My own news is good this time—I am finally seeing some improvement! I hope the same feeling of pain relief visits all of you with a Shoulder Injury Related to Vaccine Administration (SIRVA). It is a bit early to claim victory, though; I’m not 100% pain free in the shoulder by a long shot, but the trend is better and better on a weekly basis.
October 13 marks my 10 month anniversary of the flu shot that gave me SIRVA and potentially a bone infection. Here is the back history:
- I wrote a post at 3 months after the flu shot to describe what had happened
- Between 4-6 months I considered surgery or nonsurgical treatment
- After 6 months with no significant improvement I opted for surgery
- An MRI taken a week before surgery showed the growth of bone damage since the shot
- A biopsy taken during surgery where the shot hit bone came back positive for infection, so I took an aggressive course of antibiotics
It’s hard to believe 3 months have passed since surgery, and over 1 month since the antibiotics ended. Since then, my range of motion has improved and I can do a few more things functionally without pain that used to bother me, like shampooing my hair. I’m taking baby steps towards returning to the one sport I truly love, rock climbing, by gently strengthening my arms and forearms and fingers and core as much as I can without going too far, too soon, with the overhead movements.
The timing of the feeling of improvement suggests to me that either the surgery was successful (irrigation, debridement, PRP, new blood flow to the area; all could be responsible) or the infection was a true positive and the antibiotics caused the bone damage to start repairing (and hopefully, eventually, reverse completely—but it takes time). I’ll never know for sure which it was. I’m going to make sure I get a 3rd MRI by about the 1 year mark, if they let me, to assess the appearance of the bone marrow edema.
The biggest takeaways I have from my experience so far is:
- Try to advocate for getting an MRI early and, if your pain hasn’t resolved, make sure they let you get another one later. The early one may be important to prove that the changes took place due to the shot, and weren’t pre-existing issues. Bone damage appears to be pretty common with SIRVA. My MRIs were at 1 and 6 months post-shot. At 1 month it barely showed up and the doctors didn’t catch it as a part of the problem. At 6 months it was obvious.
- With no improvement at 6 months it seemed like it was time to take more drastic steps. Surgery was the right decision for me. (…..or maybe I’d have had this improvement anyway with just more time and no intervention. Who knows! But with average time to recovery from SIRVA anecdotally being EITHER very fast—i.e. within the first 3 months—or very slow—1-2 years, it seems like if you’re not lucky enough to fall into the first group, you may as well try to accelerate things to avoid it taking years.) Surgery was also very painful, unpleasant, and there may be other reasons why it’s not the right choice for you in your situation, but it seems likely to have been the catalyzing factor in my improvement (for whichever reason).
- The medical literature on SIRVA does not mention bone infection. The effect of P. acnes infection in the body is currently controversial, and the rate of false positives is high. But bone infections from punctures and other shots are known to be possible. If you are already having surgery, and have bone damage on an MRI—I’m no orthopedic surgeon and I find they don’t take kindly to suggestions, but you might also ask about getting biopsies while they are in there, and including P. acnes in the biopsies as it is commonly found in the shoulder skin and sometimes takes up to 2+ weeks to culture, so they need to hold the samples at least that long. My surgeon biopsied the bone and 2 other places in the synovial tissue and only the bone sample came back positive.
I’ll repeat again a quote from a paper by Hexter et al., 2015, in the journal Shoulder and Elbow:
“The patient in our case only regained a pain-free and functional shoulder after [surgical] washout, arthrolysis, synovectomy and decompression of the subacromial space. We recommend invasive treatment, such as that described in our case, in patients with ongoing shoulder symptoms related to vaccination that do not settle with conservative measures.”
I’ve gotten a bunch of responses to the SIRVA Survey (THANK YOU!!) and will post some information soon about what you all have tried. However, most of the folks who’ve filled out the Sirvey have done so because they haven’t recovered yet and are still searching for solutions, so I still don’t have a sense of what else people have tried that has really worked. Please, please fill out the follow-up survey if you have filled out the first one already and have changes to report!
For those of you still struggling with lack of improvement, or even worsening symptoms (mine got worse at around the 3-month mark), I am really sorry. I hope that every story of improvement and recovery at least brings a little comfort that your SIRVA pain will eventually resolve. Other peoples’ stories have been helpful to me, so I am trying to add my own to the digital pile. Thanks for sharing your experiences with me, either through the Survey or by email.