Don Cooper Ph.D.
Director of the Medical Science Division at Ramos Law
Joseph Ramos MD, JD
Principal Ramos Law
If you are like most Americans who have received a vaccine in the past year, you may have heard of SIRVA, or Shoulder Injury Related to Vaccine Administration. This condition may occur when a vaccine is injected either too high or too low on the shoulder, leading to inflammation and pain in the area. While SIRVA is a rare occurrence, it can have significant impacts on a person’s quality of life and employment. Here we delve into the medical and legal aspects of SIRVA, including how it’s caused, diagnosed, treated, and prevented. We also discuss the role of the COVID-19 pandemic in increasing the risk of SIRVA and provide information on how the medical and legal experts at Ramos Law can help you seek compensation through the Vaccine Injury Compensation Program (VICP).
What is SIRVA?
SIRVA is a type of shoulder injury that occurs when a vaccine is injected either too high or too low on the shoulder, causing inflammation and leading to damage of the nearby structures. The damage may be to the rotator cuff tendons and bursa or to local nerves. The rotator cuff is a group of muscles and tendons that attach the shoulder blade to the upper arm bone, allowing the arm to move and rotate. The bursae are small fluid-filled sacs that cushion and reduce friction between bones and tendons or muscles in the shoulder. When these structures become inflamed or damaged, it can cause pain, weakness, and limited range of motion in the shoulder. Inflammation involving a nerve, most often the radial nerve, may also result in abnormal sensations or muscle functions involving the shoulder, forearm, hand, or fingers. SIRVA can occur after any vaccine that is administered in the shoulder, but it is most commonly associated with the influenza (flu) vaccine. This is because the flu vaccine is typically given in the shoulder, and it requires a longer needle than some other vaccines. The longer needle increases the risk of injecting the vaccine too high on the shoulder, leading to SIRVA.
How is SIRVA caused?
As mentioned above, SIRVA is caused by injecting a vaccine too close to the top of the shoulder or too low in the deltoid at the lower aspect of the shoulder. It may be more likely with an improper injection technique where the needle is inserted at an angle that misses the muscle and hits the bursae or tendons or is given in proximity to a nerve. SIRVA can also occur if the vaccine is injected too quickly, causing trauma to the shoulder structures.
There are several factors that can increase the risk of SIRVA, including:
- Inexperienced vaccine administrators: SIRVA is more likely to occur if the person administering the vaccine is inexperienced or lacks proper training. This was a particular concern during the COVID-19 pandemic, when many pharmacy technicians and even medical students were tasked with giving vaccines to large numbers of people in a short amount of time.
- Smaller shoulder muscles: People with smaller shoulder muscles may be at increased risk of SIRVA, as the vaccine may be more likely to miss the muscle and hit the bursae or tendons.
- Obesity: Obesity can also increase the risk of SIRVA, as the extra fat tissue in the shoulder may make it more difficult to locate the muscle and avoid the bursae and tendons.
- Certain vaccines: Some vaccines, such as the flu vaccine, require a longer needle than others and may be more likely to cause SIRVA if injected too high on the shoulder.
How is SIRVA diagnosed and treated?
If you experience shoulder, arm, or hand pain, weakness, or limited range of motion after receiving a vaccine, you should contact your healthcare provider. They will ask about your symptoms and medical history and may perform a physical examination of your shoulder. They may also order imaging tests, such as CT scan (computed tomography) or MRI (magnetic resonance imaging), to evaluate the structures in your shoulder and determine the cause of your symptoms. A CT is a type of medical imaging that uses X-rays and a computer to create detailed, cross-sectional images of the body. A CT scan can be used to detect inflammation or damage to the bones and soft tissues in the shoulder, including the rotator cuff tendons and bursae. An MRI is a type of medical imaging that uses a strong magnetic field and radio waves to produce detailed images of the body’s internal structures. An MRI is very effective at detecting soft tissue injuries, such as inflammation or damage to the rotator cuff tendons and bursae. If your healthcare provider suspects a nerve injury, they may order an NCV/EMG (nerve conduction velocity/electromyography) to evaluate the function of your nerves and muscles. An NCV/EMG uses electrical impulses and measures the responsiveness of your nerves and muscles to those impulses to detect abnormal function and injury.
If SIRVA is suspected, your healthcare provider may recommend one or more of the following treatments:
- Rest and physical therapy: This can help reduce inflammation and promote healing in the affected area. Physical therapy may involve exercises to stretch and strengthen the muscles and tendons in the shoulder and injured extremity.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as naproxen, can help reduce pain and inflammation in the injured area.
- Corticosteroid injections: Corticosteroid injections may be used to reduce inflammation as well.
- Surgery: In severe cases of SIRVA, surgery may be necessary to repair or remove damaged structures.
The length of time it takes to recover from SIRVA can vary depending on the severity of the injury and the effectiveness of treatment. In general, mild to moderate cases of SIRVA may resolve within a few weeks or months with rest and physical therapy. Severe cases may take longer to heal and may require more extensive treatment, such as surgery.
How can SIRVA be prevented?
There are several steps that can be taken to reduce the risk of SIRVA:
- Proper training and technique: Ensuring that vaccine administrators have proper training and technique can help reduce the risk of SIRVA. This includes teaching them how to locate the muscle and avoid the bursae, tendons, and nerves when administering the vaccine.
- Using the correct size needle: Using a needle that is the appropriate size for the vaccine being administered can help reduce the risk of SIRVA.
- Administering the vaccine slowly: Administering the vaccine slowly can help reduce the risk of trauma to structures in the area of the injection.
- Avoiding the top and bottom of the shoulder: Administering the vaccine as close to the middle of the muscle as possible, can help reduce the risk of SIRVA.
How does SIRVA affect quality of life and employment?
SIRVA can have significant impacts on a person’s quality of life and employment. Shoulder pain, weakness, sensory changes, and limited range of motion can make it difficult to perform everyday activities, such as lifting, carrying, and reaching. This can affect a person’s ability to work, particularly if their job requires physical activity or manual labor. SIRVA can also have financial implications, as it may require medical treatment and time off work, leading to lost wages and increased healthcare expenses.
Are there differences in the prevalence of SIRVA in men vs. women or young vs. old?
There is limited research on the prevalence of SIRVA in different age and gender groups. However, some studies have found that women may be more likely to develop SIRVA than men, and that people over the age of 50 may be at increased risk. It is not clear why these differences may exist, and further research is needed to better understand any potential age and gender-related factors that may contribute to SIRVA.
Is SIRVA covered by the Vaccine Injury Compensation Program (VICP)?
SIRVA is a recognized injury under the Vaccine Injury Compensation Program (VICP), which is a federal program that provides financial compensation to individuals who have been injured by a vaccine. To be eligible for compensation through the VICP, you must have 1) received a vaccine that is covered by the program, 2) experienced a recognized injury or death within a certain time frame after vaccination, and 3) the injury must last a minimum of six months.
If you think you may have developed SIRVA as a result of a vaccine, it is important to see a healthcare provider as soon as possible to diagnose and treat the injury. It is also important to continue treating the injury until you are 100% better and not stop treatment if you are not completely healed.
Please contact the experts in the Medical Science Division at Ramos Law (https://www.ramoslaw.com/vaccine-injury/) to learn more about the process for seeking compensation. The VICP has established a list of “table injuries” that are presumed to be caused by vaccines, and SIRVA is included on this list. If your injury is listed on the table, you do not have to prove that the vaccine caused your injury – you only have to show that you received the vaccine and that you developed the injury within the time frame specified by the VICP. However, the filing process can be complex and a misstep in the documentation of the injury can lead to dismissal of your case. The attorneys and experts in the Medical Science Division at Ramos law are familiar with the VICP and vaccine injury cases and can help you navigate this process.
How much does it cost for Ramos Law to file a SIRVA vaccine injury claim to the VICP program?
There is NO charge to the client to file a SIRVA claim to the US Court of Federal Claims. The attorney’s costs and expert fees are paid by the VICP program and the court directly. There is no contingency fee so if compensation is awarded the client receives it all. In fact, even if the case is dismissed by the court the cost to file and associated attorney fees are paid by the court.
How much compensation can one receive from SIRVA injury?
The amount of compensation that you may be eligible for will depend on a variety of factors, including the severity of your injury, the impact on your quality of life and employment, and any related medical expenses, but it is not uncommon for compensation to be in the range of $25,000 – $70,000. Again, attorney’s fees are paid separately. Currently the maximum compensation limit for past and future lost wages and pain and suffering is $250,000.
Where can I get more information about SIRVA?
If you have experienced shoulder pain, weakness, or limited range of motion after receiving a vaccine and suspect that you may have developed SIRVA, it is important to see a healthcare provider as soon as possible to diagnose and treat the injury.
If you would like to speak with an expert about SIRVA compensation, you can contact Dr. Don Cooper, Director of the Medical Science Division at Ramos Law or Dr. Joseph Ramos, MD, JD. Our team at Ramos Law has extensive experience helping individuals with vaccine injuries, including SIRVA, navigate the legal and medical landscape. You can contact Ramos Law at the following link: https://www.ramoslaw.com/vaccine-injury/ or call us at (303) 733-6353.