Sir, – It is usual recommended best vaccination policy from the HSE and internationally to inject the deltoid muscle in the non-dominant limb to reduce the likelihood of a localised painful muscle, and soft tissue reactions which may impair function for a few days.
A patient of our service with moderately severe rheumatoid arthritis had her dominant (right) arm injected with the flu vaccine just over two months ago. As a consequence, she has had a two-month complication of a significantly disabling and painful albeit rare immunological complication called brachial neuritis which can occur a few days after a vaccination and last for weeks to months to years.
The injection was performed by the practice nurse in her GP’s practice. Thankfully, in the past week, the patient has had a 70 per cent (her calculation) reduction in the disability, loss of power, pain and paraesthesia felt down her dominant arm into her fifth finger which came on two days after the vaccination. Her reaction was associated with sleep disturbance and loss of power in her hand and arm. Everyday activities were difficult such as cooking, cleaning and self-care.
As there will be a lot more vaccinations given over the next months and many by people less familiar with the recommendation of vaccinating the non-dominant arm (nurses, pharmacists and doctors) this should be a reminder of the recommended practice. In those living alone with significantly impaired upper limb function in both arms before vaccination, where any further reduction might impair independence critically, vaccinations in the buttock or thigh may be considered as possible alternative sites for the vaccination. – Yours, etc,
Dr AINE CONNERTON,
Dr MUHANAD MOHAMED
Dr DARRAGH FOLEY-
NOLAN,
Rheumatology
Department,
University Hospital
Waterford.