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From page 253... ... 10 Shoulder Injuries and Vaccines INTRODUCTION The deltoid muscle is the preferred location for vaccination because of an apparent lower risk of subcutaneous injection, and the immunogenicity is higher compared to gluteal injections (Shaw et al., 1989) Read the entire page →
From page 254... ... 258 VACCINE EVIDENCE REVIEW The committee has reviewed evidence on the etiology of shoulder injuries following vaccination, considering three possible mechanisms of injury. The first encompasses direct trauma from improper placement within the arm, potentially due to deviations from the optimal injection technique. Read the entire page →
From page 255... ... SHOULDER CONDITIONS 259 SUBACROMIAL/SUBDELTOID BURSITIS Subacromial/subdeltoid bursitis is characterized by inflammation of the subacromial and subdeltoid bursae located in the shoulder. Bursae are small, fluid-filled sacs that serve as cushions and lubricating structures between bones (Figure 10-1) Read the entire page →
From page 256... ... 260 VACCINE EVIDENCE REVIEW FIGURE 10-1 Illustration of intramuscular injection techniques. Read the entire page →
From page 257... ... SHOULDER CONDITIONS 261 TABLE 10-1 Case Reports Regarding Subacromial/Subdeltoid Bursitis After Vaccination Symptom Onset of Duration Before Author Age Sex Vaccine(s) Symptoms Evaluation Imaging Cantarelli et al. Read the entire page →
From page 258... ... 262 VACCINE EVIDENCE REVIEW TABLE 10-1 Continued Symptom Onset of Duration Before Author Age Sex Vaccine(s) Symptoms Evaluation Imaging Wharton et al. Read the entire page →
From page 259... ... SHOULDER CONDITIONS 263 The prognosis is generally positive, with most experiencing a complete resolution of symptoms. However, the recovery time can vary considerably, from as little as 1 week to as long as over 6 months, underscoring the importance of individualized care and management. Read the entire page →
From page 260... ... 264 VACCINE EVIDENCE REVIEW ACUTE ROTATOR CUFF OR ACUTE BICEPS TENDINOPATHY Acute rotator cuff or biceps tendinopathy caused by direct injection into the tendon or tendon sheath is characterized by onset of pain within 24 hours and evidence of acute pathology (such as marked edema in the tendon) on imaging. Read the entire page →
From page 261... ... SHOULDER CONDITIONS 265 TABLE 10-2 Case Reports of Acute Rotator Cuff or Acute Biceps Tendinopathy After Vaccination Symptom Duration Onset of Before Author Age Sex Vaccine Symptoms Evaluation Imaging Findings Bansal et al. 59 F DTaP <24 hours 6 weeks MRI High-grade partial teres (2020) Read the entire page →
From page 262... ... 266 VACCINE EVIDENCE REVIEW TABLE 10-2 Continued Symptom Duration Onset of Before Author Age Sex Vaccine Symptoms Evaluation Imaging Findings Szari et al. 31 M Influenza Immediate 4 months MRI Partial cuff tear diffuse (2019) Read the entire page →
From page 263... ... SHOULDER CONDITIONS 267 From Evidence to Conclusion The committee's decision is derived from a body of evidence, as demonstrated in the case reports provided (Table 10-2) Read the entire page →
From page 264... ... 268 VACCINE EVIDENCE REVIEW CHRONIC ROTATOR CUFF DISEASE Chronic rotator cuff disease comprises a diverse range of injuries and pathological conditions, with its prevalence escalating in correlation with age. This encompassing term encapsulates chronic tendinosis as well as partial- and full-thickness tears of the rotator cuff, collectively delineating the multifaceted nature of the condition. Read the entire page →
From page 265... ... SHOULDER CONDITIONS 269 ADHESIVE CAPSULITIS Frozen shoulder, also known as "adhesive capsulitis," is a debilitating condition that affects 1–5 percent of the population (Kingston et al., 2018) Read the entire page →
From page 266... ... 270 VACCINE EVIDENCE REVIEW TABLE 10-3 Case Reports of Adhesive Capsulitis After Vaccination Onset of Symptom Duration Author Age Sex Vaccine(s) Symptoms Before Evaluation Imaging Findings Aldosary 52 F ChAdOx1-S 24 hours 8 months MRI Frozen shoulder (2022) Read the entire page →
From page 267... ... SHOULDER CONDITIONS 271 TABLE 10-3 Continued Onset of Symptom Duration Author Age Sex Vaccine(s) Symptoms Before Evaluation Imaging Findings Thompson 64 M Influenza 3 days >9 months MRI Frozen shoulder and 6 months after Ensrud injection (2020) Read the entire page →
From page 268... ... 272 VACCINE EVIDENCE REVIEW From Evidence to Conclusion The cause of frozen shoulder is still unclear, and diagnosis often comes at later stages, when a fibrotic process greatly limits motion and function. The clinical diagnosis is least clear early on, and a diagnosis months to years later makes establishing a cause and effect unlikely, given the many confounding factors over time. Read the entire page →
From page 269... ... SHOULDER CONDITIONS 273 SEPTIC ARTHRITIS Septic arthritis of the shoulder, also referred to as "infectious arthritis," is a rare but serious condition characterized by the invasion of the shoulder joint by infectious microorganisms, typically bacteria. A cross-sectional study involving 97 patients indicated that the primary source of infection is often hematogenous, meaning that the bacteria spread through the bloodstream and access the joint (Sweet et al., 2019) Read the entire page →
From page 270... ... 274 VACCINE EVIDENCE REVIEW From Evidence to Conclusion Evidence linking septic arthritis of the shoulder with vaccination is limited to two case studies. Conclusion 10-5: The evidence is inadequate to accept or reject a causal relationship between vaccine administration and septic arthritis. Read the entire page →
From page 271... ... SHOULDER CONDITIONS 275 BONE INJURY Bone injuries following vaccinations have been highlighted through numerous case reports, indicating a wide array of bone-related issues in adults. There are diverse symptoms that typically manifest within a few days after vaccination. Read the entire page →
From page 272... ... 276 VACCINE EVIDENCE REVIEW TABLE 10-5 Bone Injury After Vaccination Symptom Duration Onset of Before Author Age Sex Vaccine Symptoms Evaluation Imaging Finding Erickson et 51 F Influenza 1 day 10 months MRI at 2 months 10-month MRI showed al. Read the entire page →
From page 273... ... SHOULDER CONDITIONS 277 TABLE 10-5 Continued Symptom Duration Onset of Before Author Age Sex Vaccine Symptoms Evaluation Imaging Finding Shabhaz et al. 35 F Influenza Immediate 1 hour MRI 1 week, 6 1 week effusion (2019) Read the entire page →
From page 274... ... 278 VACCINE EVIDENCE REVIEW From Evidence to Conclusion The conclusion is derived from a body of evidence, as demonstrated in the case reports (Table 10-5) , which consistently feature imaging and symptom onset within a biologically significant time window (typically 0–72 hours after vaccination) Read the entire page →
From page 275... ... SHOULDER CONDITIONS 279 AXILLARY OR RADIAL NERVE INJURY The axillary nerve is a branch of the brachial plexus, a network of nerves in the shoulder and upper arm. It controls the deltoid, a major muscle involved in shoulder movement and stability. Read the entire page →
From page 276... ... 280 VACCINE EVIDENCE REVIEW TABLE 10-6 Case Reports of Axillary or Radial Nerve Injury After Vaccination Symptom Duration Onset of Before Author Cases Age Sex Vaccine Symptoms Evaluation Imaging Beredjikli 1 26 M Influenza 16 hours 1 day MRI edema an (2012) along radial nerve EMG neuropathy Blumstein 1 23 M Tetanus <1 day 7 hours NR and Kreithen (1966) Read the entire page →
From page 277... ... SHOULDER CONDITIONS 281 vaccination) Read the entire page →
From page 278... ... 282 VACCINE EVIDENCE REVIEW PARSONAGE-TURNER SYNDROME Parsonage-Turner syndrome (PTS) is a clinical syndrome classically typified by new onset of pain in the upper quarter followed by, within hours to days, paresis. Read the entire page →
From page 279... ... SHOULDER CONDITIONS 283 Evidence from Case Reports A syndrome is defined by a collection of clinical signs and symptoms where the pathophysiology and cause of a disease are poorly understood. PTS is no exception. Read the entire page →
From page 280... ... 284 VACCINE EVIDENCE REVIEW TABLE 10-7 Case Reports of Parsonage-Turner Syndrome After Vaccination Symptom Duration Onset of Before Author Age Sex Vaccine Symptoms Evaluation Imaging Findings Bernheimer and 42 F mRNA-1273 3 weeks 3 weeks + 1 day MRI Parsonage Gasbarro (2022) unremarkable Turner syndrome Chua et al. Read the entire page →
From page 281... ... SHOULDER CONDITIONS 285 TABLE 10-7 Continued Symptom Duration Onset of Before Author Age Sex Vaccine Symptoms Evaluation Imaging Findings Koh et al. Read the entire page →
From page 282... ... 286 VACCINE EVIDENCE REVIEW TABLE 10-7 Continued NOTES: BNT162b2 refers to the COVID-19 vaccine manufactured by Pfizer-BioNTech under the name Comirnaty®. Mrna-1273 refers to the COVID-19 vaccine manufactured by Moderna under the name Spikevax®. Read the entire page →
From page 283... ... SHOULDER CONDITIONS 287 From Evidence to Conclusion The committee identified descriptions of PTS after vaccination in 23 people. In several cases, the onset of symptoms was either not reported or months after several different kinds of vaccination. Read the entire page →
From page 284... ... 288 VACCINE EVIDENCE REVIEW COMPLEX REGIONAL PAIN SYNDROME (CRPS) Complex Regional Pain Syndrome (CRPS) Read the entire page →
From page 285... ... SHOULDER CONDITIONS 289 Mechanism of Injury The pathological etiology remains complex and multifactorial. Although a definitive cause has not been established, inflammation is considered a potential contributor. Read the entire page →
From page 286... ... 290 VACCINE EVIDENCE REVIEW descriptions in Table 10-9 include sufficiently long times between vaccination and onset of symptoms to cloud interpretation of the role vaccination might have played. Conclusion 10-9: The evidence is inadequate to accept or reject a causal relationship between vaccine administration and complex regional pain syndrome. Read the entire page →
From page 287... ... SHOULDER CONDITIONS 291 REFERENCES AAOS (American Academy of Orthopaedic Surgeons) Read the entire page →
From page 288... ... 292 VACCINE EVIDENCE REVIEW Cantarelli Rodrigues, T., P Read the entire page →
From page 289... ... SHOULDER CONDITIONS 293 Favero, M., F Schiavon, L Read the entire page →
From page 291... ... SHOULDER CONDITIONS 295 Leopold, S Read the entire page →
From page 292... ... 296 VACCINE EVIDENCE REVIEW pain syndrome in a retrospective cohort of persons aged 9–30 years, 2002–2017. Permanente Journal 27(2) Read the entire page →
From page 293... ... SHOULDER CONDITIONS 297 immune response to hepatitis B vaccination. Vaccine 7(5) Read the entire page →
From page 294... ... 298 VACCINE EVIDENCE REVIEW vaccine: a case report and review of the literature. Journal of Medical Case Reports 15(1) Read the entire page →

From page 253...

... 10 Shoulder Injuries and Vaccines INTRODUCTION The deltoid muscle is the preferred location for vaccination because of an apparent lower risk of subcutaneous injection, and the immunogenicity is higher compared to gluteal injections (Shaw et al., 1989)