Vaccine Related Pain

Shoulder injury related to vaccine administration (SIRVA) is a rare but potentially debilitating injury characterized by persistent shoulder pain, typically occurring within 48 hours of intramuscular deltoid vaccine administration. With over 150 million flu vaccines being administered in the United States each year, and the US Centers for Disease Control’s goal of immunizing greater than 70% of the population for the coronavirus disease 2019 virus, cases of SIRVA can be expected to rise.

Proper vaccine injection site and rotator cuff anatomy.
Anatomic structures at risk for SIRVA. The overall mean acromion-to-nerve distance is 6.1 ± 0.89 cm. The interval between the most proximal and distal borders of the axillary nerve is 1.39 ± 0.35 cm.15

Shoulder pain can be a vaccine side effect. A vaccine shoulder injury is can be due to how the vaccine is administered or the contents of the vaccine itself, although the latter is less well documented. Generally, a properly administered vaccination is administered directly into the shoulder muscle. Sometimes the vaccine is injected into the fluid filled sac called the bursa, a structure that is highly variable in is geometric morphology, and may lead to inadvertent injection.

An properly administered or improper vaccine injection may cause sharp shoulder pain, upper arm pain, permanent swelling and tenderness at the site of injection, lumps/nodules and injuries to the nerves at the site of injection, rotator cuff injury, and frozen shoulder. In addition, a vaccination may result in Shoulder Bursitis, Brachial neuritis, Adhesive Capsulitis, and other shoulder injuries. Most events have been associated with poor needle placement and/or a local reaction to the delivered serum during vaccine administration

These symptoms and/or conditions can last for months, even longer or can be permanent. The improper angle and/or position of the needle may be contributing to these shoulder injuries. A previous shoulder damage or injury may be aggravated due to the inflammation of the surrounding tissue. Additionally, SIRVA may occur as a result of improper vaccination technique or due to, as yet, less well documented, some contents of the vaccination material. More investigations are required to better understand the latter possibility.

The following is a list of symptoms an individual may experience after receiving a vaccination:

  • Arm Pain
  • Shoulder Pain
  • Shoulder Dysfunction
  • Limited Range of Motion
  • Shoulder Bursitis
  • Tendonitis
  • Rotator Cuff Injury
  • Brachial Neuritis
  • Frozen Shoulder
  • Adhesive Capsulitis

Treatment is individually directed and should initially consist of observation and local symptom management. Recalcitrant cases or infections may warrant surgical intervention. Published outcomes vary widely, and our understanding of SIRVA remains limited

Below is an example of a patient’s MRI scans who had persistent pain, marginally improving after 4 months from a Flu Vaccination in October 2022.

Information Sources

Vaccine Shoulder Injury