Background 

Shoulder injury related to vaccine administration (SIRVA) is postulated to be an immune-mediated inflammatory response to a vaccine antigen injected into or near the subacromial bursae or synovium, leading to shoulder pain and dysfunction. The number of studies on this topic is rapidly increasing. Recent comparative studies have reported conflicting conclusions, which suggests that a systematic review of the best-available evidence may be helpful.

Questions/purposes 

In this systematic review, we asked: What are the (1) clinical characteristics, (2) diagnoses, and (3) management approaches and outcomes reported in association with SIRVA?

Methods 

A search was performed on October 4, 2021, of the PubMed and Medline databases for studies related to SIRVA. Inclusion criteria were English-language comparative studies, case series, and case reports that involved shoulder pain occurring after vaccination. Studies of exclusively neurologic conditions after vaccination were excluded. Forty-two studies met the eligibility criteria, including three retrospective comparative studies (72 patients and 105 controls), five database case series (2273 patients), and 34 case reports (49 patients). Study quality was assessed for the database case series and retrospective comparative studies using the Methodological Index for Non-randomized Studies tool.

Results 

Among patients in the case reports, the median age was 51 years (range 15-90 years), and 73% (36 of 49) were women. BMI was reported for 24% of patients (12 of 49) in case reports, with a median of 23.5 kg/m² (range 21-37.2 kg/m²). The most common symptoms were shoulder pain and reduced ROM. The most common diagnoses were shoulder bursitis, adhesive capsulitis, and rotator cuff tears. The most frequent management modalities included physical or occupational therapy, NSAIDs, and steroid injections, followed by surgery, which was generally used for patients whose symptoms persisted despite nonsurgical management. Full resolution of symptoms was reported in 2.9% to 56% of patients.

Conclusion 

The association between inflammatory conditions of the shoulder (such as bursitis) and vaccination appears to be exceedingly rare, occurring after approximately 1:130,000 vaccination events according to the best-available comparative study. Currently, there is no confirmatory experimental evidence supporting the theory of an immune-mediated inflammatory response to vaccine antigens. Although the clinical evidence is limited, similar to any bursitis, typical treatments appear effective, and surgery should rarely be performed. Additional research is needed to determine the best injection technique or evaluate alternate injection sites such as the anterolateral thigh that do not involve positioning a needle close to the shoulder.

中文翻译：

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我们对与疫苗接种相关的肩部损伤了解多少？更新的系统审查

背景 

与疫苗接种相关的肩部损伤（SIRVA）被认为是对注射到肩峰下滑囊或滑膜中或附近的疫苗抗原的免疫介导的炎症反应，导致肩部疼痛和功能障碍。关于这一主题的研究数量正在迅速增加。最近的比较研究报告了相互矛盾的结论，这表明对现有最佳证据进行系统审查可能会有所帮助。

问题/目的 

在此系统评价中，我们询问：与 SIRVA 相关的 (1) 临床特征、(2) 诊断和 (3) 管理方法和结果是什么？

方法 

2021 年 10 月 4 日在 PubMed 和 Medline 数据库中检索了与 SIRVA 相关的研究。纳入标准是英语比较研究、病例系列和涉及疫苗接种后发生肩部疼痛的病例报告。仅针对疫苗接种后神经系统疾病的研究被排除在外。42 项研究符合资格标准，包括三项回顾性比较研究（72 名患者和 105 名对照）、五项数据库病例系列（2273 名患者）和 34 项病例报告（49 名患者）。使用非随机研究方法索引工具评估数据库病例系列和回顾性比较研究的研究质量。

结果 

病例报告中的患者中位年龄为 51 岁（范围 15-90 岁），73%（49 名患者中的 36 名）为女性。病例报告中 24% 的患者（49 名患者中的 12 名）报告了 BMI，中位数为 23.5 kg/m ²（范围 21-37.2 kg/m ²）。最常见的症状是肩部疼痛和活动范围减少。最常见的诊断是肩部滑囊炎、粘连性囊炎和肩袖撕裂。最常见的治疗方法包括物理或职业治疗、非甾体抗炎药和类固醇注射，其次是手术，手术通常用于非手术治疗后症状仍然存在的患者。据报道，2.9% 至 56% 的患者症状完全缓解。

结论 

根据现有的最佳比较研究，肩部炎症（例如滑囊炎）与疫苗接种之间的关联似乎极其罕见，发生在大约 1:130,000 次疫苗接种事件之后。目前，没有确凿的实验证据支持疫苗抗原的免疫介导炎症反应理论。尽管临床证据有限，但与任何滑囊炎类似，典型的治疗似乎有效，并且很少应进行手术。需要进行额外的研究来确定最佳注射技术或评估替代注射部位，例如不涉及将针头靠近肩膀定位的大腿前外侧。