Normally, i njection sites are focused on muscle areas and, depending on the formulation, the drug or biological is then absorbed into the bloodstream quickly or gradually. Doctors and nurses administer vaccines in four different muscular areas: deltoid muscle of the arm, vastus lateralis muscle of the thigh, ventrogluteal muscle of the hip and the dorsogluteal muscle of the buttocks. The first rule of thumb is that shorter, higher gauge needles minimize complications.

It provides the greatest thickness of the gluteal muscle and is free of penetrating nerves and blood vessels. It also has a narrower layer of fat. The dorsogluteal muscle of the buttocks, on the other hand, is linked with a higher risk of sciatic nerve injury lower back, hip, back of leg. The deltoid site is commonly used in outpatient settings, however there is a need for caution because of the close proximity of the bone, radial nerve and brachial shoulder to elbow artery.

Intramuscular injections resulting in nerve damage are fairly common, especially in children. According to a retrospective study, A literature review in the same study identified 17 reports of patients—most of which were children—with sciatic nerve injury from intramuscular injections.

A case study presented a year-old-male who developed a painful, swollen left leg after several left gluteal intramuscular injections for indications and drugs unknown. Further analysis revealed marked muscle wasting consistent with a partial sciatic nerve injury. Despite recommendations for using the ventrogluteal hip site, there are discrepancies within nursing textbooks and very few nurses choose the safest injection site.

According to a survey among registered nurses from outpatient settings, 99 percent reported using the dorsogluteal buttocks site versus 9 percent using the ventrogluteal site. A larger Canadian study showed similar findings. While 71 percent of hospital nurses most often gave intramuscular injections in the dorsogluteal site, only 14 percent used the ventrogluteal site. Further, more than one in four nurses using the dorsogluteal site were unaware of the potential nerve damage risk linked with that spot.

However, 74 percent of the nurses using the dorsogluteal site reported nerve injury as a complication in their patients. Only 15 percent of the nurses based their decision on nursing literature recommendations; 85 percent said their comfort level influenced their site selection. The findings also revealed that younger, newer nurses aged years were significantly more likely to follow the site injection recommendations as compared with their older, experienced colleagues aged 40 years or older.

All the respondents had been working in the nursing field for more than 10 years. No injection site may be without hazard, but the data indicate there is an unused best practice. What Are Intramuscular Injections?Citation: Imran M, Hayley D. Injection-induced axillary nerve injury after a drive-through flu shot. Clinical Geriatrics. Abstract: Reports of neuromuscular injuries following intramuscular influenza vaccination are rare.

However, clinicians may encounter these complications with greater frequency as more adults receive the influenza vaccination. In this article, the authors present the case of an older man who reported shoulder pain and abduction weakness for 8 weeks following an intramuscular flu shot received at a drive-through clinic.

He was diagnosed with injection-induced axillary nerve injury. This article briefly discusses the diagnosis and treatment of this injury and reviews techniques in line with shoulder anatomy that any healthcare professional administering the vaccine should use to minimize the risk of this injury. Key words: Deltoid muscle, axillary nerve, paresis, nerve damage, shoulder injections.

Millions of Americans receive influenza vaccines every year in part due to expanded community access. According to the Centers for Disease Control and Prevention CDCvaccination coverage tends to increase with increasing age, as older adults are considered one of the high-risk groups for flu-related hospitalization and death. The IM injection process is considered safe, and case reports of shoulder injuries following IM injection in the United States are rare. There are reports of occasional unexpected neuromuscular complications to the axillary, radial, and sciatic nerves documented in India, Nigeria, 6,7 and Korea.

In communities across the United States, the convenience and low cost of vaccination offered through health drives, community centers, health departments, drive-through flu shot clinics, and retail pharmacies have resulted in a higher vaccination rate. More vaccinations are likely to result in more complications. In this article, we present a case of an older man who reported pain for approximately 8 weeks after receiving an IM influenza injection at a drive-through flu clinic.

The cause of his pain was diagnosed as injection-induced traumatic axillary nerve injury. Following the case report, we review the diagnosis and treatment of this injury. For physicians, pharmacists, and nursing professionals who administer the flu vaccine in various care settings, we review administration techniques that should be used to minimize the risk of this type of injury. A year-old right-handed man presented for evaluation of left shoulder pain and abduction weakness. He had not seen a physician for the past 15 years and he never had any regular screenings performed, but he received annual flu shots.

He reported that he received a flu shot about 8 weeks earlier at a drive-through flu shot clinic offered by a hospital. He never developed a rash at the injection site, but about 5 weeks after the injection, he was not able to abduct his left arm.

There was no other specific trauma or other history of recent injections to his shoulder. His other extremities were unaffected and he had no neck or radicular pain or other symptoms. He also reported no preceding infectious illness, recent travels, or contact with sick people. On physical examination, the patient pointed to the area of pain at the midpoint of his left deltoid insertion, which was slightly tender to palpation.

There was notable atrophy of the left deltoid muscle, sensory loss on the lower half of the deltoid muscle, and he was unable to abduct his left arm.

The patient had active range of motion of the first 10 degrees of shoulder abduction, but could not abduct beyond that. Passive flexion of the shoulder was normal. Flexion and extension of the forearm and rotatory movement of the shoulder were normal.

Other than elevated blood pressure, there were no other abnormal findings. The patient declined to undergo further diagnostic testing, including nerve conduction studies and magnetic resonance imaging, because he was not a Medicare beneficiary.Last December during a routine physical exam, I received a vaccination to protect against several strains of pneumonia.

It hurt, more so than the usual injection. In the days that followed, the pain in my left shoulder worsened. Initially, I dismissed it as typical post-shot soreness. All these months later, it still hurts. My orthopedist says I have subacromial bursitis, which is chronic inflammation and excess fluid buildup in the bursa a thin, lubricated sac that prevents friction between a bone and surrounding soft tissue separating the acromion bone at the top of the shoulder from the rotator cuff.

I had no symptoms before the shot, and pain has persisted since. The needle probably entered the top third of the deltoid muscle — which forms the rounded contours of the shoulder — and probably went into the bursa or the rotator cuff, instead of lower down, into the middle part of the muscle, missing the bursa and rotator cuff entirely.

Like many, I avert my eyes at the sight of an approaching needle. Russell Huffman, an associate professor of orthopedic surgery at the Hospital of the University of Pennsylvania. Almost universally, when I ask where the shot went, they point really high up on the arm.

These injection-caused injuries often make simple tasks — such as lifting your arm to change a light bulb or reaching behind you to put your arm through the sleeve of a jacket — painful, even impossible. Some victims cannot use their shoulder at all and must find ways to compensate using the other one. Shoulder injuries become more likely as we age.

The shoulder is one of the most complex and unstable joints in the body, making it especially vulnerable to wear and tear, and to injury. Inmore than 9. Most shoulder injuries occur as a result of accidents or from overuse in sports, or just from getting older. They can also happen during everyday activities. Shoulder injuries from vaccinations are rare, according to public health officials.

I now believe she inadvertently went too high up because I was sitting in a chair — talking to someone else in the office — and she was standing. After eight days of pain, I called the practice. One of the doctors suggested I take ibuprofen for a few days. Inactivated vaccines, which are made from killed virus, contain adjuvants, or additional chemicals, that help promote a robust immune response. Injections are given to adults in the middle of the deltoid, the meatiest part of the muscle, which provides lots of space to both maximize the immune response and minimize adverse reactions.

Moreover, their shoulders began to hurt either immediately or within 24 hours, causing pain and limited range of motion. MRI scans showed, among other things, bursitis and rotator cuff tears in several of the patients. An MRI showed excessive fluid buildup in the bursa. Elizabeth Cassayre, 81, a retired schoolteacher from Napa, Calif.

I remember thinking: Will I ever be able to roll out another pie crust for my grandchildren? Between andthe compensation program received claims alleging upper-extremity injuries, including SIRVA along with others such as general arm pain and disfiguring lumps. While SIRVA has not been on the list until now, the court has awarded compensation for such injuries based on growing evidence of causation.

Shimabukuro stresses, however, that a report does not necessarily mean the vaccine caused the injury, only that it occurred sometime after a vaccination. There is no single way to treat shoulder injuries, regardless of how they occur. Treatments that work for some may not work for others. Physical therapy after an injury can help keep the shoulder flexible and strengthens the muscles that control the shoulder blade.

Cortisone injections suppress the immune response, thus relieving pain and inflammation. Bodor uses ultrasound imaging to target precise sites for cortisone injections, which cured Cassayre after several months of ineffective physical therapy.

Intramuscular Injection May Lead to Nerve Damage

Some patients undergo surgery.Forum Rules. That being said, on it's way down you might hit your "best" estrogen level and Yup that's a fine cycle. I would personally start with mg a week for a first cycle and move up from there but it's personal preference I suppose. Make sure you have your AI on hand during I am 75kgs and 5'7. I dont want to include dianabol. I wouldn't rush anything, stay at your current dose for however many weeks you planned.

Up the dose next cycle, you should be learning now. This is a long game not a sprint. Not expecting anything this week, but I am wondering typically, how long does it take for Masteron to start working?

This is my first week and today is my 3rd injection. Just curious because if I Remember Me? Register What's New? Results 1 to 18 of Hitting a nerve when injecting?

Just curious what you guys do when you hit a nerve when putting the needle in? Do you pull it out or just continue and get it over with? I usually just try to continue with the injection. Just the other say I hit one in my shoulder and the muscle was twitching pretty bad but I just pushed on. Any harm in doing that? Join Date May Posts 1, Originally Posted by yeahbuddy Join Date Dec Posts Why would I pull out? I take the pain and hope the pip wont be to bad I injected into the quad once and within a few hours I could barely walk on that leg Take the pain Sent from my SM-NU using Tapatalk.

When the wife hit my sciatic nerve while going in on my right ass cheek, I almost buckled at my knees. The God Himself. Join Date Sep Posts I am more give up to apply, and change the needle and apply on another muscle. Yeah if I were to hit my sciatic nerve I would for sure be pulling that needle out haha.

Chrisp83TRT likes this.Got the last of my 4 rabies vaccines last Saturday. The first 3 shots made my arm hurt the night I got them really bad but were fine the next day. My question is not asking for medical advice in anyway. I'm not worried about this from a medical standpoint.

My arm is super skinny and I'm always afraid someone will hit bone. As a nurse, I'm also always so scared to give IMs to skinny older patients. Specializes in Med Surg. Has 4 years experience. Nov 21, Has 40 years experience. If you arm is hurting you need to seek medical care. We can not give medical advice here whether or not you say you aren't asking for medical advice. It is possible to hit the bone or nerve but you would know that immediately.

Callyour PCP for evaluation I hope you feel better. Specializes in ICU, Telemetry. I've hit bone twice, in extremely emaciated patients despite my best efforts not to. Neither one of them seemed to be able to tell, but it freaked me out. Since Aurora said the same thing, now I wonder if the bone's that sensitive? I know when I've broken bones that as long as they were in place they didn't hurt if I wasn't putting pressure on the site foot or taking a deep breath ribs.

My sister who is extremely skinny 78lbs had an IM once and she said it felt like a knife stabbed her arm and she was in tears within seconds. I assumed they hit her bone, but from what I'm hearing, most people don't flinch. Thats why I'm thinking maybe when it hurts like heck, its a nerve that has been hit, not a bone.

But this is going into the marrow, not just hitting the outside of the bone. Has 9 years experience. I've done it twice. The first time the patient winced and said "ouch"! The second time the patient didn't even seem to notice. Of course, I don't know how they felt the next day compared to my other patients. Specializes in ER, progressive care. Has 7 years experience. I hit the bone on a tiny LOL while giving a flu shot I reacted lol but the patient was looking away and didn't even notice!

When I helped give flu shots at the hospital where I was taking my clinicals in nursing school, I gave a shot to a classmate who was very skinny, and struck bone.

I remembered my clinical instructor telling us that the patient wouldn't feel it if this happened, and to go ahead and give the shot. So I did. Not only did she not feel it, the next time I saw her in class, she told me she was the only one in her group that did not get a sore arm the day after shots were given.

I'm not saying striking bone prevents soreness or advocating hitting bone. Just relating the experience I had. Yes got all of them in the same arm.Guest over a year ago. I too had a cortisone shot in my back, when the doc was doing it, he hit the nerve. The pain was terrible, down my leg in the buttock and back. When he did this he said that is exactly where he wants it. It was so painful, all I could do was groan. I had trouble walking and had to take pain medicine for 3 days and stay in bed.

Its been 6 weeks and my leg, hip and leg hurts so bad that I can hardly move.

Needle in the wrong spot can turn injection into a big pain

How long will this pain last and what should I do. CatherineJH over a year ago. Alexander E. Trilly over a year ago. Couldn't find what you looking for? I went home right after the shot and went to bed. It was painful. The next day I could not walk. My doctor said the injection hit my nerve.

The left buttocks that I received the injection in was three times the size of my right. I had to go to therapy for 9 months.

It was very painful. I was told it would take a year for this to heal. This is April 1,I am still having pains. I have problems getting up after I sit down. What can I do? Guest over a year ago I too had a cortisone shot in my back, when the doc was doing it, he hit the nerve. CatherineJH over a year ago In reply to anonymous on - click to read.

Told my normal back surgeon and he called the other doctor in. Stated that we will not document anything he says but tell him what happened last visit during the SI injection Someone help! Guest over a year ago In reply to anonymous on - click to read. I to had shots in my si joints. As soon as doctor started he hit nerve in my right joint my leg flew up off table now couple yrs and I'm in so much pain in buttocks down my leg sometimes goes up right side of my back an neck.

I have had these flare-ups for years. It got so bad at one time that I could take it anymore.When does my current tariff end. Moving home Can Sainsbury's Energy supply my new address. Moving home - What you need to do Your online account I want to register for an online account. How do I submit a meter reading online. We know it can be difficult deciding which energy supplier is right for you. You'll see the good, and the bad - negative reviews are never deleted.

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