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Needle to scalpel: Navigating the path from SIRVA to surgical intervention
Lori McGowan1, Danielle O'Laughlin, Brittany Strelow
1At Mayo Clinic in Rochester, MN, Lori McGowan is supervisor of advanced practice providers (APPs) in the Division of Orthopedic Surgery, APP education specialist for orthopedic surgery, supervisor of the integrated community specialties orthopedic and podiatry teams, and lead preceptor in orthopedics. She also serves on the Mayo Clinic NPPA Education Subcommittee for Rochester, Florida, and Arizona. Danielle O'Laughlin is an assistant professor, PA, and team lead of the primary care gynecology clinic in the Division of Community Internal Medicine, Geriatrics, and Palliative Care at Mayo Clinic. She also serves as co-director of clinical skills in the Mayo PA program and serves on the NPPA Research Committee. Brittany Strelow is an assistant professor of medicine in the Division of Community Internal Medicine, Geriatrics, and Palliative Care at Mayo Clinic. She also serves as adjunct faculty for Augsburg University, Butler University, and Northeastern University. The authors have disclosed no potential conflicts of interest, financial or otherwise.
Abstract:
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.
