Publication date: Sep 01, 2023
The pathogenesis of SIRVA is incompletely understood, but it is postulated to be an immune-mediated inflammatory response to a vaccine antigen, leading to shoulder pain and dysfunction. The purpose of this investigation is to systematically review the literature related to SIRVA specifically after the COVID-19 vaccination by describing the diagnostic and clinical characteristics, diagnoses associated with SIRVA, and incidence between vaccine types. A systematic review was performed to identify level I to IV studies and case descriptions of shoulder pain occurring after COVID-19 vaccination. To confirm that no studies were missing from the systematic review, references of studies from the initial search were scanned for additional relevant studies. A total of 22 studies, comprised of 81 patients, were identified meeting the inclusion/exclusion criteria. Reports were most commonly published from countries in Asia (53. 1%; n = 43/81). The most commonly described vaccines were Oxford-AstraZeneca at 37. 0% (n = 30/81) and Pfizer-BioNTech at 33. 3% (n = 27/81). Symptoms occurred most commonly after at least 72 hours of administration (30. 9%, n = 25/81). One hundred percent of patients (n = 81/81) described pain as an associated symptom and 90. 1% of patients (n = 73/81) described multiple symptoms. The diagnostic modalities utilized to identify a specific pathology consisted of magnetic resonance imaging (MRI) (55. 6%; n = 45/81), ultrasound (28. 4; n = 23/81), radiograph (25. 9%; n = 21/81), and computed tomography (CT) (4. 9%; 4/81). Nearly a third of patients (32. 1%; n = 26/81) were diagnosed with bursitis, while 22 (27. 2%) were diagnosed with adhesive capsulitis, 17 (21. 0%) with either rotator cuff tear or tendinopathy, and 14 (17. 3%) with polymyalgia rheumatica (PMR) or PMR-like syndrome. The two most common treatment options were physical therapy (34. 6%; n = 28/81) and nonsteroidal anti-inflammatory medications (NSAIDs) (33. 3%; 27/81). The majority of SIRVA cases (52. 1%; n = 38/73) completely resolved within a few weeks to months. Despite the limited quality and lack of large-scale studies, it is important for providers to recognize SIRVA as a potential risk factor as the number of patients receiving COVID-19 vaccinations and boosters continues to rise.