Shoulder injury related to vaccine administration (SIRVA)
Taylor BC, Hinke D. Shoulder injury related to vaccine administration (SIRVA). Applied Radiology. 2014;43(1):30-31.
A 55-year-old woman presented with a 3-month history of left shoulder pain occurring less than 24 hrs after receiving an influenza vaccination and a tetanus, diphtheria, and pertussis (Tdap) vaccination. She described her pain as dull/achy, 5 out of 10 (10-point scale with 10 being the worst pain) at rest, and exacerbating with shoulder manipulation, most notably with abduction. In addition, she reported persistent 3-4/10 dull pain at rest, sleep disturbances due to pain, and difficulty with lifting, carrying and driving. The patient denied prior shoulder pain, fever, redness, soft tissue swelling, interval trauma, excessive lifting, pulling or exercising. Physical exam findings were positive for left deltoid tenderness, restricted adduction, and tenderness upon passive abduction and arm elevation—reflexes, strength, and sensation were intact. Serum C-reactive protein was normal. After minimal avail from multiple sessions of physical therapy and oral pain medications, a non-enhanced MRI of the left shoulder was ordered.