SIRVA, or Shoulder Injury Related to Vaccine Administration, occurs when a vaccine is mistakenly injected into the shoulder instead of the deltoid muscle, causing extended shoulder pain and restricted shoulder mobility. SIRVA usually results from a vaccine injected too high up the arm or too deeply, potentially impacting nerves or entering the shoulder capsule or bursa, leading to severe shoulder pain and inflammation.

People might not immediately associate their symptoms with SIRVA, as vaccines typically cause some soreness or stiffness, prompting many to wait for the pain to resolve on its own. However, if the pain worsens, disturbs sleep, or affects daily activities, it signals possible SIRVA and a need for medical care.

“SIRVA” isn’t a medical diagnosis but a term describing shoulder injuries from vaccines, characterized by lasting shoulder pain and reduced shoulder mobility that appears soon after the vaccination. While some individuals may experience brief discomfort from SIRVA, others might encounter prolonged issues requiring treatments like physical therapy, steroid injections, or even surgery for serious cases.

SIRVA-related injuries include:

Shoulder Bursitis

SIRVA-related shoulder bursitis typically results from a vaccine that is mistakenly injected too high on the arm, specifically into or near the bursa rather than the deltoid muscle. The bursa is a fluid-filled sac that serves to reduce friction between tissues in your shoulder. The physical act of the needle entering the bursa causes mechanical irritation and contributes to inflammation. The body’s immune response to the vaccine components in the bursa also causes inflammation in the bursa. This inflammation can travel to nearby structures of the shoulder and cause damage there as well.

• Symptoms – Pain from bursitis is often the most immediate and noticeable symptom, worsening with movement or pressure on the affected area. The inflamed bursa can also lead to noticeable swelling around the shoulder. The affected area may become warm and red due to increased blood flow. Bursitis also causes reduced range of motion, stiffness, and discomfort, and may result in limited shoulder movement and shoulder dysfunction.
  
  
• Diagnosis – Diagnosis of SIRVA-related bursitis requires a recent vaccination prior to the onset of symptoms, and tenderness, swelling, and decreased shoulder range of motion on physical examination. An MRI of the shoulder can be used to visualize inflammation in the bursa and for further evaluation of other shoulder pathology related to the spread of this inflammation.
  
  
• Treatment – Treatment of SIRVA-related bursitis includes minimizing shoulder movement to reduce irritation of the inflamed bursa. Applying ice to the shoulder can reduce swelling and numb the area, alleviating pain. Anti-inflammatory medications can help reduce pain and inflammation in the shoulder and bursa. Physical therapy (formal and at-home exercise) can help to maintain range of motion and strengthen the shoulder and surrounding muscles without aggravating the bursa. Corticosteroid injections administered in the subacromial or subdeltoid space can reduce severe inflammation in the shoulder and bursa. In severe cases, surgery may be required to remove the inflamed or enlarged bursa (bursectomy).

Adhesive Capsulitis (Frozen Shoulder)

Adhesive capsulitis, also known as “frozen shoulder,” is a medical condition characterized by tightness of the shoulder capsule and development of adhesions which cause stiffness and pain in the shoulder. SIRVA-related adhesive capsulitis results from a vaccine, improperly injected too high in the shoulder or into the bursa, causing thickening, stiffness, and tightness of the shoulder capsule and development of adhesions.

• Symptoms – The hallmark symptoms of adhesive capsulitis are intense pain and a loss of shoulder range of motion even with assistance. The American Academy of Orthopaedic Surgeons breaks down adhesive capsulitis into three stages:
  
  • • The “freezing” stage, in which the shoulder gets increasingly painful and stiff over a period of 6 weeks to 9 months.
    • The “frozen” stage, in which the persistent shoulder stiffness makes daily tasks very difficult for 4 to 6 months.
    • The “thawing” stage, shoulder movement gradually returns to normal or close to normal over 6 months to 2 years.
      
      
• Diagnosis – Diagnosis of SIRVA-related adhesive capsulitis is primarily based on a history of recent vaccination and resulting in pain and limited active-and-passive shoulder range of motion. You doctor will test “passive range of motion” by moving your shoulder in various directions to check for pain and limited movement, and compare this to how much you can move your shoulder on your own, or “active range of motion.” In cases of frozen shoulder, both types of movement are typically restricted. Imaging like x-rays or MRIs can be used to confirm the diagnosis and rule out other conditions.
  
  
• Treatment – Treatment of SIRVA-related adhesive capsulitis aims to reduce pain and restore mobility and may include non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, and corticosteroid injections. Adhesive capsulitis generally gets better over time without surgery, but it may take up to 3 years. In severe cases, surgery may be necessary to loosen the joint capsule and improve range of motion.

Rotator Cuff Tendonitis

Rotator cuff tendonitis is characterized by inflammation and irritation to the rotator cuff tendons surrounding the shoulder joint. This inflammation causes pain, discomfort, limited shoulder range of motion. SIRVA-related rotator cuff tendonitis results from a vaccine, improperly injected too high in the shoulder or too deep, causes inflammation, swelling, and irritation of the rotator cuff tendons. Direct trauma can be caused by the needle physically injuring the tendon’s fibers or nearby structures, leading to inflammation and tendonitis. The vaccine’s components can also provoke an immune response in the vicinity of the rotator cuff tendons, causing or exacerbating inflammation, swelling, and irritation of the rotator cuff tendons.

• Symptoms – Pain is often the first symptom, usually worsening with arm movement, especially overhead activities. Symptoms of cuff tendonitis also include swelling and tenderness around the shoulder, reduced shoulder range of motion, and shoulder weakness causing difficult to perform usual activities, and disrupted sleep, especially when lying on the affected side.
  
  
• Diagnosis – Diagnosis of SIRVA-related rotator cuff tendonitis typically requires a recent vaccination within 48 hours prior to the onset of symptoms. A doctor perform a physical examination of the shoulder and order imaging tests, such as x-rays and MRIs, to confirm the diagnosis and rule out other conditions.
  
  
• Treatment – Treatment of SIRVA-related rotator cuff tendonitis includes ice, non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, and corticosteroid injections. If these methods don’t alleviate pain after a few months and the relief from steroid injections is short-lived, surgery may be considered.

Shoulder Impingement Syndrome

Shoulder impingement syndrome occurs when the rotator cuff gets irritated and inflamed as it passes through the subacromial space, causing pain and restricting movement. SIRVA-related shoulder impingement syndrome occurs when a vaccine is improperly injected into or near the subacromial space, causing inflammation in the rotator cuff. This inflammation causes the space under the shoulder blade to narrow, which then pinches and irritates the rotator cuff tendons.

• Symptoms – Common symptoms of shoulder impingement syndrome include shoulder weakness, pain, and limited range of motion. The pain usually starts within 48 hours after the vaccination and gradually worsens. The pain, often a dull ache at the front or side of the shoulder, can intensify with overhead movements or reaching behind the back. It can also disrupted sleep, especially when lying on the affected side.
  
  
• Diagnosis – Diagnosis of SIRVA-related shoulder impingement syndrome requires a recent vaccination prior to the onset of symptoms. A doctor will examine the shoulder to check for pain and tenderness, assess the range of motion, and perform specific impingement tests by moving the shoulder in various directions in an attempt to reproduce the conditions of shoulder impingement. A doctor may also inject an anesthetic into the shoulder, and if this results in reduced pain and increased range of motion, it suggest likely shoulder impingement syndrome. X-rays and MRIs can also be used to confirm the diagnosis and rule out other conditions.
  
  
• Treatment – Treatment of SIRVA-related shoulder impingement syndrome often starts with simple methods like ice, anti-inflammatory drugs, and physical therapy. More advanced treatments like cortisone or anesthetic injections might also be used. The Cleveland Clinic notes that many patients improve within weeks to months, with a significant number feeling better within two years. In severe cases, surgery may be necessary to repair the rotator cuff or make more space in the shoulder joint.

Rotator Cuff Tears

The rotator cuff is a group of tendons that holds your arm in the shoulder socket and helps with arm movement. A rotator cuff tear is a rupture in one of the rotator cuff tendons. This tear can occur suddenly due to injury, or slowly from ongoing wear. It often starts with tendon fraying and progresses to a partial or full-thickness tear. In the case of a SIRVA-related rotator cuff tear, it can be caused directly by a vaccine improperly injected directly into the tendon, or indirectly by an inflammatory reaction from a vaccine injected close to but not directly in the tendon. This body’s immune response to the vaccine components also causes inflammation, further weakening the tendon and making it more prone to tearing.

• Symptoms – Common symptoms of a rotator cuff tear include sharp pain in the shoulder, increased pain with movement or activities, shoulder weakness, limited shoulder range of motion, difficulty with daily activities, crackling or popping in the affected shoulder, disturbed sleep, and increased pain or inability to lay on the affected side.
  
  
• Diagnosis – Diagnosis of a SIRVA-related rotator cuff tear requires a recent vaccination prior to the onset of symptoms and a combination of clinical evaluation and imaging tests. An MRI is particularly useful in identifying and showing the extent of a rotator cuff tear.
  
  
• Treatment – Treatment of a SIRVA-related rotator cuff tear varies depending on the extent of the tear. Conservative treatment include rest, ice, anti-inflammatory medication, physical therapy, corticosteroid injections, and lifestyle and activity modifications. Surgical treatment includes rotator cuff repair or shoulder replacement if the tear is combined with advanced arthritis. The choice of treatment is individualized, taking into consideration the extent of the tear and well as the patient’s specific circumstances and goals.