Let’s Get It Right! How to Avoid Shoulder Injury with Deltoid Intramuscular Injections

October 2018

Technically Speaking
Monthly Column by Deborah Wexler, MD
Deborah Wexler MD
Technically Speaking is a monthly column written by IAC’s Executive Director Deborah Wexler, MD. The column is featured in The Children’s Hospital of Philadelphia Vaccine Education Center’s (VEC’s) monthly e-newsletter for healthcare professionals. Technically Speaking columns cover practical topics in immunization delivery such as needle length, vaccine administration, cold chain, and immunization schedules.
Check out a recent issue of Vaccine Update for Healthcare Providers. The VEC e-newsletter keeps providers up to date on vaccine-related issues and includes reviews of recently published journal articles, media recaps, announcements about new resources, and a regularly updated calendar of events.
Let’s Get It Right! How to Avoid Shoulder Injury with Deltoid Intramuscular Injections
Published October 2018
During influenza vaccination season, and at all times of the year, it is critically important that clinic staff who administer vaccines avoid injury to patients’ shoulders by being knowledgeable about how to properly administer intramuscular injections in the deltoid muscle.

At the October 2017 Advisory Committee on Immunization Practices meeting, a presentation titled “Reports of Shoulder Dysfunction Following Inactivated Influenza Vaccine in the Vaccine Adverse Event Reporting System (VAERS), 2010–2016”, included the following background information about shoulder injury related to vaccine administration (SIRVA):

  • Definition: SIRVA is caused by injury to the musculoskeletal structures of the shoulder (e.g., tendons, ligaments, bursae, etc.)
  • It manifests itself as shoulder pain and limited range of motion occurring after a patient receives a vaccine intended for intramuscular administration.
  • These symptoms are thought to occur as a result of unintended injection of vaccine antigen or trauma from the needle going into and around the underlying bursa of the shoulder, resulting in an inflammatory reaction.

SIRVA may result in patients having chronic shoulder pain and limited range of motion, and require ongoing medical intervention.

To avoid SIRVA, make sure clinic staff who administer vaccines recognize the anatomic landmarks for identifying the deltoid muscle and use proper intramuscular administration technique.

Helpful resources to assist with staff education

IAC resources

CDC resources

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