April 22, 2016

Vaccines – And You Thought You Heard It All.

A number of years ago, 1990 to be exact, a patient entered my clinic complaining of neck pain from lifting food trays as a waitress. After a thorough examination, we began treatment which consisted of chiropractic adjustments and therapy.  After a few visits, she began to feel improvement. One day at work while cleaning up a table, she apparently grabbed some napkins and was stabbed by a hypodermic syringe that someone had inexplicably left behind. After reporting it to management, she went to the hospital to be examined and they instructed her that for safety purposes she should have a tetanus shot. They inoculated her in her right upper shoulder and sent her home.

vaccinationsWithin 24 hours the patient began to have severe pain down the right shoulder into her arm and hand. Prior to this event she had not complained of any shoulder or arm pain. Her pain has persisted until today and her pain is made worse by activity, especially at her job where she finds lifting trays extremely painful and difficult. For years worker’s compensation and insurance companies have fought her situation blaming her pain on her neck.

Recently, research has pointed to a number of similar cases concerning not only tetanus but also other vaccinations including influenza, diphtheria and pertussis vaccinations. The condition is called SIRVA, shoulder injury related to vaccine administration. In these cases the history and symptomology are typical and includes the absence of prior shoulder problems, rapid onset of pain (24 to 48 hours after vaccination) and limited range of motion. MRI and CT studies show inflammation and scarring of the shoulder bursa and thickening tissue around the damaged tendon and in one case, humeral head erosion, apparently from over penetration from direct needle impact.

The Centers for Disease Control and Prevention (CDC) vaccine administration protocol involves the patient’s sex and weight in relationship to needle length for the patient’s injection. For example, for an adult female, a 1-inch needle should be used. Research from Lippert and Wall recommends that a 1/2 inch needle length should be used and to avoid the top third of the deltoid muscle to ensure 0% risk of over-penetration.

Not only does this condition cause a great deal of discomfort, but also diagnosing and treating SIRVA is expensive. That “free” flu shot might keep you from getting sick, but might also cost you thousands of dollars in medical expenses and possible loss of job, etc.

For my patient, she has fought through this for years and now with this research on her side we are helping her obtain Social Security Disability after so many years of suffering.

There are a number of research papers on this subject. Here are just a few.

Lippert WC, Wall EJ Optimal Intramuscular needle-penetration depth. Pediatrics. 2008; 22(3):e556-e563

Atanasoff S,Ryan T, Lightfoot R, Johann-Liang R. Shoulder injury related to vaccine administration (SIRVA). Vaccine 2010; 28(51): 8049-8052.

Bodor M, Montalvo E. Vaccination-related shoulder dysfunction. Vaccine. 2007: 25(4): 849-852.

Brandon C Taylor, MD, Daivd Hinke, MD Appl Radiol. 2014; 43(12):30-31