So you had your vaccine and extra protection against those nasty bugs. But as the days pass, you begin noticing pain in your shoulder that isn't improving. You're beginning to wonder if getting the vaccine was the right call.
Hold that thought.
Shoulder pain or soreness is a common complaint from people after a vaccination. It is often mild and resolves over a few days. In some rare cases, though, you may feel more severe pain, swelling, or limitations in your movements, which can be very upsetting.
This article will explain why you might have shoulder pain after getting a shot and what you can do to prevent and ease the pain.
What Causes Shoulder Pain After Vaccine?
Feeling pain or soreness in your shoulders is normal after getting a vaccine.
This is because your body's immune system reacts to the vaccine, causing temporary inflammation. It is a typical part of your body's process of building up protection against the disease that the vaccine aims to prevent.
Additionally, minor trauma from the needle can also cause a bit of soreness, which is a common and expected side effect.
This discomfort should resolve without any treatment in a few days.
In rare cases, however, some may experience severe, worsening pain with limited movements and swelling.
These are the symptoms of a condition called Shoulder Injury Related to Vaccine Administration (SIRVA).
SIRVA may occur if the needle has been inserted too high, too low, or too deep into the shoulder. The vaccine might then hit the wrong place (like the subdeltoid bursa), which could lead to shoulder pain and swelling.
What Is Shoulder Injury Related to Vaccine Administration (SIRVA)?
Shoulder Injury Related to Vaccine Administration, or SIRVA, is a rare but significant complication that can occur after a vaccine.
This problem usually happens when the vaccine is injected into the shoulder joint space instead of the target muscle (the deltoid muscle). An inflammatory reaction then usually occurs.
Most cases of SIRVA are linked to the flu, tetanus-diphtheria-pertussis, and COVID-19 vaccines. However, it can happen with any shot given in the shoulder area.
You should know that while SIRVA can be incredibly uncomfortable and even debilitating, it's not a common occurrence and shouldn't deter you from getting vaccinated.
What Are the Symptoms of SIRVA?
Symptoms of SIRVA may begin within 48 hours of vaccination and last more than seven days. Some studies have shown that they may last up to 6 months.
The most commonly reported symptoms include:
- Severe shoulder pain,
- Limited mobility of your shoulder joint,
- Swelling, redness, and warmth at the injection site,
- Shoulder stiffness.
These symptoms may be different based on which parts of the shoulder joint are hurt and may manifest as conditions like:
- Subacromial bursitis - inflammation of the fluid-filled sac within the shoulder joint.
- Rotator cuff tendinitis - swelling of the tendons connecting the muscles and bones of the shoulder.
- Frozen shoulder (adhesive capsulitis) - shoulder inflammation resulting in pain, stiffness, and loss of motion.
It's essential to identify SIRVA symptoms promptly since they can lead to lasting pain that can disrupt daily life. In the next section, we'll explore effective treatments for this condition.
When Should I See a Doctor for Shoulder Pain After a Vaccine?
It is expected to feel some pain in your shoulder after getting a vaccine, but it usually goes away in a few days.
However, you might need to consult a healthcare professional if your pain:
- Persists for more than a few days
- Becomes severe,
- Radiates to your neck or opposite shoulder, or
- Is accompanied by limited shoulder movement
How Is SIRVA Diagnosed?
Like any other health problem, a diagnosis is generally made after a complete medical history and physical exam. Other tests may also be needed.
Let's look at what to expect when you see your doctor.
- Your doctor might ask you about your pain—when it started, how bad it is, how it might have changed since it started, and if you have had any shots recently. This is known as history and is usually followed by a physical examination.
- The doctor may look for signs of inflammation and limited mobility during the examination. This could include difficulty moving the arm where the vaccine was administered. During this examination, your doctor may also test for any weakness or damage to the vessels and nerves in your arm.
- If the diagnosis is unclear, your doctor may also consider the exclusion of other causes for your shoulder pain. In this case, your doctor may order diagnostic tests, which may include:
- X-ray: This is the most readily available method of diagnosis and is primarily used to rule out any bone-related conditions in the shoulder. It helps determine if there are any fractures or abnormalities in the bones.
- MRI (with or without contrast): MRI scans are useful for assessing soft tissues and can help identify swelling, fluid buildup, infection, or damage to the structures within your shoulder. They provide detailed images to aid in diagnosis.
- Ultrasound scan: An ultrasound scan can be used when an MRI machine is unavailable. It offers valuable information about the likely diagnosis by creating real-time images of the shoulder's soft tissues, helping to identify issues such as inflammation or fluid accumulation.
- Nerve conduction study and electromyogram: These tests are employed when there are neurologic complaints like pain, numbness, tingling, paresthesias, and weakness. They are typically performed 2 to 3 weeks after vaccination and help assess nerve and muscle function, aiding in diagnosing nerve-related conditions.
- X-ray: This is the most readily available method of diagnosis and is primarily used to rule out any bone-related conditions in the shoulder. It helps determine if there are any fractures or abnormalities in the bones.
How Do I Treat SIRVA Pain?
Treatment of SIRVA might involve a combination of methods. The treatment choice usually depends on your doctor’s assessment of your shoulder pain and the presence of any complications.
For uncomplicated SIRVA, your doctor may suggest:
- Rest
- Over-the-counter pain relievers like acetaminophen or ibuprofen
- Physical therapy to slowly regain full range of movement without causing further injury
For advanced SIRVA or symptoms that the measures mentioned above do not relieve, you may need:
- Oral corticosteroids, or
- Corticosteroid injections
Additionally:
- Your doctor may suggest surgery to fix the damaged muscles in your shoulder if all other treatments have been tried and failed.
- With a nerve injury causing severe pain, tingling, and weakness, you might feel better with rest, painkillers, nerve-modulating medications (like gabapentin), physical therapy, or surgery.
- In the case of an infection, antibiotics are often used. Surgical debridement and other aggressive treatments are often reserved for complicated or persistent infections.
Your doctor will choose the most effective treatment for your shoulder pain based on your needs.
Can SIRVA Go Away on Its Own?
Although there is not much information on SIRVA going away on its own, some sources say that symptoms usually get better with non-invasive treatments like physical therapy and anti-inflammatory drugs.
Unfortunately, some people may still have pain even after getting the proper non-surgical treatment. In these cases, surgery may be needed.
Will Massage Help SIRVA?
We could not find any studies examining how massage alone can help relieve SIRVA.
We found one case report about a 50-year-old woman who got the flu shot and was then diagnosed with SIRVA. She had soft tissue massages, physical therapy, and pain medications, which helped reduce her pain and improve her range of motion and muscle strength.
We advise that instead of massaging the injection site, you should focus on massaging the muscles around it.
Importantly, if you get a vaccine and then have severe shoulder pain or think you might have SIRVA, you should see a doctor before starting any treatments. This is because it is possible that massaging the area might make the severe shoulder pain worse if an inflammatory response is to blame.
A massage might help ease the symptoms, but it is only a piece of the puzzle and only ideal in some situations.
How To Prevent SIRVA
Preventing SIRVA largely depends on proper vaccine administration techniques. According to the Advisory Committee on Immunization Practices (ACIP), there are three essential steps to take:
- Correct injection site: The vaccine should be injected into the arm's deltoid muscle, far enough away from the shoulder joint. Experts say to shoot for the middle of the upper arm, where the deltoid muscle is thickest and the joint and nerves are the farthest away.
The injection site is usually 2-3 fingers down from your acromion - the bony part of your shoulder above the deltoid.
- Correct needle length: The needle length should be selected based on the individual's body mass to ensure it reaches the muscle but does not go beyond it. A needle that is too long can inject the vaccine too deep, causing shoulder pain post-vaccine.
- Correct injection angle: The vaccine should be injected at a 90-degree angle to ensure it's being delivered into the muscle.
Patients can also play their part in preventing SIRVA. It is perfectly fine to talk about your worries about possible shoulder pain if you have had that kind of pain after previous shots.
Pay attention to the symptoms if they do occur, though. As mentioned throughout the article, a healthcare professional should look at persistent, extreme shoulder pain after a vaccine.
Takeaway
Vaccines are incredibly useful in reducing the burden of several infections and diseases in the US and globally.
Post-vaccine shoulder pain is a common side effect that many experience after receiving a vaccination. While it's usually mild and goes away within a few days, more extreme shoulder pain, or SIRVA, can sometimes occur.
Although this can be distressing, it is rare and should not discourage you from getting a vaccine.
Proper education and awareness about accurate vaccine administration methods can prevent conditions like SIRVA and help us remain healthy, strong, and safe.
