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Chronic Arm Pain
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Chronic Arm Pain

Hello, I have read all your Q&A's on this topic.  I received the Flu/H1N1 in Septempber, 2010. Still having pain and some loss of ROM in that arm 6 weeks later, I notified employee health who were to busy to see me so directed me to the ER where I was dx with a Sprain ( no injury though) and dc'd on warm soaks and NSAIDS. No improvement ,so then directed to an Ortho Surgeon who ordered PT for 6 weeks, Never did get totally pain free or full ROM. 4 months later,sent to another Ortho with DX Left RC tendonitis. Is now 10 months since this started, 2 cortisone injections later, still unable to so some ADL's without help d/t pain and limited ROM. Dr.is talking possible surgery to "clean out" the arm. I continue to work with no loss of time,had no limitations since I am able to work around the pain and inablity to raise my arm or bend it behind my back. MRI possibly next visit. If I do elect surgery, it won't be until next winter when I can get some PTO. Is it at all possible this is still related to the injection ? We are required to have a TDap booster by August,2011 (can only decline if proof of reaction) and then the flu/H1N1 rolls around again by Oct. We are required to wear masks at all times if we decline the flu shot. I am terrified that if this happens again in my dominant arm (R), I won't be able to work or even take care of myself. I asked and the gluteus is a no, but vastus lateralis is acceptable for injection sites. Any advice or information would be greatly appreciated. Thank you.


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Avatar_dr_m_tn
Hello,

Unfortunately, I will not be able to definitively provide information regarding a cause and effect relationship between the H1N1 vaccine and your shoulder pain.

Some of the key details to consider:

1. Where on your arm was the vaccine administered? Was the vaccine administered at the upper 1/3 of the deltoid? If so, there is a possibility of the vaccine injectate being injected into or around the subdeltoid bursa depending on the administration technique and your specific shoulder anatomy.

2. When did you begin to have symptoms? That is, how long after the vaccine was administered did you begin to have difficulty with range of motion, pain, etc?

3. A primary injury to the rotator cuff is very unlikely. However, with inflammation of the subdeltoid bursa (bursitis), people tend to use their shoulder less, experience some atrophy of the rotator cuff tendons and then may be diagnosed with rotator cuff tendonitis. This is usually a clinically determined diagnosis without an indication for imaging (unless a rotator cuff tear is suspected).

4. An alternative site for the next vaccine is a reasonable thought.

5. Also, a common recommendation is administration of a vaccine in your non-dominant arm.

Please follow-up with additional questions that you may have.

~•~ Dr. Parks

This answer is not intended as and does not substitute for medical or legal advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.
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Philip D Parks, MD, MPH, MOccH, F...Blank
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