures of the shoulder. SIRVA can occur in patients who have received a seasonal flu shot in particular because the vaccine is given in the deltoid muscle of the arm.

What causes SIRVA?

Unlike other injuries associated with vaccines, SIRVA is not caused by the contents of the vaccine itself but how the injection is administered. Any vaccine normally injected into the muscle can cause SIRVA.

When administered in the wrong location (the upper third of the deltoid muscle should not be used for vaccine injections), in many cases of SIRVA rather than penetrating the arm muscle the needle instead goes into the bursa which is a fluid-filled sac which provides protection to the tendons in the shoulder. The vaccine then provokes the body’s immune system to attack the bursa, which can result in significant chronic pain and sometimes a frozen shoulder.

What are the symptoms of SIRVA?

Intense, prolonged pain and limited range of motion are the most common symptoms of SIRVA but other injuries such as bicipital tendonitis, rotator cuff tears, subacromial bursitis, periarticular inflammatory response and adhesive capsulitis (known commonly as frozen shoulder) have also been observed. Symptoms usually occur a number of days or weeks after a patient has received a shot.

How is SIRVA treated?

In the majority of cases, the symptoms of SIVRA can be treated with medication and physiotherapy to alleviate inflammation and improve range of motion. However, in more severe cases patients will remain symptomatic and surgery may be necessary to repair the damage done to the shoulder’s ligaments and tendons.

Is SIRVA on the increase?

While increasing steadily due to better reporting, awareness of SIRVA is still relatively low, even in the medical community. This is not that surprising when you consider that the first case study directly linking shoulder pain to incorrectly administered injections was only conducted in 2006. Since then, numerous other research endeavours have confirmed the link.

There is also an argument that the significant increase in reported cases of SIRVA in recent years may be due to the fact that GPs are now not the only healthcare professionals administering vaccinations. The annual flu vaccine that is recommended for specific high-risk groups by the HSE is now available from pharmacies.

How can SIRVA be avoided?

Minimising the occurrence of SIRVA can be achieved by ensuring that nurses, medical assistants and pharmacists receive proper training in the appropriate technique required to ensure that no injury occurs when administering an injection. Health professionals need to be familiar with the anatomy of the shoulder to avoid injecting too high. They should also keep themselves apprised of recommendations for intramuscular injections to ensure that a proper technique is used. It is imperative that providing this training is prioritised as any loss in public confidence in the merits of vaccination could result in needless illness and death.