SHOULDER pain is one of the most common complaints we see in general practice – and now the pandemic has drawn attention to an unusual potential cause.
Generally, shoulder pain is linked to a structural flaw in its design: unlike the hip, a strong ball-and-socket joint formed mainly from bone, the shoulder depends upon a collection of muscles and tendons (the rotator cuff) in a shallow depression in the shoulder blade.
While this complex mechanism gives the arm great mobility, it comes at the price of pain across a number of different points. One of the most common causes is subacromial bursitis, where the fluid-filled sac (bursa) that cushions the tendon of the rotator cuff used for overhead activities – such as serving at tennis or painting a ceiling – becomes inflamed. This is usually as a result of overuse.
For years, there’s been a theory that vaccine injections into the deltoid muscle, which forms the contour of the shoulder and under which lies the subacromial bursa, could cause bursitis. Now a study has confirmed flu jabs can trigger this condition.
The risk is tiny, but still caution must be exercised. Given the huge number of non-medical personnel trained as Covid vaccinators, are we going to see more cases of bursitis?
Training is everything, and I was glad to note that a trainee was ‘shadowing’ the nurse who gave me my second Covid jab several weeks ago. It looks easy – but even just a rudimentary understanding of the anatomy is essential: you must place the injection deep enough, but not too deep.
GPs should be on the lookout for persistently painful shoulders in the next few months. If subacromial bursitis is suspected, consider an ultrasound. The problem usually responds rapidly to a steroid injection straight into the bursa.
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