Clin Pain.  2022 Dec;21(2):100-108. 10.35827/cp.2022.21.2.100.

Shoulder Injury Related to Vaccine Administration (SIRVA) after COVID-19 Vaccinations: Clinical and Radiological Investigation in 8 Cases of Adhesive Capsulitis

• Paek CW
• Do JG

• KMID: 2537772
• DOI: http://doi.org/10.35827/cp.2022.21.2.100

Abstract

Objective
Recently, there are clinical reports of Shoulder Injury Related to Vaccine Administration (SIRVA) after COVID-19 vaccinations. Yet, radiological description and treatment response has not been delineated. The purpose of this study is to report clinical aspects of eight cases of SIRVA after COVID-19 vaccinations and to describe MRI characteristics in five of these patients. Method: We retrospectively identified and investigated eight patients who presented with shoulder pain and global range of motion limitation following COVID-19 vaccination between January 1 st , 2022 and March 31 st , 2022.
Results
The mean age of the eight patients (five women and three men) was 56. 0 ± 5.0 years (range, 48∼63 years). Symptoms of shoulder pain and stiffness began on the day of injection in four patients, within 24 hours in two patients, and more than three days in two patients. Initial shoulder range of motion was restricted in forward elevation, abduction, and internal rotation. Three patients who received glenohumeral intra-articular injection showed improvement of NRS scores and shoulder range of motion. Five patients’ MRI were featured with hyperintense axillary capsule, axillary capsular thickness thicker than 4 mm (6.1 ± 0.4 mm, range 5.7∼6.8 mm) and rotator interval fat obliteration.
Conclusion
Adhesive capsulitis after COVID-19 vaccine resembles idiopathic adhesive capsulitis both clinically and radiologically. Although the exact pathogenesis regarding adhesive capsulitis after COVID-19 vaccinations remains ambiguous, immune-mediated inflammatory reaction after vaccination can cause adhesive capsulitis. Appropriate anti-inflammatory treatment including intra-articular steroid injection is effective. Physicians should be mindful of this diagnosis so that such patients can be diagnosed promptly and treated properly.

Keyword

COVID-19; Vaccine; Adhesive capsulitis; Shoulder pain; Shoulder injury related to vaccine administration (SIRVA)