What Is SIRVA: Symptoms, Causes, Treatment

If you've received a vaccine, you may have experienced common side effects like a sore arm or low-grade fever. However, you may not be aware of a potential, rare side effect called shoulder injury related to vaccine administration (SIRVA).

One of the main SIRVA symptoms is shoulder pain that doesn't go away following a vaccine injection. However, neck pain is not a typical symptom—though it is possible to experience it. SIRVA has also been linked to several vaccine types, including:

• COVID-19
• Hepatitis A and B
• Human papillomavirus
• Influenza
• Measles, mumps, rubella (MMR)
• Meningococcal conjugate
• Pneumococcal conjugate and polysaccharide
• Tetanus, diphtheria, pertussis (Tdap) or tetanus, diphtheria (Td)

While SIRVA can cause discomfort, the life-saving benefits of vaccines still outweigh the risks of developing this rare side effect. Learning about SIRVA can help you to prevent it or, if you think you have it, address symptoms with a healthcare provider.

Symptoms

While dull muscle ache pain after a vaccine injection is common, it usually disappears within days. With SIRVA, an individual might have the following symptoms:

• Reduced range of motion of the affected shoulder
• Shoulder pain within 48 hours of the vaccination
• Shoulder weakness or tingling
• Unimproved pain over time

Irritation may also occur as an inflammatory response after getting an injection.

Individuals who experience SIRVA can have these symptoms for months or years. People experiencing these symptoms should talk to a healthcare provider. "It's important that we learn to recognize these signs of SIRVA so that we can access appropriate treatment," Kelly Grindrod, PharmD, a professor at the School of Pharmacy at Waterloo, told Health.

Debates About SIRVA

There has been some debate about SIRVA's existence and how common it is. The National Academy of Medicine's Committee on the Adverse Effects of Vaccines' position on SIRVA is that there is no question that the evidence confirms that injectable vaccines can cause deltoid (shoulder muscle) bursitis.

However, the American Academy of Orthopedic Surgeons (AAOS) published two positions on this topic, first in 2017 and again in 2020. Both positions stated there is no evidence that vaccines cause any injuries to the shoulder.

Other reviews seem to favor the National Academy of Medicine's position. For example, some researchers said that based on the studies they reviewed, though "exceedingly rare," about one out of 130,000 vaccinations results in SIRVA.

What Causes SIRVA?

SIRVA can occur when injections are incorrectly placed in certain locations in the shoulder. For example, an injection in or near the auxiliary nerve may result in nerve irritation, numbness, tingling, or weakness. The condition can also result from a needle injected too deeply, leading to inflammation or infection.

Risk Factors

One review suggested risk factors for SIRVA include:

• Female sex
• Improper injection techniques
• A smaller deltoid muscle
• A thin physical build
  

How Is SIRVA Diagnosed?

To diagnose SIRVA, healthcare providers may use imaging tests to help determine the level and type of damage. Those tests include:

• Magnetic resonance imaging (MRI): A healthcare provider uses an MRI, which combines radio waves and a magnet, to see your body's internal structures. MRIs would give a provider the most detail about SIRVA and what damage may be the basis for symptoms.
• Ultrasound scan: During an ultrasound, a provider gets an image of your soft tissues produced by sound waves. They may complete an ultrasound if they can't do an MRI.

Treatment

Researchers and healthcare providers are still gaining knowledge about SIRVA. Treatment for the condition varies based on a person's symptoms and the severity of their case. Options for joint symptoms not related to infection and nerve pain include:

• Activity changes that require shoulder or arm usage
• Non-steroidal anti-inflammatory drugs (NSAIDs)
  
• Physical therapy
• Rest

Healthcare providers may recommend the above treatments, in addition to nerve pain-reducing medications like gabapentin, if you have nerve pain symptoms.

If these conservative treatments don't work, oral or injectable corticosteroids may help with moderate inflammation-related complaints. Surgery for damage repair may be recommended in more severe cases.

Prevention

According to Grindrod, healthcare providers who administer vaccinations must use proper vaccination landmarking techniques. However, if you are the one getting vaccinated, there are a few precautions you can take.

"It's important to let the people administrating vaccinations see the entire shoulder so that they can reference the necessary landmarks for proper injection," Ken Donohue, MD, a Yale Medicine orthopedic surgeon and shoulder specialist, told Health.

Dr. Donohue added: "Wear a sleeveless shirt or shirt that can be removed in order to reveal the entire shoulder. Rolling up the sleeve may prevent the person administering the vaccine from seeing all of the landmarks necessary to administer appropriately."

A Quick Review

SIRVA is a rare but potential side effect after receiving a vaccine, typically due to a problem with administering an injection. Persistent shoulder pain is one of the primary SIRVA symptoms, and SIRVA can be treated with options like physical therapy and medications.

While prevention of SIRVA partly depends on the person administering the injection, you can help by ensuring your arm is fully visible for them to landmark the injection properly. It's important to remember that vaccines save lives and that the risk of SIRVA is minimal.