Needle to scalpel: Navigating the path from SIRVA to surgical intervention.

Source: PubMed, NCBI / U.S. National Library of Medicine

Shoulder injury related to vaccine administration (SIRVA) is a rare but potentially debilitating condition characterized by persistent shoulder pain and restricted movement that begins within 48 hours of vaccine administration into the deltoid region. Improper vaccine injection into the subacromial/subdeltoid region of the shoulder or glenohumeral joint can cause immune-mediated inflammatory response, adhesive capsulitis, rotator cuff tendonitis or tears, and septic subacromial bursitis or lytic lesions, among other injuries and reactions. The literature to date focuses on SIRVA prevention and early recognition, emphasizing proper vaccine administration techniques. With the aid of a formulated process that includes focused clinical history collection and thorough physical examination, clinicians can facilitate timely diagnosis and effective management of SIRVA, mitigating possible long-term complications. We present a case that illustrates the diagnostic challenge of SIRVA and highlights how affected patients may exhaust all nonoperative modalities, fail to find relief, and eventually require surgery. Literature is limited on surgical management of SIRVA; however, this case raises awareness of surgery as a management option in unusually refractory cases.