Disclosures: Ali Arafat: No financial relationships or conflicts of interest

Case Diagnosis: A (1) 50-year-old male, (2) 31-year-old male, and (3) a 28-year-old female with shoulder injury related to vaccine administration (SIRVA).

Case Description: Patient 1 developed shoulder pain immediately after receiving the influenza vaccine. Patient 2 developed similar symptoms immediately after receiving the second dose of the COVID-19 vaccine. Patient 3 also developed worsening pain following COVID-19 vaccine administration. In all cases, the vaccine was administered in the proximal deltoid. All patients developed ipsilateral shoulder pain with limitations of activities of daily living (ADLs) and severely limited active range of motion (aROM) with the affected shoulder. All patients denied any radicular symptoms or paresthesias.

Setting: Outpatient ClinicAssessment/

Results: Physical exam on each patient revealed positive provocative testing for impingement syndrome. All patients underwent MSKUS. Patient 1 showed mild SASD bursal thickening along with two small distal calcifications, with moderate supraspinatus/infraspinatus tendinosis but no visualized tear. Patient 2 showed a small hyperechoic focus in the distal supraspinatus. Both patients underwent a left SASD corticosteroid injection and had significant pain relief and improvement with ADLs. Patient 3 was found to have supraspinatus tendinosis without tear and underwent ultrasound guided SASD injection of ketorolac.

Discussion: SIRVA can present with symptoms consistent with rotator cuff syndrome and musculoskeletal ultrasounds (MSKUS) can be a useful test to confirm a rotator cuff pain generator and exclude other pathology. Subacromial-subdeltoid (SASD) corticosteroid or Ketorolac injection appears to be an effective treatment option in these patients.

Conclusion: More research needs to be done exploring the utility of MSKUS in diagnosing SIRVA. SASD corticosteroid injections can be the mainstay of treatment when SIRVA presents with rotator cuff syndrome.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/shoulder-injury-related-to-vaccine-administration-sirva-a-case-series/