Shoulder Pain After Vaccine

Influenza shots and other vaccinations occasionally lead to shoulder injuries that may necessitate treatments that range from resting the shoulder to undergoing surgery. Are you suffering from intense shoulder pain days or weeks after receiving a vaccine? Is the pain making it hard to sleep at night? If you recently received a vaccine, but the pain in your shoulder is not going away, you may have a condition known as shoulder injury related to vaccine administration or SIRVA.

Mild pain is expected following a vaccine, but it is usually temporary and quickly resolves without any need for treatment. It is important to recognize the difference between momentary shoulder pain due to a vaccine and chronic pain that indicates serious tissue damage. If a shoulder injury is left untreated, permanent damage may occur as well as the loss of proper shoulder function. Understanding the potential causes of shoulder pain due to a vaccination may help prevent this issue from occurring or promote appropriate treatment.

What Causes Shoulder Pain After Vaccine?

Vaccines that are injected into the intramuscular deltoid (dense muscle in the shoulder above the armpit) are typically associated with local reactions (e.g., redness, minor bleeding) at the site of a vaccination. The most common issues that may develop at the injection site are soreness, skin redness (erythema), and swelling (edema). Furthermore, short-term pain is a frequently reported side effect that is usually mild and short-lived.

Although a certain degree of discomfort is anticipated following a vaccination, some people occasionally experience severe, persistent shoulder pain that requires evaluation and treatment. This form of injury generally occurs within moments to days after receiving a vaccine injection and can lead to prolonged or permanent shoulder dysfunction. The occurrence is rare, but reports regarding influenza vaccines indicate that the incidence of serious shoulder pain due to a vaccine (e.g., SIRVA) is about two out of one million people. However, this number is expected to increase as more people receive vaccinations worldwide.

Injection complications are usually linked to poor needle placement, a local reaction to the serum delivered during the vaccination, or a combination of factors (e.g., allergic reaction and needle placement). If chronic pain and reduced mobility develop, clinical evaluation typically
involves the following:

• A physical examination
• An assessment of medical history
• Diagnostic imaging
  • Radiography
  • Magnetic resonance imaging (MRI)
  • MR neurography (nerve imaging)

Treatment is recommended based on the degree of severity and may entail non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, and physical therapy. If an infection or severe shoulder tissue damage develops, surgery may become necessary. Currently, the most
frequently reported cases of shoulder pain after a vaccine are associated with influenza and coronavirus vaccinations.

Influenza and COVID Vaccinations

Approximately 50% of the US population receives the influenza vaccine (flu shot) annually, reflecting more than 150 million vaccinations each year. Although mild to moderate shoulder pain is a common side effect of vaccinations, SIRVA was not added to the official list of the National Vaccine Injury Compensation Program (VICP) Vaccine Injuries until 2017. In addition, shoulder injury claims have continuously increased over the past decade, with the majority of the reported cases being female. However, it is believed that the growing incidence of shoulder
pain (e.g., SIRVA) reports may not be due to increased injury rates or administration errors, but may instead be related to previously underreported injuries. 

Evidence of this issue was demonstrated by the US Vaccine Adverse Event Reporting System, which showed that out of over 900 million doses of influenza vaccine administered in the US from 2010 to 2017, there were more than 1,200 reports of atypical shoulder pain that was experienced within 48 hours of vaccine administration that lasted longer than seven days. This number represents about 2% of the reported adverse events related to vaccines. However, this may be a misrepresentation, as some people may not associate chronic shoulder pain with a vaccination or may fail to report this side effect to a healthcare professional. Others may assume the discomfort will eventually go away and avoid seeking treatment until the pain is unbearable or the damage leads to an infection. A similar issue appears to be associated with the current recommendations for coronavirus vaccines.

Due to the coronavirus disease 2019 (COVID-19) pandemic, the US Centers for Disease Control and Prevention (CDC) has established a vaccination goal of about 70% of the US population. Depending on which type of vaccination an individual receives, the initial COVID-19 vaccination procedure requires up to two injections administered three to eight weeks apart. Furthermore, a booster shot, which will most likely become an annual recommendation, is now being encouraged for adults and children ages 5 and older. 

However, reports regarding the COVID-19 vaccine also describe the rare occurrence of substantial shoulder pain and limited range of motion in some individuals following the vaccination. Similar to the potential problems that may arise during flu vaccinations, this complication is usually attributed to incorrect vaccination technique. To avoid this issue, it is recommended that healthcare providers who administer vaccines should correctly identify the injection site, use needles of appropriate lengths, and place the vaccine needles in the correct position.

The influenza (flu) and COVID-19 vaccines represent the most common annual vaccinations. The injection frequency of these vaccines also increases the risk of experiencing sustained shoulder pain following a vaccination. It is estimated that during the next couple of years, Americans will receive about 500 million vaccines annually. Therefore, a rise in shoulder pain complaints or more serious cases of SIRVA are expected. Despite the ongoing issues, there is a consensus within the health care community that managing shoulder pain due to vaccination should involve prevention and awareness.

Serious Side Effects Related to Vaccines

Serious side effects may occur if the deltoid muscle—the main structure that facilitates shoulder joint motion—becomes damaged. However, there are additional structures that may be affected by an incorrect vaccination technique. The shoulder is a ball and socket joint that is also known as the glenohumeral joint. This region also consists of the shoulder capsule, the rotator cuff, and the surrounding subdeltoid and subacromial bursa (protective, fluid-filled sacs). The axillary nerve, which is the main nerve that supplies the deltoid, extends below the shoulder joint. An improper vaccination procedure can potentially injure any of these structures.

For instance, if an injection needle is placed too deep into the shoulder capsule, an infection (e.g., bursitis, septic arthritis) or bursal inflammation (e.g., synovitis) may develop. A needle that is placed into the rotator cuff may cause tendonitis or a torn rotator cuff. If the needle punctures the subacromial or subdeltoid bursa, a frozen shoulder (adhesive capsulitis) and painful inflammation known as bursitis may occur. Furthermore, a needle that is placed near or into the axillary nerve may cause tingling (paresthesia), numbness, and nerve irritation. Temporary deltoid paralysis may also develop, and this can lead to muscle weakness in the arm. In addition, placing the needle in any of these locations may cause an infection that could result in any of the following depending on the depth of needle penetration, the location of the infection, and the individual’s immune system status:

• Abscess (swollen, inflamed region containing pus)
• Cellulitis (inflammation of connective tissue)
• Septic arthritis (painful joint infection that originates in the bloodstream)
• Septic bursitis (inflammation of bursae due to an infection)
• Osteomyelitis (inflammation of bone or bone marrow due to an infection)

Finally, an abnormal inflammatory response to the serum delivered with the vaccine may cause pain and irritation, including bursitis of the subacromial bursa or myositis (weak, aching muscle tissue) of the deltoid. This side effect may develop due to a tissue injury or an allergic reaction to the vaccine or one of the components in the serum.

The most common cause of allergic reactions are proteins in the vaccination from gelatin and egg products. Other components that may induce an allergic response include latex, and yeast, which is commonly found in the human papillomavirus (HPV) vaccine. Furthermore, the COVID- 19 messenger ribonucleic acid (mRNA) vaccines from Moderna and Pfizer-BioNTech contain polyethylene glycol, which appears to cause an allergic reaction in some people. The Johnson and Johnson/Janssen COVID-19 vaccine contains another potential allergen called polysorbate.

Additionally, some people are more susceptible to side effects such as prolonged shoulder pain or other injuries following a vaccine due to their age. In particular, older individuals have an increased risk of experiencing a chronic rotator cuff injury that does not cause physical symptoms. This means that it is possible for an injury to be present prior to receiving a vaccination, and the injury may become symptomatic due to irritation or inflammation that the vaccination causes. A large percentage of adults over the age of 65 have a torn rotator cuff, which suggests that the chances of experiencing a serious side effect following a vaccination increases with age. Therefore, it is important to recognize and report abnormal symptoms. Overall, a doctor should be contacted right away if the following symptoms occur:

• Tenderness, redness, or swelling at the vaccination site that worsens after 24 hours
• Pain that becomes increasingly worse during the first 24 - 48 hours following the vaccine
• Side effects such as fever, numbness, or tingling that do not resolve after 2 - 3 days

If an injury occurs during a vaccination, an individual may immediately experience intense pain and difficulty moving the shoulder, but it may also take hours or days for the symptoms to develop. Severe shoulder pain that is left untreated after a vaccine can gradually lead to more
serious conditions and decreased range of motion in the affected shoulder. Debilitating pain that develops due to a vaccine needs to be treated promptly.

Management of Shoulder Pain Due to a Vaccine

Individuals who are experiencing persistent, debilitating shoulder pain following a vaccine may benefit from working with a physical therapist. This form of treatment aims at enhancing range of motion and, flexibility while decreasing , swelling, and stiffness in the shoulder region. A physical therapist tailors each therapeutic plan by first completing a thorough assessment of the injury, medical history, potential causes of the pain, and daily habits that may be worsening the symptoms.

As abnormal inflammatory responses and allergic reactions often contribute to chronic shoulder pain after a vaccination, the physical therapy regimen may focus on targeting inflammation. This may involve the use of joint stretches and manual massage techniques that help loosen stiff tissue to provide greater flexibility and reduce painful movements. A physical therapist will also incorporate methods that improve blood flow to inflamed tissue in the shoulder region, as this reduces inflammation and improves muscle function. If an errant vaccination technique caused a severe shoulder injury that requires surgical intervention, a doctor will usually recommend physical therapy following the surgery. Some people who receive physical therapy prior to surgery experience a more rapid recovery after surgical treatment due to the muscle conditioning benefits of this therapeutic approach. It is best to speak with a physical therapist if shoulder pain is making it hard to complete daily tasks or causing sleep disturbances.

Summary

An incorrect vaccination technique, an allergic reaction to a vaccine or serum, or a previous injury may cause a painful, inflammatory response in the shoulder following a vaccine. Chronic pain or tissue damage can lead to further injury without prompt treatment. Abnormal inflammation levels that may be present prior to receiving a vaccination also contribute to the progression of tissue irritation, which increases the risk of tissue damage and structural injuries (e.g., rotator cuff, bursa, nerves) due to an improper injection procedure.

Another issue that may occur is SIRVA, which is a rare but potentially devastating injury characterized by chronic shoulder pain that develops within about 48 hours of getting a vaccine. As over 150 million influenza vaccinations are administered in the US each year, and the CDC has established a goal of immunizing more than 70% of the US population against COVID-19, the cases of shoulder pain injuries due to vaccinations are expected to increase. However, individuals who seek treatment including physical therapy have a good chance of experiencing a full recovery.

If you’ve been struggling with shoulder pain ever since receiving a vaccine, the dedicated team at FYZICAL can discuss personalized treatment options that can help target your discomfort. Call FYZICAL today to speak with one of our highly trained physical therapists.

FYZICAL offers a wide variety of physical therapy services by qualified providers across the U.S. To find a FYZICAL Therapy & Balance Center near you, visit our website at FYZICAL.com. Our highly skilled therapy providers are 100% focused on your optimal health so you can Love Your Life®!

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