Every fall, doctors, pharmacies and TV commercials urge all of us to get our flu shots. For many, this routine, annual chore is done as a preventative health habit, and in recent years it’s become easier than ever to get the vaccine. While a flu shot once required a doctor’s office visit, you can now find them at the corner pharmacy, mobile clinics and grocery stores.
You may not know about the small chance your flu vaccine could be injected improperly, which can result in a condition known as shoulder injury related to vaccine administration (SIRVA). This condition is defined as persistent shoulder pain and dysfunction, starting within 24 hours of vaccine administration, with limited range of motion and pain for a prolonged period.
It’s caused when the vaccine is injected too high up, into the soft tissue of the shoulder joint instead of into the thick part of the deltoid muscle, causing inflammation and bursitis. For some, SIRVA can last for months, but for others, it can be a chronic issue causing reduced or total loss of function in the shoulder.
As of 2010, SIRVA is recognized as a known type of vaccine injury by the Secretary of Health and Human Services, the Centers for Disease Control and the Institute of Medicine. This led to the creation of new vaccine recommendations that “the upper third of the deltoid muscle should not be used for vaccine injections, and the diagnosis of vaccination-related shoulder dysfunction should be considered in patients presenting with shoulder pain following a vaccination.”
I developed SIRVA after receiving a flu shot at a retail pharmacy in early 2014, and I have endured X-rays, an MRI, physical therapy and several steroid shots in my shoulder to reduce the inflammation and pain. Surgery will be my next step, once the most-recent steroid injection wears off. SIRVA is painful, it can limit your daily routine and it’s frustrating to have an injury caused by something as simple as a flu shot.
SIRVA is something no one should have to go through, so here are a few tips I’ve learned about how to reduce your risks when receiving a flu shot — or any other vaccine injection.
1. If the needle position seems too high, say something
A shot should be given at least two finger widths down from your acromion process (the knobby end of your shoulder). Not sure how to bring it up? Try this when the alcohol pad is rubbed on the spot, “Wait. That seems really high on my arm. I don’t remember getting any other shots that high. Can you position it lower down?”
2. Ask if you can stand while the shot is given.
If you’re required to sit, ask the vaccine administrator to sit as well, so you’re both at the same level. The person administering the vaccine should be seated if the patient is seated to reduce error. Injecting from above tends to result in the injection being given higher on the deltoid, which increases your risks.
3. For the flu shot, ask if you’re eligible for Flumist.
The Flumist version of the vaccine is sprayed into your nose — no needles! Not everyone is a good candidate for this version of the vaccine, since it’s a live vaccine. If you’re eligible, you’ll prevent any needle injury by avoiding the poke altogether.
4. Consider who administers your shot.
Pharmacies are convenient for flu shots, but how much experience does your pharmacist have with shots? Many pharmacists have a short training on giving injections, but may not give them regularly depending on the demand in their area. On the other hand, you may know your pharmacist better than your doctor’s office nurse. Ideally, you want someone who has a good amount of experience giving shots and who gives them with some regularity.
However, sometimes, you get a bad shot, no matter the person giving it. I’ve had flu shots at pharmacies, student nurse clinics and doctor’s offices without any issue, but nearly any medical professional has a risk of giving a bad shot. That’s why it’s important to pay attention and ask questions if something seems wrong, even if the professional is someone you trust.
This advice isn’t meant to warn you away from receiving vaccinations. I do think it’s vital to consider each injection as a careful medical procedure. Any medical procedure has the ability to help, but most also have the ability to harm if done improperly. Be cautious in who you choose to give an injection, and don’t feel dumb or bossy about speaking up and asking questions if you’re uncertain. It’s your health.