What is SIRVA?

If you’ve landed on this website, maybe it’s because you went in for a vaccination, you were surprised to find yourself still in pain more than 3 days later, and you searched for information about why your shoulder still hurts. I did a lot of that in the days and weeks after my flu shot, when it became obvious that the usual soreness should have passed already. Then I learned about SIRVA.

There are a few articles about Shoulder Injury Related to Vaccine Administration (SIRVA) in newspapers and in peer-reviewed scientific journals. I have provided links to those on the Resources page, and will continue to update that page whenever new articles come out. This post is my summary of that information, after reading and poring over everything I could find. If there’s something medically incorrect here, please, correct me in the comments! I am not medically trained, although I am a scientist and can distinguish between reliable and unreliable sources of information.

Anyway, welcome to this website, and please leave a comment to say “hi” and tell me what you know about SIRVA. If you have SIRVA, please consider taking the SIRVA Survey! It’s private and anonymous. Only by gathering more information can we begin to understand this condition better, together.

What’s going on in my shoulder?

SIRVA is thought to be an immune response to the active agents in the vaccine, which results in inflammation, excess fluid where it doesn’t belong (bursitis), and potentially (in the worst cases) even more damaging effects to the tendons and bone. These features are often visible on MRI and ultrasound imaging, although bursitis and other tendon issues may have pre-existed before your vaccine but were previously not causing you any pain.

With the added inflammation and fluid often comes impingement, which is when certain things get pinched in the tight shoulder joint. Before your SIRVA started, you probably had just the right amount of space for all the bones, tendons, nerves, etc. in your shoulder joint. Now, the fluid and inflammation take up extra space and stuff starts rubbing wrong. It results in the sharp pain you’re feeling on certain movements. Frozen shoulder is also sometimes an associated side effect of SIRVA.

What causes SIRVA?

By this point in time, it SHOULD be well known in the medical community that injecting a vaccine too high on the shoulder will put it into the bursa space (subdeltoid or subacromial) or other part of the shoulder where it doesn’t belong. However, many people who are trained to give the shot are unaware of the dangers (50% in one study). SIRVA can be caused by any vaccine, but it is thought that having previously received at least one dose of the same vaccine increases the risk.

The difference between a properly administered shot (in the deltoid muscle) and improperly administered is that the muscle is highly “vascular” (good blood flow) and the vaccine is designed for that system. In your bursa, in your shoulder joint, it is far less vascular and the body isn’t prepared to deal with the highly “immunogenic” agents in the vaccine. So it fights it, but unlike your body fighting it safely in the muscle, it leads to the undesired symptoms and potential damage described above.

What can I do about it?

Because there are several ways SIRVA manifests in the body, there are multiple possible ways to approach treatment. I can’t tell you what will be effective in (a) reducing your pain or (b) hastening recovery to full shoulder health. I will tell you what I’ve tried, and if you fill out the SIRVA Survey, I will let you know what has worked for other people in future blog posts!

Anti-inflammatories: You might want to start these, if you haven’t already (UPDATE: I’m not sure THAT was good advice, I took them for months before hearing the opinion that they can potentially block the appropriate signals your body sends to injured areas. My primary care doctor and first orthopedist recommended them, but my current doctor doesn’t. Consult your doctor.) Because of the strong inflammation component of SIRVA, they are likely to help cut the pain (UPDATE: but maybe not promote healing). I chose Aleve (naproxen) over Advil (ibuprofen), because I’ve previously found it works better for me (I don’t know why).

Ice: A lot of people recommended icing for 20 minutes 3 times a day. As SIRVA drags on for a while, that becomes pretty difficult to do every day (for me anyway), but I try to apply ice after doing anything that aggravates the shoulder or causes pain. I don’t notice that it makes any difference.

Physical therapy: Frozen shoulder is a common outcome of SIRVA, so getting on top of PT soon is a good idea. It can also help a lot with some associated imbalances and tension that may occur from using your painful shoulder. I don’t know if it’s helpful by itself, given the biochemical nature of SIRVA, but it’s worth a try. Unfortunately, there is probably not one standard way a PT will approach SIRVA cases, with so little information out there. There are standard approaches for subacromial bursitis and for frozen shoulder.

Cortisone shot: You might be reluctant to get another shot when your whole problem was caused by a shot in the first place. I was. But some people find relief, or even complete recovery from SIRVA symptoms (!), from cortisone injections. I had high hopes for this and was disappointed to find absolutely no improvement in my case, and there are possible negative side effects of cortisone shots themselves. In consultation with your doctor, you should consider it, but be prepared (emotionally) for either outcome. I have heard it said that you should see an orthopedist for your cortisone shot and not your primary care doctor (to ensure accurate placement).  Some doctors will even do ultrasound-guided cortisone injection, but mine didn’t.

Rest: Unfortunately, this is the one everyone recommends: I have heard from multiple medical practitioners that you should avoid doing the motions that hurt or aggravate your symptoms. For me, that’s rock climbing, my absolute favorite thing on the planet to do, but for you it might be swimming, tennis, reaching for things, whatever. I wish I could do a controlled experiment where I kept rock climbing in one case and rested in another, and see if it makes a difference (since it is a chemical response), but I didn’t want to risk it.

Surgery: I ended up having surgery. I have a couple of posts discussing this difficult decision, here and here.

Here’s a random picture of me climbing, long before the SIRVA incident.

Running: One doctor theorized that running might help, since it involves pumping the arms (encourages fluid movement in the joint) without overhead motions. If it hurts, don’t do it, but if it doesn’t hurt, maybe it’s worth a try. I’m going to give a go, even though I don’t enjoy running very much.

What does the CDC have to say about SIRVA?

The Code of Federal Regulations (CFR), Title 42, Part 100, discusses recognized injuries from vaccines and the compensation that sufferers are eligible for. SIRVA is defined there as:

(10) Shoulder injury related to vaccine administration (SIRVA). SIRVA manifests as shoulder pain and limited range of motion occurring after the administration of a vaccine intended for intramuscular administration in the upper arm. These symptoms are thought to occur as a result of unintended injection of vaccine antigen or trauma from the needle into and around the underlying bursa of the shoulder resulting in an inflammatory reaction. SIRVA is caused by an injury to the musculoskeletal structures of the shoulder (e.g. tendons, ligaments, bursae, etc.). SIRVA is not a neurological injury and abnormalities on neurological examination or nerve conduction studies (NCS) and/or electromyographic (EMG) studies would not support SIRVA as a diagnosis (even if the condition causing the neurological abnormality is not known). A vaccine recipient shall be considered to have suffered SIRVA if such recipient manifests all of the following:

(i) No history of pain, inflammation or dysfunction of the affected shoulder prior to intramuscular vaccine administration that would explain the alleged signs, symptoms, examination findings, and/or diagnostic studies occurring after vaccine injection;

(ii) Pain occurs within the specified time-frame;

(iii) Pain and reduced range of motion are limited to the shoulder in which the intramuscular vaccine was administered; and

(iv) No other condition or abnormality is present that would explain the patient’s symptoms (e.g. NCS/EMG or clinical evidence of radiculopathy, brachial neuritis, mononeuropathies, or any other neuropathy).

The CDC is well aware of SIRVA (e.g., presentation pdf), but avoids mentioning it on its pages about possible vaccine complications (e.g., here). A lack of knowledge about the problem, even among health care providers, contributes to its ongoing recurrence. Please write the CDC, everyone, and encourage them to take further steps in promoting good practices for administration of vaccines.  If you have ideas about how else to get the word out, please let me know!

 

78 thoughts on “What is SIRVA?”

  1. thanks for creating this page. I am only 12 days in and it has been hell. It was a relief to get a confirmation that it was the vaccine, but now I wonder what the road to recovery entails. I will follow up with your surveys.

    1. Thanks Nicole. If I were you I’d keep hope up that your case will resolve quickly. Some folks get better in under 3 months. Please keep me posted!

    2. What a nightmare! M&M size complete rotator cuff tear, bursa fluid, muscle & tendon impingement and early degenerative bone disease of the AC joint. If the doctor would have said “agree to a couple vaccines and you might end up without a limb” my reply “no way”! Depressing when you ask doctors and nurses if they are familiar with SIRVA and every one of their replies “What’s SIRVA I do not have a clue”. When one is up sleepless nights one has a lot of time to surf the web and learn a lot. Got the bad jabs in 2017 – will never get another – no amount of money justifies the loss of your limb and the misery of a bad jab for life from a vaccine; my opinion for myself – yes I have filed a SIRVA claim – and everyone be smart when you get vaccinated and be safe my friends!

        1. Debbie, if you google for SIRVA you will find a lot of webpages of lawyers who specialize in the vaccine injury courts. For example,
          https://vaccinelaw.com/
          I would recommend trying to get in touch with a few of them to figure out who is responsive and who you like, then, if they agree to take your case, they will have you sign paperwork and they will file your claim for you. You need to have been injured for 6 months before a claim can be filed.

  2. I received the flu jab six weeks ago, and am still in considerable pain. Pain killers have no affect at all, I am getting little sleep, my GP has offered nothing that can immediately help, but will refer me to a physiotherapist.

    1. Jackie, sorry to hear that. I hope you find a good physiotherapist who comes up with a helpful treatment plan. An orthopedist referral would also be good for you to get from your GP, and an MRI. In my experience, without knowing exactly what inside your shoulder the shot hit (maybe possible but hard to tell based on your physical symptoms alone by a good PT), the PT may not be able to design an ideal program for you. They will have better resources at their disposal if you have even more information. GOOD LUCK!

  3. I had a flu shot in the middle of Oct. 2018 and am still experiencing pain in my left shoulder down to my elbow, my neck and a lump/knot popped up on my shoulder blade. Ice/heat/Aleve help for a little while but pain never goes away, even just sitting still at rest. I had NO pain prior to the flu shot. I am 63, on social security with no insurance. Had the flu shot at a local Walgreens Pharmacy. I do not know what to do now.

    1. Kathy, I know what you mean about the “knot” or lump in your shoulder blade. That’s been a constant companion for me too. I don’t think it’s directly related to the injury from the shot but is from tension/compensation of the other rotator cuff muscles as they try to protect the injured ones closer to the joint and injection itself. I am feeling it right now as I type this, too. I also find that it can be temporarily alleviated with Aleve and ice and heat and massage. I think maybe PT can address it as well. It is very, very annoying and often (for me) more persistently painful than the primary injury area (which hurts more with certain motions). UGH!!

      As far as your next steps I am afraid I don’t know much about health insurance while on social security and past a certain age but if you can’t afford to see an orthopedist and get an MRI and get good targeted physical therapy (which would be my recommendation), I would at least try to get one appointment with a really good PT to get some idea of stretches you can try.

      You should talk to a vaccine lawyer (lots of them come up when you google SIRVA) but I think they will tell you two things: 1. you have to be injured for 6 months before they’ll talk to you seriously about becoming a client, and 2. you should get the care you need (which takes $$$) and hope for reimbursement later, likely much later (1+ years IF your case goes well). #2 isn’t helpful if you don’t have the money right now of course. I am sorry.

      Finally (and this is poor consolation) you should know that those of us who are doing all those things that require good health insurance aren’t necessarily getting better any faster…I’m over a year out and still injured and that’s with a LOT of care (orthopedists, PTs, etc). No one really knows how to treat it best anyway, which is what I’m hoping this website and survey will help with eventually. That is a depressing way to wrap up this comment but sadly it is true: some SIRVA cases get better in fewer than 3 months without intervention (I hope that is you!!), some cases turn into frozen shoulder (PT can help avoid that), some cases have resulted in damaged structures that would improve better with surgery (e.g. rotator cuff or bursa), some people get relief from cortisone injections but not all, etc.

  4. It’s been about 1 yr for me but have not been diagnosed with sirva. Was told it’s shoulder impingement. Had steroid shot and saw a chiropractor. I had never heard of Sirva until our local tv station did a story on it. Have another appt w orthopedic doc Jan 14th.

      1. Hi. I had the flu jab 2 weeks ago. Have never had a reaction to it before. I’m 69 years of age but very fit. The next day I was in agony with my shoulder and could not take a tee shirt off without my wife’s help or wash my face as I had to lift and bend my arm. After a few days it eased considerably. The pain in the shoulder stayed though and never went fully. It’s now been 3 weeks and if I do certain actions it hurts a lot. An example is flicking the duvet cover off myself using my left shoulder. Raised positions hurt and sometimes hurt a LOT. I can, however, at the minute anyhow, hit a golf ball and ride a bike. It doesn’t actually hurt when I do these but not sure if it may aggravate it. Will check with my doctor now (it was the pharmacist who administered the jab though) and explain what has happened. I will pay privately for a scan to see what’s going on as my whole life revolves around being physically active. I need to get it evaluated as there is just no improvement. I am used to injuries and what my body feels like and because of the timing of this I’m convinced it’s something to do with the flu jab.

        1. Hi Roger, sorry about your case – some of the symptoms sound really familiar – like the duvet cover. Adjusting the blankets at night was very painful for me right away.

          I’m glad you’re still able to do some of your activities and I don’t have a good answer for the aggravate question. I kept active (running and biking) as much as I could, as well. (Had to stop rock climbing, though.) For nothing else, it makes the experience a little less miserable, if it takes a while to heal.

          Since you’re still early, there’s hope that your pain will resolve quickly. Some cases do resolve within a few months. Good luck and please keep us posted!

        2. Interesting. I just had mine on 10/21 and it was still bothering me (same symptoms as yours) a week and a half later so I messaged my doctor this week and was told ice and ibuprofen/aleve and let them know if it didn’t get better after a few days. Went to the doctor today (unfortunately, my normal primary isn’t in till mid month) so had to see someone else. I had found information about Sirva and when I mentioned it, they didn’t know what I was talking about. Wish my doctor would have been there, feel like she would have listened a little better. Anyway, gave me some exercises to try and said to contact in 4-6 weeks if I’m still having problems. I guess time will tell. I feel like it’s aggravated more after the appointment. Was told deltoid/rotator cuff.

  5. Hi Amy

    Thanks for this resource – it’s really informative and makes the best of a terrible situation.

    I’m 3 weeks in. Had 10 days of Arcoxia 90 mg. Worked like a miracle, then the original pain and discomfort came back swiftly after the last dose of Arcoxia.

    My diagnosis was bursitis with a frayed tendon based on MRI.

    The good news is that the MRI does not show a torn or ruptured tendon, but I don’t know whether the tendon damage will increase with time due to the inflammatory reaction (do you know?).

    Was quite concerned to read about the possibility of bone damage / edema.

    How often does this occur? I guess I don’t have this yet as the radiologist did not mention it in the report. What can I do to reduce the likelihood of it happening?

    Any other advice would be so much appreciated.

  6. Hi again Amy

    In addition to seeing an orthopedic doctor, have you or anyone you know of seen a rheumatologist?

    I actually think SIRVA straddles two medical specialties. Whilst the damage is physical, the cause is biochemical.

    The orthopedic doctor is great for the first, whilst rheumatologist would be much better for the second.

    An immune response which results in the body attacking itself is essentially what the rheumatologist does (and is what SIRVA is).

    The risk is that the orthopedic doctor focuses on physical healing, but is not accustomed to thinking about ways to stop the underlying cause (which is not physical). A wonderful knowledge of shoulder anatomy doesn’t really help to do for reasons mentioned.

    1. I didn’t see a rheumatologist but I think it is a great idea, especially if you live in an area where you can find a rheumatologist who is excellent and interested in problems that are maybe a bit on the edge of what they normally study (but as you say, potentially related by the sort of biochemical/physiological behavior). I wondered out loud to a couple of doctors whether the better way to think of it is “we need to dampen the immune response” to make the injury heal (i.e., get the body to stop attacking the antigens), or “we need to strengthen the immune response” to make it heal. I don’t know that I ever got an answer but a good rheumatologist might know more than the average doctor or orthopedist about that question. Please do try it out if you have the opportunity, and let me know what you learn!!!

      1. Hi Amy, I fully intend to see a rheumatologist.

        In my country, there are several. They are all fully booked and I was not able to get a slot today. But I have an appointment scheduled for next week.

        Part of the reason I thought about seeing a rheumatologist is because the orthopedic doctor (who has a shoulder sub-specialty) kept going on about wear and tear and was very afraid to commit to a view that it was SIRVA — even though we all knew it probably was this.

        He was certainly medically competent in my view. But I guess where financial incentives lie, his business depends much more on GP referrals than me. So I think that would create a disincentive to say or write something which I could use as a basis for a medical negligence claim against the GP. In fact he absolutely refued to put anything in writing. (GP stands for general practitioner, the equivalent of an “MD” in the USA).

        The radiologist on the other hand had no such financial incentives, and his written MRI report actually said that some of the injuries could have been caused by an inflammatory reaction due to vaccine.

  7. Hi Amy, assuming the MRI scan done 11 days after the vaccination only showed tendon fraying and no other damage, do you know if the inflammatory reaction will cause further, more serious, damage (e.g. rotator cuff and tendon tears) with time?

    Or is it generally the case that the damage is constant?

  8. Hi David, thanks for the comments. I’m not sure about the likelihood of the tendon damage worsening, but I’d definitely suggest advocating for getting an MRI again in a few months to monitor the situation (including both keeping an eye on the tendon and the possibility of bone marrow edema growing between now and then). I think bone edema is very common in SIRVA cases. Before starting the survey I crunched the numbers from the medical papers and it was about 30% of the reported cases that mentioned bone changes—but it may be a biased sample of course because perhaps only the “worse” cases make it into the literature.

    I don’t think the physiological mechanism that causes the bone damage from SIRVA is well understood. In the Salmon et al 2015 paper (linked on the Resources page) he lists 3 possible hypotheses for what causes the bone damage. He seems to lean towards this one: “The third hypothesis is a direct mechanism by injection of the vaccine to bone contact [10]. The local inflammatory reaction is responsible for erosion and edema of the upper outer of the humeral head.” I don’t think that provides any guidance for prevention of the slow growth of an edema in the humerus if it is going to happen, except maybe you should talk with your doctor about really stifling the inflammation. I thought I was going that route (sort of) with both steroid injections and ~2 months of large doses of NSAIDs but it certainly didn’t prevent it in my case.

    Based on what I’ve learned so far I’d guess that if you are still symptomatic in a couple of months the best course of action MAY be to have an excellent orthopedist go in and “scope” it out. Once in there they can do what they would typically do based on the severity of damage they observe, whether it’s a bursectomy or rotator cuff repair. Recovery from a bursectomy and debridement only of the rotator cuff should be relatively fast as far as surgeries go. But the thing to be hopeful about is that your symptoms will resolve in the 3-4 month timeframe which is also pretty common. GOOD LUCK!!

    1. Thanks Amy. I’m looking forward to the 3 -4 months to see if it will get better.

      The pain came back much worse after disappearing when I was on Arcoxia 90 mg. This made me wonder if the treatment was effective for the underlying cause in the first place.

      Is the surgery you refer to keyhole surgery?

      1. Yes, it would probably be arthroscopic surgery, at least mine was, nd the way my orthopedist phrased it is “we’ll just see when we get in there what the right course of action is”. He ended up only taking out a bit of the inflamed bursa (as opposed to the whole thing—my shot missed more of the bursa and hit at the teres minor attachment to the humeral head), debriding the frayed teres minor, and taking bone biopsy but otherwise not touching bone other than to observe that it was “soft” and yielded too easily under the awl.

        Yeah, interesting observation about the medication. I stayed on NSAIDs for about 2 months (440 mg sodium naproxen 2x/day) and certainly felt no better when I came off them, and my pain also got worse after that long before it got better. Also suggests it was not helping any part of the underlying cause as well.

  9. Hi Amy

    I thought further about the rheumatologist. I have a confirmed appointment in a few days’ time.

    I know for a fact that people with rheumatoid arthritis (RA) take immune system suppressants. See “Methotrexate” on Wikipedia, for example.

    Concetually, RA is similar to SIRVA — the immune system attacking the body.

    Of course, the causes and triggers are totally different. But the mechanism of destruction of body parts seems very similar (once triggered).

    If the treatment for RA is to suppress the immune system, logic suggests SIRVA should be treated in the same way. Or rather, I cannot think of a logical reason why it would be treated in the opposite way — i.e. boosting the immune repsonse.

    What do you think?

    I feel the orthopedic doctor did not carefully apply his mind to the immune system as the trigger for this reaction.

    I’ll keep you posted.

    1. I thought about this a lot too when I was considering stem cell injections, which are essentially boosting the immune response, by providing the raw materials for immune system activity directly to the site of injury. The way I thought of it is: If there is a battle going on in your shoulder between your immune system and the antigenic agents in the vaccine, and your healthy tissue is the collateral damage, then is it better to avoid collateral damage by (a) making your immune system walk away from the battle altogether (i.e. suppress it) or (b) boosting your immune system to go ahead and win the battle faster and get back to healing?

      Here is how I posed that question to a doctor by email: “My biggest question is whether you think there is any risk that a BMAC+PRP [stem cells] injection could increase the body’s immune attack on its own cells, i.e., if there is any chance it could inadvertently make things worse. If SIRVA is the immune system mobilizing to fight the antigenic agents of the vaccine, and its cause is inflammation/collateral damage of healthy cells while the immune system fights the antigenic invaders, then is there any chance (based on what mechanisms are thought to be active in PRP and/or BMAC) that this process could be “helped” by the injection and it might make things worse? Would it make a difference if we knew whether there was any remaining antigen in the originally-affected tissue or if the continued, long-term pain is at this point a residual of the earlier immune system battle?”

      The doctor didn’t give an answer directly at that time; he wrote: “These are good questions. I don’t know the answer. I got an email today relating to MSCs (mesenchymal stem cells, the ones we get from bone marrow) being involved in a positive way with regard to infections and the immune response. I’ll dig up the article and send it to you. Arnold Caplan, PhD, of Case Western Reserve University, is the MSC expert and talks about the MSCs protecting structures from an overactive immune system. I’ll email him and see what he says.”

      I didn’t hear back from the doctor about his conversations with Dr. Caplan but we spoke in person and my recollection is that he said that he believed stem cells could cause a flare in pain followed by dramatic improvement. But he didn’t know for sure, and while he wanted to do whatever I thought was best to get better, he also was interested (from an experimental standpoint) in trying out the stem cells on SIRVA.

      I found this quote: ” In autoimmune diseases persistent antigenic stimulation recruits endogenous MSC to the site of lesion that contribute to the fibrotic evolution. Therefore, administering MSC to a chronic inflammatory disorder may not be desirable.” I sent it to the doctor and he responded: “Your situation is not like autoimmune disease. In autoimmune disease, the antigens are always present and present everywhere, whereas in what you have the antigens were in just one place and we think are in decline if not absent as you suggested. The safest and simplest thing to do would be another “wash-out” if you think that helped you before.”

      Even though I agree with you that the logic suggests suppressing the immune system and that rheumatologists are the experts at that, I find what seems like conflicting information in the literature but I’m sure that’s an artifact of my not totally understanding what people are talking about. E.g., “Most surprisingly, use of MSCs for in immune-/inflammation-mediated diseases appears to yield more efficacy than for regenerative medicine” (https://jbiomedsci.biomedcentral.com/articles/10.1186/s12929-016-0289-5).

      Yes, please keep me posted about what the rheumatologist says and about anything else you learn along the way!!!

      1. Hi Amy, thanks for the detailed information on stem cells.

        Regretfully, it sounds pretty speculative and, on balance, I wouldn’t feel confident doing it based on the present information.

        I can understand why you opted for surgery instead.

        Just curious, won’t the immune reaction come back again after surgery? If not, why not?

        1. Your last question definitely stretches the limits of my understanding about how it all works, but I think there are a couple of ways surgery helps. So if the antigenic agents from the vaccine are already gone/dealt with a couple months out, what you’re left with is the pain from that collateral tissue damage, i.e., the frayed tendon and/or bursitis and/or bone marrow edema. In the case of a bursectomy, removing the inflamed bursa appears to relieve the symptoms. When the bursa “grows back” it is healthy.

          There are papers about how long, exactly, the antigens from flu shots are retained in the system. There is one interesting old paper where they found that collagen-rich tissue (as opposed to the muscle where the shot is supposed to go) is especially “retentive” of flu vaccine agents, i.e., they stick around longer than when in the muscle, but this was a lab study on rabbits (Cooke et al. 1972): “The retained intraarticular antigen was eliminated very slowly, with a half-life of over 20 days. These data indicate that the chronic synovial inflammatory response is associated with a chronic local immune response in which prolonged active synthesis of immunoglobulin and specific antibody directed against the locally retained inducing antigen takes place.”

          A study was actually done in humans and published in 1990 (Trollmo et al 1990). They talk about systemic response to flu shot injection either intraarticularly or subcutaneously (they don’t compare intramuscularly). They write: “There are at least two possible explanations for the observed inerease of antibody response In serum after intra-articular compared with systemic immunization. A unique feature of the
          joint tissue is long-term antigen retention in avascular and hypovascular collagen-rich areas (Cooke et al., 1972; Hollister
          & Mannik. 1974). This phenomenon is probably due to the
          eleclrostatic interaction between the antigen and the cartilage
          (van den Berg et al.. 1986). The retention of high amounts of
          antigen may facilitate the uptake and presentation process by
          antigen-presenting cells. Also, the Arthus-like reaction observed in all the subjects shortly after the intra-articular immunization might have contributed to the enhancement of systemic antibody response by increase of vascular permeability in synovial tissue leading to influx of T-lymphocytes into the joint space. The antigen-presenting cells residing in the synovial tissue would, by the interaction with these T cells, give rise to an efficient immune response in situ.” This would probably be a good paper to show a rheumatologist. (https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1365-2249.1990.tb05458.x)

          1. Thanks for the paper, Amy. I’ll show it to my rheumatologist.

            These are the two questions I’ve framed for him to answer.

            What can we do to:

            (a) calm the immune reaction going on now (not just mask the pain), to prevent further damage to tissue and bone;

            (b) reduce the retention period of antigens by tissue in the joint space (i.e. expel the antigens faster)?

  10. I just realised that one of the co-authors of the AFP article (“Don’t Aim Too High”), Dr Sally Ayoub, is a rheumatologist.

    So it does seem that seeing a rheumatologist might be appropriate, even though there are no reports of one actually being consulted for SIRVA.

    1. Nice!! Yes, I totally agree that it is a good idea and very appropriate. I hope you end up with a good one and get some good insights and ideas for treatment. Could even be a breakthrough if RA-type strategies have not been tried on SIRVA yet (I haven’t seen any indications of it in the literature). But my only concern is that it sounds like the immune suppressing drugs used to treat serious autoimmune disorders can have major downsides/side effects, which are a fair tradeoff for people with chronic illness but maybe not worth risking for an acute problem. BUT, I know very little about this, and the rheumatologist would all about drugs or treatments that have less risks!! Good luck!!!

      Amy

      1. Actually, according to WebMD, a steroid injection IS a form of suppressing the immune system:

        “Steroids work by decreasing inflammation and reducing the activity of the immune system. ”

        https://www.webmd.com/arthritis/steroid-injections#1

        Based on your research, do you think a high proportion of people had success with the steroid injection?

        I am quite concerned as my condition has deteriorated so rapidly since I stopped Arcoxia. This morning I could raise my hand 90 degrees, by evening it was just 30 degrees.

        1. I saw Dr. Bodor, who wrote an article in 2007 about his good success rate (in 2 patients) with multiple targeted steroid injections (https://www.ncbi.nlm.nih.gov/pubmed/17064824). When I saw him in 2018 he says he would not recommend the same thing he did back then. I don’t want to put words into his mouth but I wonder if it has something to do with what I said in an earlier comment about tendon damage from steroid injections—my other ortho said that steroid injections to the bursa are considered safer than targeting the tendons, even though once you inject the steroid moves around for sure. I may be misrepresenting all of this.

          In the survey, some respondents have tried cortisone injections. Of them, 6 report “extremely helpful”, 9 report “slightly helpful”, 4 report “not at all helpful or harmful”, and 1 reported “harmful/made symptoms worse”. Of course this doesn’t get at the question of whether it’s just pain relief or meaningful improvement. Your finding in webMD suggests a mechanism for it to be actually meaningful.

          Thanks for having me look deeper into the Survey responses specific to steroid injections. That gives me an idea to do a full post on specific treatment concepts, like steroid injection, with more survey results. There are also written comments about steroid injections, too many to go into here, but I can summarize them in a post. But they include, “I’ve had two cortisone injections, one on Nov 30 by my primary, one on Feb 14 by the orthopedist. Neither worked, although the one given by the orthopedist helped with pain for a week or so”. Etc.

          1. Thanks so much for digging up your survey results, I appreciate it Amy.

            Would it be fair then to say that based on the evidence you have seen, keyhole surgery appears to have a higher success rate the steroid injection?

  11. I also wonder if I did the MRI scan too early (9 days after vaccination) such that the orthopedic doctor’s conclusion was a false negative.

    He said it was good news that that only bursitis was present (and he would rate this a 3 or 4 out of 10, relative to all other cases of bursitis), and there was only tendon fraying, but no rupture.

    In your case, and many others in the literature, the MRI scan was done later than T+9 days. In that sense, the progression of time allowed more stuff to be destroyed.

    I’m concerned that doctors would look at the MRI scan and take a conservative view. But in reality, things have gotten worse inside my shoulder since the MRI scan (the level of pain has certainly increased), which is now almost 2 weeks ago.

    Hence the treatment recommended might not be the most appropriate in the circumstances due to inaccurately identifying all injured parts of the shoulder.

    1. Yeah, in my 1 month MRI (technically: 1 month and 4 days) there was also a moderate bursitis signal, nothing extreme, although my orthopedist called it “significant”. We proceeded to treat as if bursitis, including the steroid injection, and PT that focused on bursitis/impingement. Later (4 months in) when I saw Dr. Bodor with the diagnostic ultrasound and he identified the teres minor as the site of the damage, my PT shifted to supporting/helping the teres minor and I believe that shift in PT was helpful—and it would not have happened without identifying the real site accurately. (My PT said to me after we found out, “I suspected that bursitis was not really consistent with your symptoms, but wasn’t going to question the doctor’s diagnosis”). By the time I got the second MRI at 6 months the bursitis signal had basically disappeared, and in surgery at 6.5 months the surgeon found the bursa hardly inflamed.

      No one really mentioned the teres minor fraying in either of the MRI reports in my case (which is why when Dr. Bodor found it on ultrasound it was very surprising to me). The surgeon saw it when he was in there.

      Anyway, yeah, I agree with your last sentence, but if frequent MRIs are off the table (maybe you can convince your docs for more!), maybe try seeking out someone skilled in diagnostic ultrasound? Apparently not every ortho with an ultrasound is good at interpreting it, so you would want to find someone good. Even though MRI is the gold standard for seeing SIRVA-related damage, the ultrasound was a very helpful key in my case.

      Best,
      Amy

  12. Thanks Amy. My MRI report said:

    “moderate oedema with bursal sided surface fraying involving the left infraspinatus tendon. This is located at the region behind the humeral head. This is centred towards the interior half of the Infraspinatus tendon. There is surrounding overlying oedema. If there is recent injection at this site, this can represent post injection inflammation or reactive change. No loculated fluid collections are seen. Remnant fibres are still seen inserted at the infraspinatus footprint”.

    My doctor’s diagnosis was “left shoulder bursitis and rotator cuff tendinosis”.

    I am probably going to start seeing another doctor because this doctor was not keen to commit to the reality that this was in fact SIRVA. He spent a lot of time going on about wear and tear, and how bursitis is a result of the frayed tendon (in non-SIRVA cases, tendon damage leads to bursitis, not the other way round).

    So I’m concerned of ending up in a situation similar to yours — i.e. bursitis being an inaccurate diagnosis and failing to treat the more serious damage.

    Thanks for making me aware of that possibility.

  13. Hi Amy

    I saw the rheumatologist. He didn’t say much. But as promised, here’s the report below.

    Inflammation will take 6 weeks to settle. There is nothing you can do to speed this up. This 6 week figure is based on injection of some other kind of oil into joints (was not able to understand this part clearly) — not a vaccine.

    Whilst on Arcoxia, the pain reduction was due to control of inflammation, not merely the masking of pain. If it were really just the masking of pain, then taking lots of panadol or ibuprofen would have done the job (but it did not).

    You cannot let the pain go untreated otherwise the surrounding muscles will become stiff. Your body’s protective mechanism will kick in. This is why you need to take Arcoxia for as long as you experience the pain. Concurrently, do PT.

    Taking Arcoxia helps to calm the immune reaction going on in the shoulder (by reducing inflammation). This is not an autoimmune disorder (I think by that, he meant there is no need to take an immune suppressant).

  14. [continued]

    It is possible that the inflammation alone caused the frayed tendon (as opposed to wear and tear before the vaccination), but this is hard to know for sure.

    In a small proportion of the population, a vaccine can trigger rheumatoid arthritis even if administered to the right location. The fact that it was administered to the wrong location here does not increase that risk.

    Whilst on Arcoxia, it should not damage your shoulder if you do movements which would otherwise be painful without Arcoxia, as long as not lifting heavy weights.

    Did blood test for some inflammation markers.

    Prescribed Arcoxia 90 mg for next 2 weeks, plus Norgesic.

    David

  15. Consulted today with an orthopedic surgeon who’s supposed to be one of the best in my country.

    • He has never seen a case of SIRVA and was quick to say this was his honest view. He was sceptical at first. Said any condition can be found if you look hard enough in the medical journals but was quick to clarify that he was “not trying to protect the GP”.

    • He said a more major concern would be nerve damage because the vaccination was injected at the wrong place. He confirmed I did not have this. He has seen cases of this before. You will feel weakness and numbness if this is the case.

    1. I think your orthopedist’s comment about “you can find anything if you look hard enough” may well be true, but the number of papers about SIRVA in the literature is surging, not the other way around (e.g., the famous case where a paper claiming a causal link between vaccines and autism had to be retracted for the medical journal: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831678/). Here in the U.S., I find the paper by Dr. Atanasoff useful to show first because she works for the U.S. Department of Health and wrote this paper collecting 13 cases—i.e., the U.S. government health services doesn’t deny SIRVA’s existence at all, they way they deny a link between vaccines and autism. But I’m sorry the “show the docs some papers” approach had limited success in your case.

      The skeptical ortho I saw (#3 in my post about Talking to Doctors about SIRVA) also was at first telling me it was nerve damage. That is a well known complication, I believe, from injecting too LOW, as opposed to too high. Most givers of vaccines, doctors, and orthopedists are aware of this complication—much more aware than of the damage that can be caused by shooting too high.

    2. I have been following this conversation closely. My orthopedist does not believe in SIRVA and so he wanted to inject a corticosteroid without any imaging first. To me, this sounds traumatizing and terrifying. It also sounds like a great recipe for my worker’s comp claim to continue to be denied because now they can claim the steroid injection caused damage if I get an MRI later on with a different provider.

      At a standstill, I’ve been looking into other options while I go to PT twice a week. I am going to ask my GP for a referral to a rheumatologist, if for no other reason than to keep proving I’m in treatment to the worker’s comp people and to see if I can get an order for Arcoxia.

      Today I sent my ortho a 4th SIRVA article, this one from a radiology journal. I don’t know if he’s just sick of my emails but he finally ordered an MRI. HURRAY! I agreed to get a steroid shot after the results are read. I wish I’d be in better shape for Christmas, but at least things are progressing.

      This site makes it a bit less lonely.

      1. Hi there,
        I think your reasoning about waiting for the MRI to try a steroid injection is sound. A very recent paper (not even yet added to the resources page) talks about giving two SIRVA patients a steroid injection within 5 days of getting their misplaced shot, with good outcomes, but for most of us we haven’t seen a competent qualified orthopedist within 5 days of our injury, so that’s out of the question:
        https://academic.oup.com/milmed/advance-article/doi/10.1093/milmed/usz269/5588762

        In terms of the responses from people on this site, steroid injections at a later date seem to be helpful in fewer than half of everyone.

        I’m glad you’re finally getting an MRI from your orthopedist. I think David’s idea about seeing a rheumatologist is a very good one too, and I hope you have some luck and it turns out to be helpful—-please report back with what you learn!!

        Best,
        Amy

  16. Hello,
    Thank you for all the work going into this website. I am waiting for my second PT appointment about two months out from a tetanus shot to the right shoulder. The pain has not stopped even after two months. Also, I have reduced range of motion. MRI at five weeks shows partial tear of teres minor tendon.

    1. Mikael, sorry to hear you’ve gotten a SIRVA injury too. Sounds like maybe we got the shot in approximately the same incorrect place, with damage to the teres minor tendon. Please keep me posted on how things progress for you!

  17. I am a 72 year old white male who was in awesome shape. I received a flu shot in my left shoulder bursa on Sept 17,2018 at Walgreen’s and still have pain, dead arm ect. I’ve done Physical Therapy, x-rays with an Orthopedic Surgeon and an MRI.
    The problem in Tucson, Az is that the good medical professionals are unfamiliar with SIRVA. Luckily my Doctor and his PA are working with me to find a resolution for the SIRVA damage. I’ll forward this website to them as I have other information concerning SIRVA. I have retained a lawyer to represent me that specializes in SIRVA claims.
    He told me the steps my doctors would put me through while searching for a resolution to the damage in my shoulder and was correct.
    I would suggest retaining a lawyer to recover out of pocket expenses.
    This too shall pass.

  18. THANK YOU for this website! I got my flu shot on September 27, 2018 and still dealing with it. To make a VERY long story short, my MRI (end of Nov) shows bursitis, infraspinatis tendinopathy, narrowing of acromiohumeral interval, edema, etc. But no tear, so that’s good! I’ve done PT, two rounds of oral steroids and one cortisone shot. My ortho doc (who has been WONDERFUL) talked with a rheumatologist, and it’s recommended I see him. I guess there’s a battery of tests they can do to find out what medication would work best for me. Hopefully, we can figure it out!

    1. Thanks Jen for sharing your experience!! Some other folks have also wondered about seeing a rheumatologist and whether that would help—I hope it does and you can report back what you find out. Can you tell me (by comment on the Doctor Finder page or just by email to me) who is your wonderful ortho? It would be amazing to fill in more points on the map so others can luck into the right doc on the first try!! Thanks!!! Please let us know how the rheumatology visit goes if you follow up with that.
      Amy

      1. Hi Jen, thanks for asking; I’m struggling a bit with a relapse, haven’t posted about it yet because I’m still waiting to see how my shoulder recovers.

        How are is your shoulder doing and how did your visit with the rheumatologist go? If you have some doctor recommendations, please let me know so I can add ’em to the Doctor Finder page!
        Best,
        Amy

  19. I just had two injections ( flu and shingles vaccine) in my left arm two days ago. The first injection was the shingles vaccine and I immediately felt a sensation in my entire left arm that can best be described as a short burst of electricity. I mentioned it to the administrator right then and asked if it was possible they hit my nerve. They stated that it was not likely and proceeded with the second injection. There was no sensation with the second injection. I proceeded with my day expecting a mild stiffness in my left shoulder and was shocked to discover about 5 hours later that I was basically unable to move my arm without intense pain that has now lasted for 48 hours. I have now booked an immediate appointment with my doctor to diagnose the problem and hopefully reverse and joint or nerve damage.

  20. It’s too early for me to be officially diagnosed with SIRVA but my ortho doctor said the pneumonia shot I received at a local pharmacy by a pharmacist was likely injected into the bursa. He’s thinking she didn’t hit the nerve, but cannot be 100% sure at this point. Although he says he’s seen several people who’ve had shoulder injuries from vaccines, he didn’t respond as though he knew what SIRVA was when I mentioned it.

    The shot was immediately painful and within 7 hours I could not lift my arm and the pain was/is excruciating. I am about to start a dose pack of medrol in hopes we can get ahead of the inflammation process. I have already had two frozen shoulders over 10 years ago, so my doctor feels that will not happen again at least. He said if the nerve was hit, there’s a remote possibility I could have encapsulation occur again. After having experienced that, I pray this does not happen.

    It’s beyond ridiculous that the public at large has not be made more aware of this problem or that it’s a possibility. I had never heard of this before, nor that the possibility existed from having an improperly place injection. I asked another pharmacist if she was aware of it and she said it happens more often than we realize. It’s now my opinion that pharmacists are not the correct healthcare providers to give an injection. I’m beyond devastated that I walked into a local Walgreens perfectly healthy and left with a damaged shoulder/arm.

    My doctor says I should feel better in a week, if not to make a follow up appointment. I will come back in a month to take the survey on this site.

  21. Looks like I have this, too.

    Just under two weeks ago I was in to see my GP for another matter. While I was there, I asked for the flu shot. I have a tattoo on my left shoulder, and I usually ask the person administering a vaccine to miss it. The nurse said, “sure, I’ll just go a little higher”. That has never been a problem in the past. I was seated; she was standing.

    The vaccine (not the needle) going into my arm hurt like… something else. I’d never felt anything like it before. The pain began near the site where the needle was depositing the fluid and spread down my upper arm. It continued to hurt for several days, then seemed to be starting to improve. At about day 10 it got bad again. That brings us up to the present.

    I have difficulty raising my arm. Crossing my left arm over my body hurts too. The pain is at its worst at night. I feel it from my shoulder down to the bottom of my deltoid. That bit at the bottom of the muscle makes me wonder if there’s nerve involvement.

    I enjoy lifting weights, and continued that a bit after the injury. A few days ago, I was unable to do even a warm-up set of bench presses. I’m gathering that “walking it off” might not be a good idea, so I should probably lay off upper body work until I see what’s going on.

    Googling “flu shot pain weeks later” brought me to a Washington Post article, which gave me “SIRVA” as a further search term. That got me here and to a bunch of articles in the medical literature.

    I’ll go see my doctor this week. It’s a teaching practice, so I expect they will be receptive to diagnosing this properly. (Plus I’m in Canada, so there’s less fear of lawsuits.)

    Thanks for the site, Amy!

    1. Hey there, sounds pretty similar to me. I also had pain during the shot that was intense. I remember leaving thinking, “I guess some people are not as good at giving shots as other people,” since it hurt so bad! Like you, for a few days the pain was really bad, then it got a bit better before getting worse again. I’m sorry you’re going through this and I hope your case does not end up being severe. Best of luck and please keep me posted on what you learn from the doctor.

      1. Just noticed that one of the articles listed on the Resources page is from the pharmacy school at the university my doc’s practice is affiliated with. So even more reason to think they’ll take me seriously.

        Thanks for the kind wishes, Amy. I’ll keep you posted. And I’ll fill out the survey after I’m a little further along in the process.

    2. Same for me. The pain was immediate down to my elbow. Coming up on 2 months now. I’ve been through 2 Prednisone packs which help while I’m on it but it comes back 48 hours later. Not sure what the next step will be. At least my doctor is on top of it and it is well documented that it’s all connected to the moment of the vaccine. So frustrating.

      1. Hi! How long were your prednisone doses? I did a burst of 5 days, and then another burst of 5 days a week later.
        It helped when on it, but like yours, came back as soon as it was done.

        Then I was on a ten day taper and the pain has come back but not as badly as before I went on it the third time. This result lasted a full week before getting back to bad again.

        Unfortunately for me it’s my lung doctor prescribing the steroids for my asthma… my ortho doesn’t really understand SIRVA.

        Maybe your doctor would consider a longer course… depending on when your injury was it could help decrease the inflammation in a more longterm way?

  22. My parmacy gave me a polio booster injection and within a few days my shoulder has been very painful. Over the last few months I have had physio and several cortisone injections but my shoulder is still painful and basically frozen. I would like for the pharmacy to take some responsibility in all this. What did you do?

    1. Hi Andrew, sorry for the delay in responding. If you’re in the U.S., the pharmacy has no liability and you should consider looking into this:
      https://www.hrsa.gov/vaccine-compensation/index.html

      If you speak to a vaccine injury lawyer you’ll learn that you do have to have symptoms for 6 months or more to be considered for compensation. The system is pretty screwed up if you ask me, for a lot of reasons (mainly because it does nothing to incentivize the pharmacy where you got the shot to do better, because they’re not liable).

      But I would consider going back and talking to them, bringing some papers on SIRVA if you can (there are some good ones about proper injection technique for providers on the resources page, scroll down to the bottom):
      http://sirvasurvey.org/resources/

      They may not take responsibility but they should KNOW what they’re doing wrong!! Potentially, severe injuries on other people could be avoided in the future if you go back and tell them what has happened to you, and remind them to teach their people to not aim too high!!

      There are a few papers on the Resources page that deal with frozen shoulder due to SIRVA, which has a specific diagnosis. I hope you can find a good orthopedic doctor in your area who is familiar with SIRVA (about half of them are and the other half might be dismissive). Check out my advice for a first appointment with your doctor, urgent care, or orthopedist:
      http://sirvasurvey.org/talking-to-doctors-about-sirva/

      Best of luck,
      Amy

  23. I’ve been experiencing this in Canada. The Canadian health care is pathetic and doesn’t care about anyone. I can’t lift my left hand or so anything. I played sports and was so athletic before my flu shot. This is so pathetic that no one takes responsibility for this. I can’t lift my left hand anymore. I’ve lost everything I’ve enjoyed about life. I wish a million times over I didn’t get my vaccine. I hope someone reads this and doesn’t get a “routine” vaccine. Sirva is a million times worse than a flu you may get. I’m so depressed now

  24. I’m suffering from these symptoms. I’m a 22 year old female. I don’t know who to turn to as this point. I’m in pain all the time.

    1. I didn’t have that particular pattern; for me I noticed the most pain while trying to type at work, or going for jogs/walking/anything that moved my arm. But it did hurt at night too and affected my sleep as well.

  25. I had an MMR vaccine in May 2019. I didn’t notice at the time any unusual discomfort. I didn’t think anything of it, but around that time I noticed pain in my shoulder. I started physio thinking it was work related (I’m a dental hygienist) sometime in January be and did that until February with no changes. I had IMS and was given exercises. I’ve also done chiropractic care every 3 weeks which I’m still continuing for this as well as maintenance due to my career. I asked my doctor if SIRVA was a possibility and she said no. She did however send me for an ultrasound. I was scheduled to have my ultrasound on April 3rd but they called me today and cancelled due to COVID-19 and have no idea when they will be able to re-schedule. I also had a massage cancelled today as well! I don’t even know if I have SIRVA, but it’s the only thing that makes sense and I feel very alone as no one has ever heard of it…I came across it while googling “can an mmr vaccine hurt months later” 😢. I’m so frustrated and don’t know what to try next…especially with everything shutting down due to this virus.

  26. I received my vaccination the end of October 2019. I had the usual “feels like someone punched me in the arm” pain for a week or so. Then the pain never went away. It got progressively worse. Dr wanted to rule out heart—so spent $2000+ on nuclear stress test, cat scan, rays etc. went to a nerve dr and he did an nerve induction. More $$$. I had an MRI which showed bursitis. I googled bursitis and vaccine and that is where i learned about SIRVA. I told my physical therapist who informed my dr. I went to an orthopedist yesterday and got a cortisone shot (hurt so bad) and he confirmed it was bursitis—SIRVA. He said it could take a year or more to heal. I’m so frustrated and in pain. I never had any shoulder problems before all this….

  27. My mother just got back from getting her shingles vaccine a few hours ago and her she is experience sharp pain in her upper right shoulder. She has significant reduced mobility in her arm.
    She hadn’t been diagnosed yet but we are now waiting for her doctor’s office to call back.

    1. Hi Sophie! It is understandable to be very worried about the possibility of SIRVA with sharp pain and reduced mobility right after a shot, especially if it appears that the shot was too high on the arm. Most of us recognized when we got SIRVA that the shot itself was more painful than usual. I hope very much that your mother is just experiencing a short discomfort associated with the vaccine and that it does not develop into a case of SIRVA. I don’t know about for the shingles vaccine in particular, but I was once advised not to start worrying that unusually intense pain after a shot is SIRVA until a week or two weeks with consistent bad pain. I’m not sure that’s great advice, but it is what I was told, so maybe there is hope that it will be short lived in her case. I think I have heard that the shingles vaccine is extra painful so you will probably get a lot of people telling her to not be worried, but it is only natural to be concerned that something was done wrong when the pain is a lot more than usual for a vaccine. Please keep us updated!

  28. Both my 18 year old son and I went to our neighborhood pharmacy and each got the flu shot. It has been over a month and we both are in so much pain. It must have been poor placement of the shot. We are feeling all the symptoms you have described.

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