Understanding SIRVA injuries: causes, symptoms and treatment

Posted: 27/03/2025

In recent years, SIRVA - which stands for 'shoulder injury related to vaccine administration' - is a term that has been gaining attention in the medical community. This type of injury occurs when a person experiences shoulder pain or injury after receiving a vaccine. While vaccines are a crucial part of maintaining public health, the occurrence of SIRVA has raised concerns, especially regarding the technique of vaccine administration. 

Our team has been receiving a high number of enquiries from patients who have received a diagnosis of SIRVA and wish to know whether they can make a clinical negligence claim. We are currently in the process of investigating some of these claims to determine whether the legal tests for negligence can be demonstrated. This article will explore SIRVA, its causes, symptoms and treatment, as well as making a claim.

What is SIRVA?

SIRVA appears to occur when the needle is inserted incorrectly or inappropriately into the shoulder joint area, resulting in an inflammatory response and damage to the muscles, nerves or tendons surrounding the shoulder. The injury typically manifests itself within a few days or weeks of being vaccinated and can lead to significant pain, discomfort and, sometimes, long-term disability. 

The SIRVA injuries are most commonly associated with vaccines administered in the upper arm, such as the flu or Covid-19 vaccine, but they can occur with any injection given in the shoulder region.

Causes of SIRVA

SIRVA injuries typically appear to result from inappropriate injection techniques. Intramuscular vaccinations administered into the upper arm should be delivered with the needle at a 90-degree angle into the middle of the deltoid muscle. This tends to be around 2.5cm below the acromion process, which is a bony prominence at the top of the shoulder joint. The acromion process should be located and used as a landmark in order to administer the injection correctly into the deltoid muscle. 

SIRVA can occur in the following instances:

Incorrect needle placement: When the vaccine is injected too high or too deep into the shoulder, it can damage the muscles or tendons in the rotator cuff or the bursa.

Injection into the shoulder joint: If the needle enters the shoulder joint itself, it can cause direct injury to the structures inside the joint, including the cartilage, ligaments and tendons.

Where there has been a negligent failure to correctly identify the appropriate injection site and the injection has been inappropriately administered into the bursa or the shoulder joint, it may be possible to bring a clinical negligence claim.  

Symptoms of SIRVA

Common signs and symptoms include:

Pain: The most common symptom, typically starting as a sharp, localised pain in the shoulder. Over time, this pain may radiate down the arm or increase in intensity. This will typically significantly affect a patient’s ability to perform daily activities and will often affect the patient’s sleep.

Swelling: Inflammation around the shoulder joint and upper arm can occur, making the shoulder appear swollen.

Stiffness: Many people with SIRVA experience a limited range of motion, making it difficult to raise the arm or perform overhead activities.

Tingling or numbness: Damage to the nerves in the area may cause sensations of tingling, numbness or weakness in the arm.

Weakness: As the muscles in the shoulder are affected, there may be noticeable weakness, making tasks like lifting, carrying or reaching more difficult to do.

Diagnosis of SIRVA

A healthcare provider will typically diagnose SIRVA based on the patient's history and symptoms. Since the injury occurs soon after vaccination, the healthcare provider will often inquire about the timing of the vaccine and the nature of the pain.

To confirm the diagnosis, an ultrasound or MRI may be used to assess the damage to the shoulder joint, muscles, tendons, or ligaments. 

SIRVA can often manifest as subacromial bursitis (ie inflammation of the bursa, a fluid-filled sac that cushions the shoulder joint), and this is the diagnosis many of our clients have been given.

Treatment for SIRVA

Treatment for SIRVA varies depending on the severity of the injury. The goal is to reduce pain, improve mobility, and allow the shoulder to heal properly. Five common treatment methods include:

1. Rest and ice: The first step in treating SIRVA is to rest the shoulder and apply ice to reduce swelling and inflammation.
2. Physiotherapy: In mild to moderate cases, physiotherapy may be recommended to restore the range of motion and strength in the shoulder. A physiotherapist will guide the patient through exercises designed to promote healing and prevent further injury.
3. Anti-inflammatory medications: Over-the-counter pain relievers like ibuprofen can help reduce pain and inflammation. In some cases, stronger prescription medications may be necessary.
4. Corticosteroid injections: For more severe cases, corticosteroid injections may be used to reduce inflammation and provide temporary pain relief. However, these are not long-term solutions.
5. Surgery: In rare cases, surgery may be necessary to repair damage to the shoulder muscles, tendons or joint structures. This is usually only considered if conservative treatments fail.

Claims for SIRVA

To succeed in bringing a clinical negligence claim for SIRVA, it is necessary to prove two things:

1. First, we have to establish that there has been a 'breach of duty' – in other words, that no reasonable and responsible body of clinicians would have provided the treatment that was given.
2. Secondly, if we can establish any breaches of duty we must go on to prove what injuries have been caused as a result and that this would not have happened but for the breaches of duty – this is known as 'causation'. 

Both breach of duty and causation need to be established for a claim to succeed. 

Compensation
In a successful claim, compensation may be awarded for the following:

• pain, suffering and loss of amenity;
• care and assistance required as a result of the injury;
• loss of earnings where applicable;
• cost of employing a gardener, decorator or handyman;
• cost of private treatment and medication;
• aids and equipment;
• travel expenses.

Time limits
It is important to be aware of the time limits involved in bringing a claim. In most cases, a claim for damages as a result of injuries must be issued (ie, court proceedings commenced) within three years of the date of the negligent act or omission. On occasion, it may be the case that the limitation period starts on a later date if you first became aware of a significant injury that may have been caused by a negligent act or omission.

How we can help
Our team of experts have had success in securing damages for clients who have suffered from SIRVA.

Rosie Nelson, senior associate at Penningtons Manches Cooper, comments: “The number of enquiries we are receiving relating to SIRVA is concerning. Clients are reporting very similar experiences of a vaccination being administered unusually high up in their arm, with immediate pain and loss of function in the shoulder which persists, and with no prior history of shoulder injury. 

“Although vaccinations are crucial in preventing illness, it is vitally important that those administering them are adequately trained and are injecting their patients with due care and attention, adopting appropriate intramuscular vaccination techniques. I would urge anyone who has been affected by SIRVA to come forward so that they have the opportunity to obtain legal advice as to whether or not they may have a claim”.

If you have suffered an injury following a vaccination and you would like to investigate a potential claim, our specialist orthopaedic injury team is here to offer an informal discussion to explain your options, please call 0800 328 9545, email clinnegspecialist@penningtonslaw.com or  complete our online assessment form.

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