Calcific Tendinitis of the Shoulder Induced by an mRNA Vaccine for COVID-19: A Case Report.

Coronavirus disease 2019 (COVID-19) vaccines have been widely used and have been shown to be effective in combating the pandemic. However, various side effects have been reported following vaccination. For instance, a condition called "shoulder injury related to vaccine administration" (SIRVA) is characterized by shoulder pain and limited range of motion after intramuscular injection of a vaccine into the deltoid muscle of the shoulder. Despite an increase in SIRVA cases, the exact incidence of the disease is unclear, and there are a few reports of SIRVA about the COVID-19 vaccine. Here, we report a rare case of an 83-year-old woman who was diagnosed with calcification in her left shoulder one year ago and developed calcific tendinitis after receiving an mRNA vaccine for COVID-19 (Pfizer-BioNTech). Radiographs showed calcification of the supraspinatus tendon, and magnetic resonance images showed continuous inflammatory findings from the subdeltoid bursa to the subacromial bursa. We treated the patient with celecoxib and acetaminophen, and she recovered after about two months. In order to prevent SIRVA, the presence of shoulder joint disease should be carefully asked during a pre-vaccination assessment. The puncture point should be chosen with the median point of the deltoid muscle or the anterior-posterior axillary line as landmarks, because the more cephalad the puncture position, the greater the chance of causing SIRVA.

Shoulder Weakness Following Intramuscular COVID- 19 Vaccine

History: Transient and generalized adverse effects are common following COVID-19 vaccination;among other adverse effects, shoulder injuries related to vaccine administration (SIRVA) have been known to occur. In this case, a previously healthy right-hand dominant 62-year-old male presented with left shoulder pain and weakness 3 months after receiving a COVID-19 intramuscular vaccine in the left deltoid. Approximately 2 weeks after the injection, he started experiencing pain and numbness around the injection site along with ipsilateral shoulder weakness. Despite conservative management with Motrin, Medrol Dosepak, gabapentin and physical therapy (PT), the pain and weakness persisted. Physical Exam: Left Shoulder-No calor or erythema;significant atrophy of the anterior and middle deltoid muscle relative to right side;abduction 4/5;external rotation with shoulder adducted 4/5;range of motion for active forward flexion was 150 degrees and passive was 170 degrees;passive range of motion for external rotation was 70 degrees;internal rotation to the level of L5;sensation to light touch was intact. Right Shoulder-Range of motion, strength, and sensation were intact. Cervical Spine-Full ROM;no cervical paraspinal tenderness noted. Negative Spurling's and Lhermitte's tests. Differential Diagnosis: 161. Axillary Nerve Palsy 2/2 Chemical Neurotoxicity 162. Brachial Neuritis 163. Mechanical Axillary Nerve Palsy 2/2 Vaccination 164. Partial-Tear of Left Supraspinatus Tendon 165. Acromioclavicular Osteoarthritis Test Results: Left Shoulder-XR:Mild pseudo-subluxation;MRI w/o contrast: 8x9mmpartial-thickness articular surface tear of the distal supraspinatus tendon (<50%fiber thickness). Minimal subacromial bursitis. Mild acromioclavicular joint osteoarthritis. EMG/NCV: Left and Right Axillary Motor Nerves: prolonged distal onset latency;Left Deltoid: increased insertion activity, moderately increased spontaneous activity, reduced recruitment;Remaining LUE muscles without evidence of electrical instability Final Diagnosis: Axillary Nerve Palsy Secondary To Chemical Neurotoxicity from Intramuscular COVID-19 Vaccine. Discussion(s): We postulate that the neurologic deficits presented in our case may be attributed to chemical neurotoxicity to the axillary nerve following vaccination as the delayed onset of pain and weakness are most consistent with this differential. There are several cases of brachial neuritis following vaccination for the prevention of COVID- 19, however, EMG/NCV results in our patient were not consistent with brachial plexopathy. Additionally, while there have been a handful of reported cases of bursitis following COVID-19 vaccines falling under the SIRVA classification of injuries, this is the first case of reported axillary nerve neurapraxia. Outcome(s): The patient's left shoulder numbness and pain improved with PT and medical management. While mild improvement in strength was noted, weakness and atrophy persisted even on the third follow up visit 6 months after the initial appointment. He was counseled on his injury and was recommended to undergo repeat EMG testing to document recovery after his 6-month follow-up appointment. Follow-Up: The patient did not follow-up for a repeatEMG after his 6-month follow-up appointment. At that time, the patient was clinically stable, tolerating PT, and expecting recovery of his deltoid function.

COVID-19 Vaccines: Fabrication Techniques and Current Status

The year 2020 was the most challenging period due to the havoc caused by the outbreak of novel coronavirus SARS-CoV-2. Scientists and researchers all around the world have endeav-ored every possible approach to find solutions in context to therapeutics and vaccines to control the spread of this life-threatening virus. The acceleration instigated by the outbreak of SARS-CoV-2 and its mutated strains has leveraged the use of numerous platform technologies for the development of vaccines against this unfathomable disease. Vaccines could play an important role in miti-gating the effects of COVID-19 and reducing the ongoing health crisis. Various innovative plat-forms like proteins, nucleic acids, viruses, and viral vectors have been exploited to fabricate vaccines depicting almost 90% of efficacy like BNT162b2, AZD1222, Ad5-nCoV, etc. Some of these vaccines are multipotent and have shown potent activity against newly emerged malicious strains of SARS-CoV-2 like B.1.351 and B.1.1.7. In this review article, we have gathered key findings from various sources of recently popularized vaccine candidates, which will provide an overview of potential vaccine candidates against this virus and will help the researchers to investi-gate possible ways to annihilate this menace and design new moieties.Copyright © 2022 Bentham Science Publishers.

Shoulder injury following COVID-19 vaccine administration: a case series and proposed diagnostic algorithm.

BACKGROUND: Shoulder Injury Related to Vaccine Administration (SIRVA) is a preventable adverse event following incorrect vaccine administration, which can result in significant long-term morbidity. There has been a notable surge in reported cases of SIRVA as a rapid national population-based COVID-19 immunization program has been rolled out across Australia. METHODS: Surveillance of Adverse Events Following Vaccination in the Community (SAEFVIC) in Victoria identified 221 suspected cases of SIRVA following the commencement of the COVID-19 vaccination program, reported between February 2021 and February 2022. This review describes the clinical features and outcomes of SIRVA in this population. Additionally, a suggested diagnostic algorithm is proposed, in order to facilitate early recognition and management of SIRVA. RESULTS: 151 cases were confirmed as SIRVA, with 49.0% having received vaccines at state vaccination centers. 75.5% were suspected incorrect administration site, with most patients experiencing shoulder pain and restricted movement within 24 hours of vaccination, lasting on average 3 months. CONCLUSION: Improved awareness and education regarding SIRVA is imperative in a pandemic vaccine roll-out. The development of a structured framework for evaluating and managing suspected SIRVA will aid in timely diagnosis and treatment, essential to mitigate potential long-term complications.

Shoulder injury related to vaccine administration following SARS-CoV-2 inoculation: Case series and review of literature.

Introduction: Shoulder Injuries Related to Vaccine Administration (SIRVA), describes those cases of shoulder severe post-inoculation complications, including pain and prolonged disability. Most of the reported cases have been secondary to influenza vaccination. This study retrospectively describes a series of 18 patients following SARS-CoV-2 inoculation and compares the findings with those previously reported for other vaccines. Materials and methods: Inclusion criteria was onset of symptoms within 48 hours after injection, symptoms duration of at least seven days, and restricted range of motion in absence of symptoms prior to vaccination. Average age was 59.4 years old (38-76), and 72.2% were women. Results: In many cases (58%) the initial diagnosis was not clear, which lead to incorrect treatment. The most common pathological finding was subacromial-subdeltoid bursitis (66.6%). All patients who received depot corticosteroids followed by a gentle rehabilitation program showed strong clinical improvement but did not completely resolve the symptoms at 7.2 months average final follow-up. Surgical intervention was necessary in one of the patients due to the persistence of symptoms despite conservative treatment. Conclusions: Shoulder injury related to vaccine administration is rare, but when present, its torpid evolution makes it difficult to treat. We have found in our case series a similar pattern to that already described for other vaccines. A high index of suspicion helps to pick up the condition promptly and early treatment can bring satisfactory outcome.

Shoulder Pain and Injury after COVID-19 Vaccination

Shoulder injury related to vaccine administration (SIRVA) is a term given to describe shoulder pain and dysfunction arising within 48 hours after vaccine administration and lasting for more than one week. While SIRVA is most commonly seen after influenza and tetanus vaccines, there have been a few recent case reports describing SIRVA-like symptoms after COVID-19 vaccine administration. Two patients presented to the shoulder surgeon's practice center with complaints of shoulder stiffness and pain following the COVID-19 vaccine. The first patient was a 33-year-old man;he presented within 2 days of onset of the pain and 14 days from the vaccine date. He had a complete restriction of shoulder motion (0degree flexion, and no external or internal rotation) at presentation. This patient was treated with non-steroidal anti-inflammatory drugs (NSAID) and rested in a sling for a week. The second patient was a 53-year-old woman;she presented with a 6-week duration of mild restriction of active shoulder motion and shoulder pain. Her magnetic resonance imaging (MRI) revealed the presence of subacromial-subdeltoid bursitis. She was treated with subacromial steroid injection and range of motion shoulder exercises. Both patients recovered a near-normal range of motion recovery within a month, and their pain improved significantly. The main lessons from this case report were: (1) patients presenting with a recent increase in pain and acute loss of shoulder movements after vaccination may be managed conservatively with rest and NSAID medications and (2) in case of a subacromial-subdeltoid bursitis in the MRI, subacromial injection of steroid may provide good pain relief. Copyright © 2022, Yale Journal of Biology and Medicine Inc. All rights reserved.

PFIZER COVID-19 VACCINE CAUSES SHORTNESS OF BREATH IN A 24-YEAR-OLD PATIENT: A CASE REPORT

SESSION TITLE: Variety in Risk Factors and Treatment of VTE SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: The year of 2020 will be a year never forgotten when the COVID-19 pandemic began. The healthcare system is going into a crisis facing a disease that is unknown and overwhelming. Companies were frantic to find a solution to help prevent so many unnecessary deaths. Pfizer mRNA COVID-19 vaccine was granted emergency use by the FDA after proving efficacy in early trials. Many side effects were unknown and discovered as time went on. Unprovoked isolated pulmonary embolisms are rare. CASE PRESENTATION: A 24 year old male with no significant past medical history presented to the emergency department due to shortness of breath, hemoptysis and chest pain. He denied any family history or personal history of clotting disorders. He received the mRNA COVID-19 Pfizer vaccine 5 days prior to symptom onset. He describes it as constant sharp pain with varying intensity that he rates a 6/10 and can reach a 10/10 pain exacerbated with lying flat and deep breathing. He also states he has been coughing up a teaspoon amount of blood with this chest pain. Physical examination revealed reduced breath sounds in the left lower lobe. Patient was hemodynamically stable. Labs were stable and hemoglobin was stable throughout the hospital course. Fibrinogen was elevated and hypercoagulable work-up was negative. CTA of chest was performed and revealed left-sided pulmonary emboli involving the left lower lobe with pulmonary infarction. Therefore, he was managed by Eliquis. DISCUSSION: Pfizer released a safety and efficacy report of the BNT162b2 mRNA Covid-19 Vaccine. Many of the common side effects reported were pain at the injection site, fatigue, headache, and fever [1]. Adverse events that were reported were shoulder injury, right axillary lymphadenopathy, paroxysmal ventricular arrhythmia, and right leg paresthesia [1]. Isolated PE in a young healthy patient was never reported as an adverse event from the Pfizer safety and efficacy report. Severe acute respiratory syndrome-coronavirus-2 has been proven to increase the risk of venous thromboembolism because it is a prothrombotic virus [2]. Vaccination reports of pulmonary embolism are increasing, however, isolated PE without a DVT is still very underreported and rare. The literature states that a lot of patients that are having PE after mRNA vaccine also have associated thrombocytopenia, however, this is not what this patient demonstrates [3]. A total of 43, 548 participants were observed for the safety and efficacy report of the Pfizer COVID-19 report and not a single patient demonstrated an isolated pulmonary embolism event [1]. CONCLUSIONS: This case is a demonstration of a rare occurrence of isolated PE with no evidence of DVT in such close proximity to receiving the mRNA COVID-19 Pfizer vaccination.There are few reports of pulmonary embolism in healthy patients with no history of clotting disorders and further data are needed to support this association. Reference #1: Polack FP, Thomas SJ, Kitchin N, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020;383(27):2603-2615. doi:10.1056/NEJMoa2034577 Reference #2: Hesam-Shariati S, Fatehi P, Abouzaripour M, Fathi F, Hesam-Shariati N, Hesam Shariati MB. Increased pulmonary embolism in patients with COVID-19: a case series and literature review. Trop Dis Travel Med Vaccines. 2021;7(1):16. Published 2021 Jun 12. doi:10.1186/s40794-021-00145-3 Reference #3: Muster V, Gary T, Raggam RB, Wölfler A, Brodmann M. Pulmonary embolism and thrombocytopenia following ChAdOx1 vaccination. Lancet. 2021;397(10287):1842. doi:10.1016/S0140-6736(21)00871-0 DISCLOSURES: No relevant relationships by Muhammad Azaz Cheema No relevant relationships by Morcos Fahmy No relevant relationships by Christina Gearges No relevant relationships by Asma Iftikhar

Shoulder injury related to vaccine administration (SIRVA): What do we know about its incidence and impact?

Background: Shoulder injury related to vaccine administration (SIRVA) has been recognised as the compensable term for any shoulder injury that may result from an improper vaccination technique since 2017, however, its incidence and impact remain poorly understood. Objectives: To examine knowledge of SIRVA through reported cases, determine SIRVA incidence related to COVID-19 vaccinations, and investigate recovery rates. Methods: Six pharmacovigilance agencies in the United States of America (USA), Canada, United Kingdom, European Union, Australia, and New Zealand were systematically search to identify all reported cases of SIRVA between January 2017 to July 2021. Primary outcome measures were SIRVA case reports. Secondary outcome measures included recovery status as well as vaccine received, age, and sex. SIRVA-related outcome measures were retrieved between July 18th and July 22nd 2021, with UK data received via personal correspondence. Results: Retrospective analysis yielded 505 SIRVA cases since 2017, with 330 (65%) of cases reported from January to July 2021. Sub-analysis, using COVID-19 data of 189 SIRVA cases from 891,906,986 vaccinations, estimated incidence to be 2 per 10 million. 32 cases (7%) had recovered from symptoms at the time of reporting, with 311 (62%) reported as 'not recovered', and 162 cases (32%) 'unknown'. Females represented 75% of reported cases. Conclusion: SIRVA case report numbers and incidence from COVID-19 data, compared with prior evidence, raises questions around health practitioner knowledge and reporting accuracy of SIRVA. Recovery rates are poorly understood. A global consensus definition of SIRVA and more transparent and routine reporting is required. The disproportionate representation of females is of concern with no known reasons for this disparity. Further research is needed on SIRVA knowledge in healthcare practitioners, reporting rates, incidence, management, and long-term outcomes for those impacted. Pharmacist vaccinators should be aware of their role in preventing SIRVA and be active in its detection.

WHY YOU SHOULDN'T AIM TOO HIGH ALL THE TIME: A CASE OF SHOULDER INJURY RELATED TO VACCINE ADMINISTRATION (SIRVA) OF COVID-19 MRNA

CASE: A 23-year-old female presented to resident clinic for 7 months of right shoulder pain. She received her second COVID-19 mRNA vaccine just prior to onset of pain. She noted vaccine administration was “traumatic” with significant bleeding and bruising. She started noticing pain with overhead activities several days later. She is very active with cardiovascular exercises. She lifts weights but none requiring overhead motions. The pain was worst at the front of the shoulder but radiated to the lateral aspect. She had not tried, ice, heat, medications or physical therapy. Because of her injury, she was hesitant to receive her COVID-19 booster. BMI was low at 16.65. Exam showed thin build and overall low muscle bulk. Right shoulder showed no signs of muscle atrophy. There was tenderness of subacromial and coracoid areas. No pain along biceps tendon or AC joint. She had full ROM with shoulder abduction, internal and external rotation. She had full strength of supraspinatus, infraspinatus, teres minor, and subscapularis muscles. She noted pain with abduction, internal rotation and lift-off maneuver. Her Hawkins and Neer's maneuvers were positive. No pain with Yergason's and Speed's maneuvers. The patient was diagnosed with right shoulder subacromial bursitis and impingement syndrome. IMPACT/DISCUSSION: Mild shoulder pain is expected after vaccine administration and typically resolves in days. However, SIRVA is an increasingly recognized complication of improper vaccine administration particularly in the occupational setting. SIRVA results from vaccine being delivered inadvertently within the subdeltoid bursa or joint space. It is thought to result from an immune mediated reaction to the vaccine components as injury tends to be greater than expected from a needle injury. We were able to find 5 cases of reported SIRVA related to the COVID vaccine. All included some form of subacromial, subdeltoid, or subcoracoid bursitis. One case noted a supraspinatus tear. Ultrasound has demonstrated the subacromial bursa can extend distal to the acromion by up to 6 cm, so administration to bursa is possible in the superior deltoid. Appropriate injection technique can reduce the risk of injury;administrators should use landmarks of the acromion and distal insertion point of deltoid mid-humerus. Proper needle length is important. It has been suggested a smaller deltoid fat pat and smaller deltoid muscle bulk are risk factors for SIRVA. Women tend to have a higher incidence. CONCLUSION: We presented the case of a slender female who developed shoulder bursitis and impingement following administration of COVID-19 mRNA vaccine. She was referred to PT for rotator cuff strengthening, instructed to refrain from aggravating activities, and provided NSAIDs for pain relief. She reports pain relief. Another option for a more severe case would be a subacromial bursa steroid injection. It is important for providers to be aware of this pathology to provide appropriate treatment and decrease vaccine hesitancy.

SHOULDER INJURY RELATED TO VACCINE ADMINISTRATION (SIRVA)

CASE: A 62-year-old woman presented with 4 months of sharp progressive left shoulder pain, radiating down her arm with associated weakness, numbness and tingling most pronounced at the 4th and 5th digit. Her symptoms began within hours of receiving the influenza vaccine to her left shoulder. She denied prior left shoulder or neck pain, headaches, changes in vision, other neurologic symptoms, or trauma. Exam: Left upper extremity without skin changes or deformity, normal muscle bulk, tone and DTRs, lateral upper arm tenderness to light and deep palpation, reduced sensation to light touch at the 4th and 5th left digit with loss of two-point discrimination, reduced active and passive ROM of the glenohumeral joint to flexion/extension/abduction, and restricted internal and external rotation. Cervical x-rays showed spondylosis at C5-6, C5-6 neural foramen narrowing. Normal left shoulder x-ray. Left shoulder MRI showed high grade bursal surface, full-thickness tear of the distal supraspinatus tendon at its insertion, mild subscapularis tendinosis, and small subacromial subdeltoid bursitis. She was treated with a topical NSAIDs, tramadol and cyclobenzaprine as needed and referred to physiotherapy and PM&R. Despite maximum therapy, there was only marginal improvement of left shoulder pain and function at 9 months, she is still unable to perform her ADLs or return to work, and currently receiving home care through her daughter as a caregiver. IMPACT/DISCUSSION: The MRI findings and the temporal relationship between vaccine administration and onset of symptoms, suggest Shoulder Injury Related to Vaccine Administration (SIRVA) as the most likely diagnosis. SIRVA is defined as shoulder pain with limited ROM that commences within 48 hours after vaccine receipt in individuals without prior history of pain, inflammation, or dysfunction of the affected shoulder. SIRVA occurs when a vaccine is delivered into the sub-deltoid bursa or joint space, leading to a robust inflammatory response. The single most important factor in SIRVA diagnosis is the temporal association between vaccine administration and symptom onset. Commonly reported symptoms include shoulder pain, decreased limb mobility, numbness/tingling and muscle tightness. SIRVA complications include bursitis, tendonitis, rotator cuff tear, and adhesive capsulitis. Approximately 65% of patients with SIRVA will have pain lasting more than 3 months. SIRVA is challenging to treat, but there has been some success with early corticosteroid injection within 5 days of symptom onset. Given the current increase in vaccine administration with COVID-19, this case highlights SIRVA as a diagnostic consideration for patients who present with shoulder pain post-vaccination. CONCLUSION: SIRVA should be considered in any patient with new-onset shoulder pain that began within 48 hours of vaccine administration. SIRVA is a post-vaccination complication resulting in shoulder injury that can be prevented with proper vaccine administration technique.

Shoulder injury related to vaccine administration (SIRVA) after COVID-19 vaccination.

OBJECTIVE: The global fight against COVID-19 has required mass vaccination clinics as well as mass recruitment of personnel, including many who may not regularly administer intramuscular deltoid immunizations, potentially increasing the incidence of improper intramuscular injection. Shoulder injury related to vaccine administration (SIRVA) is a well-described, preventable injury resulting from improper injection into anatomic structures adjacent to the deltoid muscle leading to mechanical and chemical trauma augmented by an inflammatory immune response to the vaccine and/or adjuvants. SIRVA is best described in the setting of influenza vaccination, and little is known about it as it pertains to COVID-19 vaccination. This study aims to describe SIRVA in the current pandemic, increase clinician awareness, and offer considerations for prevention. METHODS: To identify clinical characteristics of patients with post-COVID-19-vaccination shoulder injuries, we performed a systematic review of the cases of vaccination-related shoulder injuries reported in the literature and conducted a review of the public Vaccine Adverse Event Reporting System (VAERS). RESULTS: We identified 305 cases of SIRVA in the VAERS database and 28 cases of SIRVA in the setting of COVID-19 vaccination from the literature (n = 333). Patients had a mean age of 51.8 years and a median of 51.5 (range: 19-90) years. Of these, 76.3% were female and 23.7% male. Most patients sought medical evaluation with 54 of the 305 VAERS cases reporting utilizing emergency services. Of patients with imaging-confirmed SIRVA (n = 95), the most common diagnoses were adhesive capsulitis and bursitis, and the most common symptoms were pain (97.7%) and limited range of motion (68.1%). Most patients reported requiring treatment with the majority receiving physical therapy (56.3%), followed by cortisone injection (34.4%). Other modalities used were non-steroidal anti-inflammatory drugs, oral steroids, and surgery. Only 5 patients from this group reported recovery while 60 stated they had not yet recovered. Of those, 23.3% reported disability. CONCLUSION: SIRVA should be regarded as an under-reported, significant cause of post-vaccination morbidity. In the setting of COVID-19 mass vaccination, clinicians must be aware of signs and symptoms of SIRVA as well as appropriate diagnostic modalities and treatment options. Additionally, standardization and proper education regarding injection technique and appropriate needle length is imperative to reducing harm.

Prolonged shoulder dysfunction after coronavirus disease vaccination: A case of shoulder injury related to vaccine administration.

Shoulder pain is a common symptom after intramuscular vaccination. However, only a few cases of shoulder joint injury have been reported after coronavirus disease 2019 vaccination. A 52-year-old woman experienced clinically significant pain in the left shoulder joint after receiving the first dose of a coronavirus disease 2019 vaccine. She neglected the shoulder pain, hoping that it would spontaneously improve without medical attention. However, the pain continued with obvious limitations in shoulder movement and function. After 8 months, she presented to the outpatient clinic with a frozen left shoulder. Such rare consequences of vaccinations, known as shoulder injury related to vaccine administration, can be prevented by using an appropriate needle gauge and length according to the patient's sex and weight with the correct injection site away from shoulder structures.

Shoulder Injury Related to COVID-19 Vaccine Administration: A Case Series.

BACKGROUND: A shoulder injury related to vaccine administration (SIRVA) is a vaccination complication that can affect daily life activities. To date, there have been no case series of patients diagnosed as SIRVA following a COVID-19 vaccination. We offer a series of seven SIRVA cases including clinical presentations, investigations and treatment outcomes. METHODS: A retrospective chart review was performed for seven patients who developed SIRVA following a COVID-19 vaccination between April 2021 and October 2021. All patients had no prior shoulder pain before their vaccination and then developed shoulder pain within a few days following the vaccination, which did not spontaneously improve within 1 week. RESULTS: Four of the seven patients were male, and the average age was 62.29 ± 7.76 years. The average body mass index was 25.1 ± 2.2 kg/m2. In all cases, the cause of the SIRVA was from an incorrect COVID-19 vaccine administration technique. Two patients developed shoulder pain immediately following the injection, one patient about 3 h after the injection, and the other four patients within the next few days. Two of the seven patients visited the orthopedic clinic after the persistent shoulder pain for 3 and 4 days and the other five patients 1-9 weeks following their injections. One of the seven patients was treated with combined intravenous antibiotic and oral non-steroidal anti-inflammatory drug (NSAID) because septic arthritis of the shoulder could not initially be ruled out, and recovered within 2 weeks. The other six patients had shoulder pain without acute fever, and five of them were treated with only oral prednisolone 30 mg/day for 5-10 days, following which the pain improved and they all could return to normal activities within 14 days, with no side effects from the prednisolone such as stomachache, nausea, vomiting, headache, or dizziness. DISCUSSION AND CONCLUSION: In our series, the most common cause of SIRVA was an incorrect vaccination technique. Most patients responded well to oral NSAIDs or oral prednisolone. CLINICAL RELEVANCE: All SIRVAs were from an incorrect injection technique and not actually the vaccination, so our series highlights the importance of ensuring all vaccinators understand the importance of taking proper care with the injection technique. Additionally, most of our patients with SIRVA from a COVID-19 injection responded well to oral prednisolone (30 mg/day). If there are no contraindications, we suggest this as the first line treatment for COVID-19-related SIRVA.

Do bio-psycho-social self-reported factors distinguish rotator cuff tendinopathy from other shoulder problems and explain shoulder severity? A case–control study

Keywords: Tendinopathy;Rotator cuff;Digital transformation Purpose: Similar associations between self-reported bio-psycho-social factors and the presentation of people with various shoulder disorders and rotator cuff (RC) tendinopathy have been reported;however, only limited numbers of variables have been assessed, often in small cohorts. We aimed to test whether RC tendinopathy could be distinguished from other shoulder problems using a range of bio-psycho-social self-reported factors and the degree to which they explain severity. Methods: Self-reported bio-psycho-social factors were collected via an online survey battery from an international sample. The dependent variables were diagnosis (having RC tendinopathy or other shoulder problems) and severity. After group comparison and univariate regression analyses, multivariable logistic and linear regression analyses were used to construct explanatory models for group differences and severity. Results: 82 people with RC tendinopathy (42.8 ± 13.9 years, 50 female) and 54 people with other shoulder problems (40.2 ± 14.1 years, 33 female) were recruited and found not to differ in severity on four patient-reported PROMs (Shoulder Pain and Disability Index (SPADI) = 37.3 ± 24.5 vs 33.7 ± 22.5, Western Ontario Rotator Cuff Index (WORCI) = 56.2 ± 22.0 vs 60.3 ± 22.2, Single Assessment Numeric Evaluation = 56.6 ± 25.3 vs 56.5 ± 28.7 and Patient Acceptable Symptomatic State (yes:no) 51:31 vs 23:22, respectively). Eight self-reported factors individually distinguished RC tendinopathy from other shoulder problems, with the model distinguishing tendinopathy from other shoulder problems including 4 variables;having a previous injury in the shoulder (OR (95% CI) = 0.30 (0.13–0.69)), activity effect on pain (OR (95% CI) = 2.24 (1.02–4.90)), General Self-Efficacy Score (OR (95% CI) = 1.12 (1.02–1.22)) and activity level according to Global Physical Activity Questionnaire (moderately active OR (95% CI) = 3.97 (1.29–12.18) and highly active OR (95% CI) = 3.66 (1.41–9.48)), with acceptable overall model accuracy. Univariate linear regression analysis showed that 32 variables were associated with RC tendinopathy severity with a multivariable model consisting of quality of life (β coefficient = −0.38), having night pain (β = 0.19), having unilateral morning stiffness (β = 0.25), BMI (β = 0.29), FABQ (work) score (β = 0.25);and pain catastrophising (β = 0.21) explaining 68% of the variance in severity. Conclusion(s): Well validated patient-reported outcomes to explain severity do not distinguish RC tendinopathy from other shoulder problems however self-reported bio-psycho-social factors do, so may be useful for clinical evaluation. Further, these factors were strongly associated with severity, reinforcing the potential to improve patient assessment, for example, using pre-consultation online data collection in usual care. The models warrant prospective validation and consideration alongside data from physical and imaging assessment. Impact: Online survey including self-reported bio-psycho-social factors may help augment diagnosis and, more importantly, provide some of the detail needed for holistic assessment by complementing physical examination and imaging. Therefore, the online survey may be useful to minimise the clinical time commitment and optimising safety during the Covid-19 pandemic. Funding acknowledgements: The review is a part of Mehmet Delen's Ph.D., which is sponsored by the Turkish Ministry of National Education. The sponsors had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Shoulder Injuries Related to the COVID-19 Vaccine: A Report of Two Cases

Coronavirus disease (COVID-19) is a major health crisis with more than 100 million cases and almost 3 million deaths having been reported to date. According to the World Health Organization (WHO), vaccination of the majority of the global population is the most critical strategy to return to normal. Vaccines are approved following meticulous work regarding safety and efficacy;however, very little attention is paid to the injection itself. Shoulder injury related to vaccine administration (SIRVA) is a complication due to erroneous injection. SIRVA can be easily prevented, and with millions of people now having COVID-19 vaccine injections, it is crucial to be aware of this complication. In this article, it was aimed to present 2 cases of SIRVA developing secondary to COVID vaccine injection. In the first case, a 30-year-old female presented with pain and limitation of movement in the right shoulder joint. Her complaints started within the first 24 hours following the COVID vaccine. In MRI examination, bursitis and bone marrow edema were present. In the second case, a 53-year-old female had a painful shoulder joint. Her complaints started approximately one day after the COVID vaccine, similar to the first case, bursitis was observed in the MRI.