Shoulder injury related to vaccine administration (SIRVA) following mRNA COVID-19 vaccination:

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Shoulder injury related to vaccine administration (SIRVA) following mRNA COVID-19 vaccination: Report of 2 cases of subacromial-subdeltoid bursitis


Abstract

Shoulder pain has been reported as a common side-effect after COVID-19 vaccination particularly after administration of mRNA vaccines. Although it is usually mild and self-limiting, occasionally it can become more extensive causing severe pain and marked limited range of motion. Shoulder injury related to vaccine administration has been reported following injection of other routine vaccines. In this case report, we describe 2 cases of shoulder injury related to vaccine administration due to subacromial-subdeltoid bursitis after administration of mRNA COVID-19 vaccines.

Introduction

As the widespread use of COVID-19 vaccination is ongoing worldwide, radiologists have become more aware of its related imaging findings. Incidental axillary lymphadenopathy has been among the initially recognized and widely reported post vaccination findings in different imaging modalities [[1], [2], [3], [4]]. On the other hand, post-vaccination arm/shoulder pain, particularly at the site of injection, has been reported as one of the most common vaccine related side effects though usually self-limiting and resolving within a few days with or without conservative treatment for which imaging examination is rarely needed. Shoulder injury related to vaccine administration (SIRVA) is a well-known entity described previously and before the COVID-19 era with other types of vaccinations, particularly influenza vaccine [[5], [6], [7]]. SIRVA includes a variety of conditions such as adhesive capsulitis, tendinitis, and subacromial-subdeltoid bursitis. A recent case report described a case of SIRVA, specifically subacromial-subdeltoid bursitis, after administration of Oxford-AstraZeneca vaccine (Serum Institute of India) [8]. In this paper, we report 2 cases of SIRVA, namely subacromial-subdeltoid bursitis, after administration of mRNA COVID-19 vaccines.

Case 1

A 42-year-old male right-handed healthcare worker with no significant past medical history presented with severe left shoulder pain (numerical pain rating scale of 10/10) and severe limited range of motion. The symptoms developed within 2 days after receiving the first dose of Moderna's mRNA 1273 vaccine. A high injection site was reported by the patient at the time of vaccine administration. MRI of the left shoulder was performed in which subacromial-subdeltoid bursitis was detected (Figs. 1A and B). Due to severe pain, 1 course of oral Prednisolone was administered after which the pain subsided in few days. Follow-up MRI of the left shoulder 2 months later demonstrated resolution of the bursitis (Figs. 1C and D).

Case 2

A 38-year-old male right-handed healthcare worker with no significant past medical history presented with non-traumatic severe left shoulder pain (numerical pain rating scale of 10/10). The symptoms developed 2 weeks after receiving the second dose of Pfizer-BioNTech COVID19 vaccine (BNT162b2) leading to severe limited range of motion. The patient did not report any significant vaccine related symptoms with the first dose of vaccine except for moderate arm pain around the injection site. There was no report of deep or high injection site at the time of vaccine administration. Subsequently, ultrasound of the left shoulder was performed in which subacromial-subdeltoid bursitis was detected (Fig. 2). The symptoms almost completely resolved by conservative management in less than a week.


Conclusion

To our knowledge our cases are the first reported cases of imaging and clinically proven SIRVA due to mRNA COVID-19 vaccines. Given the widespread COVID-19 vaccination clinicians and radiologists should be familiar with potential musculoskeletal side effects of these vaccines.

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https://www.sciencedirect.com/science/article/pii/S1930043321005872?via%3Dihub


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