COMMENTARY

Avoiding Shoulder Bursitis With Vaccine Administration

Sandra Adamson Fryhofer, MD

Disclosures

June 23, 2020

This transcript has been edited for clarity.

The topic is vaccination-induced bursitis and why vaccination technique matters, published in the Annals of Internal Medicine. This CDC-funded Vaccine Safety Datalink study looked at nearly 3 million vaccinated patients and found an increased risk for shoulder bursitis following flu vaccination — an additional 7.78 cases of bursitis per 1 million vaccinations.

Concerns about vaccinations and subdeltoid bursitis are not new. The Institute of Medicine voiced similar concerns in 2012. Subdeltoid bursitis occurs in about 1% of the US population, most often as a result of injury or overuse; but as this study shows, it can also occur after vaccination. Possible mechanisms of injury involve needle placement and needle length.

Perhaps a vaccination technique "tune-up" is in order. The objective is to inject into the muscle rather than through the muscle. For needle placement, know your landmarks. Aim for the midpoint of the deltoid muscle, two to three fingers' width below the acromion process, and above the armpit. Inject at a 90˚ angle — no aspiration needed. Proper needle length is determined by the patient's weight and sex.

Figure. Intramuscular influenza vaccination infographic. Centers for Disease Control and Prevention.

The ongoing COVID-19 pandemic may present challenges for vaccination for the upcoming flu season.

In traditional in-office flu clinics, patients could just put on a gown (replacing long-sleeved clothing) to allow adequate exposure of anatomic landmarks. Now, with the prospect of more drive-thru vaccination clinics and the possibility of needing to administer multiple vaccines — sometimes in nontraditional settings — it's more important than ever for patients to dress appropriately to facilitate efficient and safe vaccine administration that minimizes the risk for subdeltoid bursitis. Patients should either go sleeveless or be prepared to unzip or unbutton appropriately and adequately. For men, unbuttoning the first few buttons of a long-sleeved shirt so they can keep their tie on will not work.

We must all remember the critical, protective value of vaccination as we aspire to "do no harm" in vaccine administration. During the 2016-2017 flu season, included in this study of vaccine-related bursitis, vaccination prevented 72,000 hospitalizations and 5200 deaths.

So please, keep vaccinating!

For Medicine Matters, I'm Dr Sandra Fryhofer.

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