It’s Not Just Because You Got The Shot
Getting your annual flu shot is the first and most important step in protecting yourself and your loved ones against an unavoidable flu season. For the most part, that flu shot comes with only minor side effectsfatigue, headache or muscle aches, a mild feverand they’re much more manageable than getting the flu itself.
Another side effect from the flu vaccinearguably the most common oneis pain, swelling, or redness where the shot was given. On the surface, it makes sense: You’ll have arm pain if you get a flu shot in your arm. But is your arm really supposed to be that sore after a tiny needle delivers the vaccine?
Turns out, there’s a little more to that localized arm pain according to experts. Here’s why it tends to happen, and what you can do to lessen the discomfort, both before and after you get the shot.
Treatment For Injection Related Neuropathy
Ulnar neuropathy symptoms often settle on their own, or through the use of pain medications, physical therapy and activity modifications deemed necessary by your healthcare provider. In more severe cases, surgical intervention is necessary. The standard procedure for ulnar neuropathy is Ulnar Nerve Decompression, which involves making a small cut over the inside of the elbow and dividing the bands of tissue constricting the nerve. Sometimes, repositioning of the nerve itself is necessary and an ulnar transposition is performed to alleviate persistent side effects.
Why Is Your Arm Sore
The flu shot introduces influenza virus components into your body. This can be in the form of an inactivated virus or single viral proteins.
The goal is for your immune system to make antibodies to fight off these viral components. These antibodies can then protect you against an actual influenza infection.
While the flu shot cannot cause you to become sick with the flu, your immune system still recognizes whats been injected into you as foreign.
As a result, it produces an immune response, which leads to the soreness or swelling that occurs near the injection site.
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Shot In The Arm Can Lead To Shoulder Injury
— You get a shot at a doctor’s office or a pharmacy and you end up with a serious injury.
CBS 2’s Roseanne Tellez reports on a mistake that’s becoming more common when patients are given shots.
Raul DeJesus demonstrates how he can’t raise his left arm. He has painful nerve damage in his left arm and takes powerful pain medications.
Debby Russo needed surgery to fix the damage to her shoulder.
“I knew something was wrong because I couldn’t really move my arm,” she says.
Both suffered serious shoulder injuries, not from an injury, but from their flu shot.
“It can really be quite a significant problem,” says infectious disease specialist Dr. RobertDuncan.
He says this kind of injury isn’t common but can happen and is usually because the shot is given too high in the arm.
“It goes right into the joint space instead of the muscle belly,” Duncan says.
Russo remembers how it felt: “I thought he actually stuck it into my bone.”
“Shoulder injuries really just started to become recognized,” says attorney Paul Brazil.
He notes the federal government’s vaccine injury compensation program recently added shoulder problems to their list of injuries eligible for cash damage awards. The condition is called SIRVA, or Shoulder Injury Due to Vaccine Administration.
“Most cases all fall somewhere in the $20,000 to $150,000 range,” Brazil says.
While any injectable vaccine can cause this damage, Brazil says most of his cases have involved the flu shot.
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Other Injection Site Events
Case reports that mention SIRVA also describe other shoulder injuries that can occur when landmarking is not performed correctly. Injections that occur below the deltoid muscle can hit the radial nerve and injections that are too far to the side of the deltoid muscle can hit the axillary nerve.3,4 If a nerve is hit, the patient will feel an immediate burning pain, which can result in paralysis or neuropathy that does not always resolve.3,4
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What Is Injection Related Neuropathy
The ulnar nerve, which spans from the medial cord of the brachial plexus to the hand, is susceptible to injury from vaccines. Several mechanisms can explain injection-related neuropathy, including direct trauma to the nerve fibers from the needle, hematomas caused by the injection which lead to nerve compression, and a direct toxic effect of the injected material on nerve fibers.Neuropathy involves weakness, numbness and pain resulting from nerve damage. The most common injury for injection-related neuropathy, or neuropathy induced by a vaccine, is ulnar neuropathy. The ulnar nerve in the upper arm, based on its location, is specifically susceptible to trauma from vaccinations injected too deep into the deltoid muscle or rotator cuff area. This trauma can result in nerve damage.
Why Does The Flu Vaccine Cause A Sore Arm
There are actually a few different things that can lead to you having a little arm soreness after your flu shot, infectious disease expert Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security, told Health.
For starters, the flu shot is an intramuscular vaccine, which means that it’s injected directly into a muscle in your arm. “You just had puncture in your skin and muscle,” said Dr. Adalja. “That’s going to hurt and there will be some inflammation that occurs post-trauma to that muscle and skin.”
At the same time, there’s a localized immune response happening in your arm where the vaccine was injected, William Schaffner, MD, an infectious disease specialist and professor at the Vanderbilt University School of Medicine, told Health. This means your immune system jumps into action to react to the vaccine where it was injectedyour arm. “Your immune system is really starting to take advantage of that vaccine and working on it,” said Dr. Schaffner. As a result, you’ll experience arm soreness.
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Seek Help If Its Extreme
This is all assuming you have a normal amount of pain, which is anything up to a few days worth of the same feeling of soreness you might get from a hard workout.
If it feels like something beyond that, get back in touch with your provider. Serious complications from a flu shot are rare, but possible. For example, if the needle misses your muscle and hits one of the fluid-filled sacs around your shoulder joint, you could experience pain, weakness and possible nerve damage in your shoulder.
If the pain is so bad you cant sleep, Id check in with your doctor, or if you dont have a primary care physician just call the clinic where you got the shot. But a little bit of soreness is normal, and you can use the tips above to reduce your chances of feeling it next time.
Why Does It Happen
The symptoms of SIRVA stem from the shot going into the wrong part of your upper arm or due to trauma from the needle. Research suggests that this brings on inflammation, and it could injure body parts inside your shoulder like:
- Ligaments. These tough bands of tissue connect two bones in a joint.
- Tendons. These thick cords connect muscles to bones.
- Bursae. These fluid-filled sacs cushion bones, tendons, and muscles.
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Are There Ways To Lessen Arm Pain After Your Flu Vaccine
You’ve probably heard a lot that you should move your arm after you get vaccinated, and experts say that’s sound advice. “Moving it helps with blood flow to the arm, allows for the immune cells to get in, do their jobrecognize the foreign antigenand get out,” explained Alan.
Dr. Adalja pointed out that there are no studies on just how often you should move your arm after your shot, but Holmes suggested aiming to get a little movement and stretching in there every hour for about six hours after your shot.
At the same time, Dr. Schaffner advised against working your arm too hard after you’re vaccinated: “I don’t recommend going to the gym right afterward and lifting.”
If you still develop soreness after moving your arm, you can try putting ice on the spot, Timothy Murphy, MD, senior associate dean for clinical and translational research at the University at Buffalo Jacobs School of Medicine, told Health. “Ice can help with the inflammation,” added Dr. Murphy. And if you’re still uncomfortable after that, Dr. Murphy said it’s OK to take a non-steroidal anti-inflammatory drug , like ibuprofen or acetaminophen.
Is The Nasal Spray As Effective As The Flu Shot
In the past, the Centers for Disease Control and Prevention recommended against getting the nasal spray vaccine.
The reason for this was because studies in children found that it was less effective than the flu shot for protecting against the 2009 H1N1 pandemic influenza strains.
However, there have been recent advances in the production of the nasal spray vaccine.
Since the 2018 to 2019 flu season, the
- people with underlying health conditions, such as asthma, diabetes, or cancer
- those with weakened immune systems
- individuals living in a nursing home or long-term care facility
Getting your flu shot is also particularly important in light of COVID-19. Both the flu and COVID-19 have similar symptoms and will circulate within communities this winter.
While the flu vaccine wont protect you from COVID-19, it can help prevent you from getting the flu.
In addition to keeping you out of the doctors office, this can also conserve medical resources for those that have COVID-19 or other health conditions.
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How Long Does The Flu Shot Protect You From The Flu
A flu shot should help to protect you for the duration of the current flu season. However, youll need to get another flu shot next fall.
You may be wondering why you need to get a flu shot every year. There are a couple of reasons for this. One is related to the virus itself while another has to do with your level of immunity.
Influenza viruses are continually evolving throughout the year. Because of this, last years vaccine may not be a good match for the viruses that are prevalent this flu season.
The flu vaccine protects against the strains of influenza that research predicts will be the most prevalent in the upcoming flu season.
Your vaccine will typically include four strains , but may sometimes include three .
Additionally, a 2019 research review showed that the immunity provided by the flu shot decreases quickly over time.
This is why you likely wont have enough immunity from this years shot to protect you into the next flu season.
Symptoms Of Nerve Damage From A Vaccine
This ulnar nerve impingement typically results in numbness and tingling down the arm into the small and ring fingers. It can also affect grip strength and hand/finger coordination. These injuries are different from SIRVA, which can result in shoulder pain, subacromial bursitis, or an axillary nerve injury. In rare cases, an adverse event from a vaccine can trigger a response in the peripheral nerve system which is located around the brain and spinal cord. The immune response for these events is often weakness and numbness throughout the hands and feet.Recently, My Vaccine Lawyer’s founding partner Paul Brazil was interviewed by Jodie Fleischer of NBC4 Washington about SIRVA injuries from vaccines along with the National Vaccine Injury Compensation Program, a federal compensation program for flu vaccine injuries in the United States. Paul and Jodie also discuss the frequency of vaccine injuries and the lack of public knowledge about the VICP.
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Ways To Reduce The Pain Of Your Flu Shot
First, recognize that there might be some soreness, and plan for it. Get the shot in your left shoulder if youre right handed, for example. If youre often sore after a flu shot, consider not scheduling the shot right before arm day in the gym.
Next, ask your provider if its okay to take a pain reliever like ibuprofen before or after the shot. Sometimes that helps.
Relax your muscle before the needle goes in. Injections tend to hurt more if a muscle is tensed.
Finally, move your arm around after the shot. This may help because it moves the injected liquid around your arm a bit, so that when that inflammatory reaction occurs, its not as concentrated in one place. Also, its important to recognize that its just soreness, not a serious injury, and you can move around and use your shoulder. Dont baby it. Whether a few arm circles after the shot could actually reduce late-night pain, we arent sure, but in general the muscle soreness tends to feel better with movement.
Deltoid Bursitis As An Adverse Event Following Injectable Influenza Vaccine In The Vaccine Safety Datalink United States 20162017
- In 2012, the Institute of Medicine reported that the injection of a vaccine can cause deltoid bursitis, a type of shoulder injury that can include severe inflammation and pain. To date, there has never been an epidemiologic study to determine how often deltoid bursitis occurs after vaccination. We used the Vaccine Safety Datalink, a collaboration between CDC and eight participating healthcare organizations that examines electronic health and vaccine records, to see if we could answer that question with regard to flu vaccination.
- About 2.9 million people received a flu shot in the 2016-2017 flu season. Of those, we identified 16 cases of bursitis that started within two days of vaccination. This meant that there were an additional 2.5 cases of bursitis for every million people who got a flu vaccine that year.
- CDC education programs are underway to improve vaccine provider awareness about the risks of bursitis and how it can be prevented through proper injection technique. CDC will continue to monitor the rates of bursitis and other shoulder injuries following vaccination, and focus training and education programs accordingly.
Elisabeth Hesse, MD, MTM& H, EIS Class of 2017
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Are There Any Other Options For The Flu Vaccine Besides Getting A Shot
In addition to the flu shot, a nasal spray vaccine is also available. You may see this vaccine referred to as FluMist or the live attenuated influenza vaccine .
This vaccine is sprayed into your nose. Unlike the flu shot, it contains active influenza viruses. However, these vaccine viruses have been weakened so they wont cause an infection.
Like the flu shot, the nasal spray has some potential side effects. These can be different in adults and children and can include:
The nasal spray vaccine is approved for individuals ages 2 to 49. Its not recommended for certain groups, such as pregnant people and those with a weakened immune system.
If youre interested in receiving the nasal spray vaccine, talk with your doctor about whether its a safe option for you.
How Can I Prevent Arm Pain After A Flu Shot
Flu shots are more important than ever this year so I hope youre all scheduling yours, if you havent gotten one already. But when you do, you might have a sore shoulder for a couple of days. A reader asks if theres a good way to prevent that soreness:
Not everyone gets a sore arm after a flu shot, but its pretty common. The pain is because your immune system has to react to the antigen in the vaccine , and that process involves inflammation, and inflammation tends to involve soreness, redness, and swelling. These are the most common side effects of almost every vaccine.
The amount of inflammation from a flu shot is fairly minimal, and for many of us the pain is mild, but everybody experiences it differently. Some people have a better pain tolerance than others, for example, and pain also has a lot to do with expectation: If you expect the shot to hurt, and spend a lot of time thinking about how much it hurts, you may have a harder time than someone who gets distracted and forgets to even think about it.
The pain can also vary from shot to shot. Some vaccines have a reputation for being more painful than others, probably because their contents provoke a more pronounced immune reaction. If Im ever getting more than one shot in the same visit, I always ask if one tends to cause more soreness than the other, and I choose which one goes in which shoulder accordingly.
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Shoulder Injury Related To Vaccine Administration
Shoulder injury related to vaccine administration is “shoulder pain and limited range of motion occurring after the administration of a vaccine intended for intramuscular administration in the upper arm . . . thought to occur as a result of unintended injection of vaccine antigen or trauma from the needle into and around the underlying bursa of the shoulder”.
How To Report An Ulnar Neuropathy Vaccine Injury
In the wake of a suffering damaging side effects to your nervous system from the influenza vaccine or another vaccination, you should immediately notify your doctor’s office. Be sure to provide the date of vaccination, the vaccine administrators information and the site of injection Your medical provider will ensure that you begin a course of treatment to best address your symptoms. Additionally, you should:
- Tell your doctor exactly what happened, the date and time of your vaccine, and shoulder it was given
- Ask your doctor to file a Vaccine Adverse Event Reporting System form.
VAERS stands for the Vaccine Adverse Event Reporting System, which is a program managed by the CDC. The program processes submitted reports of vaccine injuries and adverse events from those who have been injured. It is important to note that VAERS does not diagnose those who have been injured with a vaccine injury, but rather compile data about reported adverse reactions for the CDC and the Food and Drug Administration in hopes of improving vaccine safety measures in the future. There are no restrictions to who can file a VAERS report and it is often used as supplemental evidence in vaccine cases when determining the onset of an injury or symptoms.
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