Lyman Kade, Kelley Tim, Walthall Joel, Lang Sarah D, Gilmer Brian B, Guttmann Dan
Taos Orthopaedic Institute, Taos, NM, USA.
Mammoth Orthopedic Institute, Mammoth Hospital, Mammoth Lakes, CA, USA.
JSES Rev Rep Tech. 2023 Apr 6;3(3):350-355. doi: 10.1016/j.xrrt.2023.02.011. eCollection 2023 Aug.
Shoulder pain following intramuscular administration of vaccine is common. However, a small number of patients experience prolonged pain and dysfunction atypical to normal transient postvaccination shoulder pain. Shoulder Injury Related to Vaccine Administration (SIRVA) remains incompletely understood, whether a robust immune response to vaccine antigen or inappropriate injection technique with needle placement in synovial or bursal tissue, or some combination of the two. Symptoms overlap with those of () infection but the relationship between the two, if any, has not been evaluated.
Clinical case files were reviewed for 3 cases of SIRVA with positive cultures for were reviewed. Presentation, treatment, and clinical outcomes were compared.
In all cases, patients were thin (body mass index < 23), females, who had high injection placement of a vaccine, all patients had positive magnetic resonance imaging findings of increased signal in the subacromial bursa, and/or greater tuberosity. All patients underwent arthroscopic débridement and culture harvest and cultures were positive for . A combination of oral and intravenous antibiotics was used, and all patients demonstrated clinical improvement from the preoperative state.
This case series presents 3 patients with refractory SIRVA who ultimately underwent arthroscopic irrigation and débridement with culture biopsy. Each case had culture results positive for and all responded, at least partially, to arthroscopic débridement and intravenous antibiotic therapy. The purpose of this manuscript is to raise awareness of potential coexistence of SIRVA and which may be of assistance to surgeons treating refractory cases of SIRVA.
肌肉注射疫苗后出现肩部疼痛很常见。然而，少数患者会经历长时间的疼痛和功能障碍，这与正常的疫苗接种后短暂肩部疼痛不同。与疫苗接种相关的肩部损伤（SIRVA）仍未被完全理解，其原因是对疫苗抗原的强烈免疫反应、针头误置于滑膜或滑囊组织的不恰当注射技术，还是两者的某种组合。其症状与（）感染的症状重叠，但两者之间的关系（如果存在的话）尚未得到评估。
回顾了3例SIRVA且培养结果为阳性的临床病例档案。比较了临床表现、治疗方法和临床结果。
所有病例中，患者均体型消瘦（体重指数<23），为女性，疫苗注射位置较高，所有患者的磁共振成像结果均显示肩峰下滑囊和/或大结节信号增强。所有患者均接受了关节镜清创和培养取材，培养结果为阳性。采用了口服和静脉联合使用抗生素的治疗方法，所有患者的临床症状均较术前有所改善。
本病例系列介绍了3例难治性SIRVA患者，他们最终接受了关节镜冲洗和清创及培养活检。每例患者的培养结果均为阳性，且所有患者至少部分地对关节镜清创和静脉抗生素治疗有反应。本文的目的是提高对SIRVA与（）可能共存的认识，这可能有助于外科医生治疗难治性SIRVA病例。
