ArticleJournal of anesthesia2026
Ultrasonographic evaluation of safer deltoid intramuscular injection sites to reduce the risk of SIRVA.
Article in Journal of anesthesia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
6 authors.
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Abstract
Intramuscular injection into the deltoid muscle has increased in Japan following coronavirus disease 2019 (COVID-19) vaccination programs and the introduction of vaccines such as Shingrix™. Limited experience with this technique may increase the risk of shoulder injury related to vaccine administration (SIRVA). Landmark-based techniques have not been sufficiently validated using ultrasonography. Thirty-four healthy volunteers were enrolled. Using ultrasound, we measured the distances and depths from the conventional injection site-defined as the intersection of a vertical line from the acromion and the axillary horizontal line (AHL)-to the axillary nerve, radial nerve, and subdeltoid bursa. The axillary nerve/posterior circumflex humeral artery was located 1.8 ± 1.2 cm from the AHL at a depth of 2.6 ± 1.2 cm. The inferior margin of the subdeltoid bursa was located - 0.3 ± 1.2 cm at a depth of 2.5 ± 0.4 cm. The radial nerve was located 9.4 ± 2.0 cm caudally. There were no differences between left and right. An injection site located 3.0-3.5 cm below AHL, with a needle depth < 1.7 cm, may represent a safer approach for injection. These findings provide anatomical insights that may help optimize injection techniques and potentially reduce the risk of SIRVA. Clinical trial registration: UMIN000048777.
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