SIRVA: Shoulder Injury Related to Vaccine Administration

Shoulder Injury Related to Vaccine Administration (SIRVA) is a prolonged episode of shoulder dysfunction that commences within 24 to 48 hours of a vaccine immunisation injection. Symptoms include a combination of shoulder pain, stiffness and weakness. There has been a recent rapid increase in reported cases of SIRVA within the literature, particularly in adults, and is likely related to the mass immunisation programmes associated with COVID-19 and influenza. The pathophysiology is not certain, but placement of the immunisation in the subdeltoid bursa or other pericapsular tissue has been suggested to result in an inflammatory capsular process. It has been hypothesised that this is associated with a vaccine injection site that is “too-high” and predisposes to the development of SIRVA. Nerve conduction studies are routinely normal, but further imaging can reveal deep-deltoid collections, rotator cuff tendinopathy and tears or subacromial subdeltoid bursitis. However, all of these are common findings within a general asymptomatic population. Medicolegal claims in the UK, based on an incorrect injection site, are unlikely to meet the legal threshold to determine liability.