Vaccination-related shoulder dysfunction

We present two cases of shoulder pain and weakness following influenza and pneumococcal vaccine injections provided high into the deltoid muscle. Based on ultrasound measurements, we hypothesize that vaccine injected into the subdeltoid bursa caused a periarticular inflammatory response, subacromial bursitis, bicipital tendonitis and adhesive capsulitis. Resolution of symptoms followed corticosteroid injections to the subacromial space, bicipital tendon sheath and glenohumeral joint, followed by physical therapy. We conclude 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.     

The unstable shoulder

Not all unstable shoulders are the same, and careful patient selection ensures proper treatment. Improved understanding of the mechanisms of stability, advances in imaging and arthroscopic technology mean that repeated visits to the emergency department with a painful dislocated shoulder should be a thing of the past.