Ultrasonic aspiration for vaccination-related shoulder dysfunction

Area of Science:

• Orthopedic Surgery
• Musculoskeletal Imaging
• Pain Management

Background:

• Chronic shoulder pain can occur rarely after vaccination, potentially due to injection into subacromial structures.
• This condition, termed shoulder injury related to vaccine administration (SIRVA), may involve rotator cuff, capsule, or bone.
• Factors like rotator cuff avascularity and genetic/environmental influences may contribute to persistent pain and dysfunction.

Observation:

• Five patients with chronic shoulder pain (8-42 months post-vaccination) were evaluated using ultrasonography and sonopalpation.
• Ultrasound-guided anesthetic injections identified the infraspinatus and teres minor tendons, their insertions, or adjacent bone as the pain source.
• Ultrasound-guided ultrasonic aspiration and debridement were performed using specialized equipment.

Findings:

• All five patients experienced pain originating from the distal infraspinatus and teres minor tendons, their insertions, or adjacent bone.
• The mean Quick Disabilities of the Arm, Shoulder and Hand (QDASH) score significantly improved from 65 to 11 at 2 weeks (P=0.001) and 1 at 4 weeks (P=0.003).
• Sustained improvements in pain and function were observed at one year in most patients, with one experiencing recurrence due to unrelated osteoarthritis.

Implications:

• The distal infraspinatus and teres minor tendons and adjacent bone are identified as common sources of post-vaccination chronic shoulder pain.
• Ultrasound-guided ultrasonic aspiration and debridement demonstrate potential efficacy in treating SIRVA.
• This minimally invasive approach offers a promising option for resolving pain and restoring function in patients with vaccination-related shoulder dysfunction.