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Raising the Bar in Rehab

Flu Shots

Published October 6, 2011 3:00 PM by

A friend of mine developed some shoulder pain last fall and asked me to look at what the injury may be. I was a little hesitant to jump in, as I am not an orthopedic practitioner at this time, but did my best to determine the possible cause. I started with active range of motion, then some manual muscle testing and noticed she continued to describe pain in the upper deltoid area that I could not replicate other than with active shoulder flexion and palpation to the area. Long story short, my friend had developed bursitis following an influenza vaccine she received just one week earlier. 

I don't actually remember learning about that diagnosis in school; perhaps I was sleeping that day. I did some research and found an article from 2007 titled "Vaccination-related shoulder dysfunction" (Vaccine. 2007 Jan 8; 25(4): 585-7. Epub 2006 Sep 8.) and learned that flu shots (or other vaccines) inserted into the upper third of the deltoid muscle can result in injury to the muscle and may develop into more serious injuries. 

Since the H1N1 flu pandemic took over the nation, the number of mandatory flu shots for health care workers continues to grow. This article by Time magazine questions the legality of making flu vaccines a job requirement. Health care facilities generally have requirements for other vaccines, such as measles, mumps and rubella, and a flu vaccine is really no different. Yet people in any industry are protective over what goes into their bodies. Most employees want to protect their patients, but there is a valid argument regarding where is the line drawn over the right to privacy. If one vaccine becomes mandatory, what are the chances of further vaccine requirements? 

Personally, I get a flu shot every year, in spite of the risks of shoulder dysfunction. I would rather be protected than vulnerable to using more of my sick days, and I would hate to carry anything to my patients. I actually just came down with a common cold, and after coughing for the past week I remember how much I hate being sick. Learning about shoulder dysfunction following a flu vaccine just reinforces how important it is that I get my shot in my non-dominant hand! After all, I know many good physical therapists who can treat me if that should ever happen. 

What do you think? Do you get an annual flu shot? Does your employer require you to get one?


Yep, I always get my flu shot without fail.

When I worked in NYC, they were just starting to try to make it mandatory, that didn't go over so well. However, the percentage of people in that agency who voluntarily took the shot was around 85%.

Here in the UK there is a lot of fear around them due to guillan-barre outbreak which occurred in the 70's when the last swine flu came around. Currently the uptake percentage is about 45% which is higher than it has been in decades.

I think it should be personal choice as to whether or not to get a vaccine, but one needs complete disclosure as to risks and benefits before being able to make an informed decision. Also, 100% compliance is not necessary due to "herd immunity". Only a certain percentage is required as someone who does catch the flu can't spread it to someone who is vaccinated. If most people, like at my old job, are vaccinated, those who choose not to have the shot will probably not get the flu. There will be nobody to catch it from.

Good post for this time of year.

Cheers, Dean

Dean Metz October 7, 2011 12:33 PM

Interesting we target health workers for vaccines and safety.  Food service handlers do not always wear gloves when making our food (check state laws, its scary) and they may not have been vaccinated, yet when we walk into a patients room we wear gloves and have multiple shots like we left the veterinarians office.  Are food handlers less dangerous than us?  

Another question to pose is: Should we force the patients to get a flu shot too?  Most go along with the suggestion but do they understand what is being injected into them?  Perhaps more patient education.

Great post, never heard about a shoulder dysfunction from vaccines.  Good idea with having the injection in the non dominate arm.

Jason Marketti October 7, 2011 12:25 AM

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