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improper flu shot
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improper flu shot

Would anyone here have a clue as to what a flu shot given in the shoulder joint and bone may cause?  I know it's highly unlikely it would happen, but trust me it did, and I'm not the only one.  The nurse's supervisor, who is also a doctor, stated she had given them too high as she was apparently trainined wrong.  My MRI showed bursitis and bone marrow edema and this was three months afterwards when I could finally convince my own doctor there was something wrong.  The pain has gone from sharp shooting, to hot achy, to shooting down the arm and stiffness.  When you think it's going to get better it comes right back again.  I'm only 30 so it worries me as I can't do an activity without it hurting afterwards, and there is no rotor cuff damage.
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Avatar_dr_m_tn
Your experience with the influenza vaccination is an unfortunate and infrequent occurrence.

An improper injection into or around the shoulder joint can result in an inflammatory response (the bursitis). Also, if the injection is given "too deeply" -- at the surface of the upper arm bone (the humerus), there can be inflammation of the bone as well.

In addition to soft tissue, muscle, and periosteal (around the bone) inflammation, nerves can be irritated or even traumatized by a vaccination. It is possible that a nerve has been inflamed based on your report of "shooting down the arm." Usually, this improves with time.

I would encourage you to remain as active as you can and to use your shoulder and arm as much as you can tolerate. Ice therapy applied to the areas where you have discomfort can provide significant relief.

Your symptoms should become less and less over time. However, the complete recovery may take weeks to months.

I hope that this comment/answer is helpful to you.


~•~ Dr. Parks

This answer is not intended as and does not substitute for medical 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.
9 Comments
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Avatar_n_tn
The MRI was done 3 months after the shot was given and still showing ( I hadn't had a prior MRI), as stated in the report, "marrow like edema" of 3cm by 2cm by 1.5cm, slight bursitis and periosteal fluid around something.  Would it be normal for there to still be that much edema that far out, as I have maintained staying active?  After the MRI  it was easier to convince people that there was something wrong and they huried me back in for bloodwork to rule out an infection.  I wish I would have had an MRI a few weeks after the shot when the pain was extremely sharp so I could have compared, but trying to get someone to take you serious that you're still in pain from a flu shot can be a tough task.  It's been five months now and I've noticed my shoulder pops and didn't use to and it still gets sore.  The pain seems to come and go, but feels as though it's from the head the bone, it's a deep pain.

Thanks
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Avatar_dr_m_tn
Where exactly in your arm did you receive the injection? In the should muscle (deltoid)? Above the deltoid? Below the deltoid?

There are case reports in the medical literature that describe shoulder and upper arm problems after vaccinations. If the injection was given too high in the shoulder, it is possible that the subdeltoid bursa can become inflamed and this would cause a deep pain that would be worse with arm activities over your head and with raising your arm from your side. If the injection was given too low (below the deltoid muscle), then it is conceivable that the needle could strike the bone of the upper arm (humerus). It would be quite unusual for the mild trauma of a vaccination to result in "bone marrow edema" (swelling inside the bone). Periosteal edema (swelling or fluid) refers to swelling on the outside surface of the bone.

Do your health care providers have plans for re-imaging your arm?

Is the pain decreasing?

Have you ever had shoulder pain before?

Please feel free to keep the dialogue going.

~•~ Dr. Parks

This answer is not intended as and does not substitute for medical 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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Avatar_n_tn
It was given in about the same location as you would receive a cortisone shot, so above the deltoid.  I have never had shoulder pain of any kind before this, nor any kind of anything.  My medical record is pretty bleak, basically it would show I was born, had a mole removed, and this.  The radiologist suggested plain films or CT to help exclude evidence of subtle periosteal reactino and a follow up MRI in 2-3 months.  Trying to get the care has been a hassle but that is a whole other story because of the intertwining of the insurance company, doctors, and hospital (the hospital owning them all), and the hospital is the one that gave the shot.  My doctor told me to just put heat on it and take ibuprofen.  I didn't understand putting heat on something that was swollen.  The pain itself has decreased where I don't get the sharp pain with every movement that I had at the beginning, but I still have that deep pain after activity, usually when lifting something weighted, and stiffness in the morning which has never completely gone away.  I also got the stomach flu after this and with that my shoulder got just as worse as it had directly after the shot.  The pain is worse with overhead activity or if you lean on your elbow putting weight on the shoulder joint itself.  Right now it's more of a nagging pain which bugs me because I would like to know why it has never gone away

Here are the exacts of my MRI if that will spread some insight  



Rotator Cuff:  no partial or full thickness tears.  There is a mild increased signal in the subacromial subdeltoid bursa overlying the supraspinatus tendon and a small element of bursitis cannot be excluded.  Muscle signal and bulk are normal.

Labrum:  intact

Biceps tendon:  Intact and located

Bone:  In the region of the greater tuberosity, there is a focal area of edema-like bone marrow signal measuring 3.0 x 1.5 x 1.0 cm.  This area most closely corresponds to the region of the terres minor insertion.  Mild low T1 signal in this region.  No destructive lytic or blastic bone lesion in this region.  No surrounding cortical distruction, but there is a small sliver of periosteal edema/fluid.  

Misc:  No soft tissue masses.  No joint effusion.
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Avatar_n_tn
I should mention too that I play volleyball every week.  If I had any type of shoulder issue I would have been well aware of it while playing, and I have never had pain.  Also as mentioned, the Doctor from the hospital whose nurse gave the shot stated he had 10-15 cases already from the same nurse.  Two of those are my office staff whom are having the same issues.  One's MRI showed nearly identical to mine, the others showed arthritis, which she had never had.  We all have experienced the same pain after this shot.  All of us are also thin, which may have played somewhat to the effect as we don't have the extra fat and I'd be curious as to if the others that had the issue were also thin.  The shot was given on Monday and everyone in the office was experiencing soreness through Friday as she gave the shots high to everyone.  The three of us had the continued soreness into the next week and that is when it really kicked up and started huring worse, roughly 10 days after the shot.
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Avatar_dr_m_tn
Thank you for the additional comments and information. It would be nice for your case and your colleagues' cases to be written up in the medical literature so others may at least learn from this unfortunate event.

- Dr. Parks
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Avatar_n_tn
You're welcome.  I'm glad to have someone listen.  In your opinion is that odd for an MRI to still show that 3 months out?  What is the normal timeline for edema and such to be reabsorbed?  I know that is hard to judge since there is no comparison MRI early on to see if there has been improvement.  What is your opinion of those MRI results?  My concern is if this is going to cause me long term pain or lead to anything else which is something we've all been having a hard time getting an answer since everyone seems to be puzzled by it and there really isn't a lot of information out there in this regards.  
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Avatar_n_tn
How long does it normally take for Edema to clear up or reabsorb?
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Avatar_dr_m_tn
Bone marrow edema, depending on the cause may take for 3-6 months to resolve.

And, I would encourage you to not use heat. As you mention in your post, heat can result in worsening edema, swelling, and pain in the setting of already present edema.

The follow-up MRI hopefully will demonstrate less and less edema over time.

~•~ Dr. Parks

This answer is not intended as and does not substitute for medical 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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