Greater humeral tuberosity erosions commonest MRI finding in chronic shoulder injury related to vaccine administration

The COVID-19 pandemic has brought vaccinations back to the center of attention for global health. In rare cases, local pain can be severe and persist over weeks with limited limb function. In this scenario, shoulder injury related to vaccine administration (SIRVA) has to be excluded. SIRVA summarizes injuries to the shoulder joint or surrounding tissues that are typically considered to be caused by vaccine misapplication.

Ricardo Donners et al found in a study that the greater humeral tuberosity erosions, infraspinatus muscle tendonitis, capsulitis, synovitis, and bone marrow oedema were common MRI findings in chronic SIRVA. The study was conducted at University Hospital Basel, Basel, Switzerland. It has been published in ‘Skeletal radiology’ journal.

While the pathogenesis is not yet fully understood, injection into the bursa or intra synovial vaccine deposition appear to trigger a prolonged autoimmune response, targeting extracellular matrix proteins, which results in bursitis and chronic joint inflammation.

Two fellowship-trained musculoskeletal radiologists retrospectively reviewed the MRI of nine patients with clinically established SIRVA. Study inclusion criteria were, with the exception of SIRVA, otherwise healthy adult patients without pre-existing shoulder injury, a known time point of vaccine administration and the vaccine type, availability of diagnostic, intravenous (iv) contrast-enhanced shoulder MRI > 4 weeks and <2years after vaccine administration.

Patients were excluded when clinical history and SIRVA diagnosis were equivocal, systemic, especially rheumatic disease was suspected or confirmed, or when iv contrast-enhanced MRI was not available.

3 T MRI was performed at least 4 weeks after vaccination and included Gadolinium-based intravenous contrast-enhanced sequences. MRI was reviewed for the presence of erosions, tendonitis, capsulitis, synovitis, bone marrow oedema, joint effusion, bursitis, cartilage defects, rotator cuff lesions, and lymphadenopathy. The number and location of focal lesions were recorded.

Findings of the study were:

• Erosions of the greater tuberosity were present in 8/9 (89%), tendonitis of the infraspinatus muscle tendon in 7/9 (78%), capsulitis, synovitis, and bone marrow oedema in 5/9 (56%) cases, respectively.

• Effusion was found in three, and subdeltoid bursitis, rotator cuff lesions as well as cartilage defects in one patient, respectively.

• None of our included subjects showed axillary lymphadenopathy.

The authors concluded that - ‘greater humeral tuberosity erosions, infraspinatus muscle tendonitis, capsulitis, synovitis, and bone marrow oedema were common findings in chronic SIRVA in this case series. These findings should alert the radiologist to a potential SIRVA diagnosis in an appropriate clinical context.’

Further reading:

Chronic stage magnetic resonance imaging findings in patients with shoulder injury related to vaccine administration (SIRVA)

Ricardo Donners, Julian Gehweiler et al

Skeletal Radiology

https://doi.org/10.1007/s00256-023-04334-3