I still can’t move my shoulder after having Covid and flu jabs: Ask the GP DR MARTIN SCURR

I recently had a Covid jab at a local pharmacy and the guy administering the jab offered me a flu jab at the same time – which made sense.

But I now have SIRVA (shoulder injury related to the administration of vaccines): the pain is unbearable and I have reduced mobility in my arm and shoulder. My GP has put me on antibiotics for a week and if it doesn’t go away he will send me for scans. It’s been three weeks since the shot.

Phil Harvey, Derby.

I’m sorry to hear this – SIRVA is an unfortunate but fortunately very rare complication of injections into the deltoid muscle (the large triangular muscle that wraps around your shoulder).

It occurs when an injection is given too high in the upper arm or too deep, accidentally damaging tissues or structures in the shoulder. This results in inflammation in the surrounding tissues and bursae (fluid-filled sacs that protect ligaments and joints).

It leads to pain and reduced range of motion of the shoulder within hours of the injection, as you describe.

There are set ways to administer a flu or Covid-19 jab – or any routine vaccination for that matter. They should be administered with the arm completely exposed, in the center of the deltoid muscle (injections into the muscle are better absorbed and more reliable).

The needle should penetrate the muscle but not reach the underlying structures, and the angle between the needle and the skin should be 90 degrees.

I suspect that these instructions were not fully followed in your case. The antibiotics you have been prescribed may be a ‘belt and braces’ approach by your GP, in case an infection has been introduced.

The next step is an ultrasound to assess any damage, including inflammation, and you may be offered an injection of a corticosteroid drug such as triamcinolone.

Physical therapy can also help you regain full range of motion and strength. The shoulder will heal, but it may take several months.

I think you should report this injury as it reflects a lack of competence on the part of the vaccinator. You can do this via the website of the Quality Assurance Committee.

I developed tinnitus prior to prostate surgery, around 2016. I thought once I had the surgery all concerns would go away, and so did the tinnitus. But I still have it. Most of the time I don’t notice it because I have trained myself to ignore it.

I suffer from quiet spots, especially when I drink a lot, which is clearly not the solution, but does show that there must be a cure somewhere for what I think is a psychological version of the ringing.

Nick Eagle, Isle of Wight.

Tinnitus is when you ‘hear’ a sound that has no obvious outside source. It can cause a buzzing or ringing in the ears, which can be continuous or intermittent. Sometimes it is temporary, but many people suffer from it constantly.

In some ways it is the auditory version of Charles Bonnet syndrome, in which people with zero or near zero vision see alarming and realistic hallucinations, turned on by the visual cortex in the brain when there is no input from the eyes. It’s as if the brain is compensating for a loss of visual input.

As with tinnitus, it appears that nerve cells in the auditory cortex generate sound hallucinations.

Tinnitus is usually linked to some form of hearing loss. This may be age-related, but also as a result of, for example, an infection or a build-up of earwax.

One theory is that the auditory cortex causes tinnitus due to loss of signals coming from the cochlea, an area in the inner ear where sound waves are converted into electrical signals sent to the brain.

This may be due to damage, injury or overactive nerve cells (the latter could explain why patients with severe deafness may suffer from tinnitus).

Another theory is that it is due to changes in the balance of chemical messengers in the brain, such as serotonin, that coincide with a mood disorder such as anxiety or depression. This could explain what happened to you seven years ago, caused by anxiety prior to your prostate surgery.

The best approach is to try to reduce the impact of tinnitus through tinnitus retraining therapy, which involves teaching patients how to ignore the tinnitus. This is essentially what you’ve done, with great success, because you can ignore it most of the time.

I can’t explain why alcohol suppresses this – although alcohol, as a sedative, can reduce the messages sent by the nerve cells in the auditory cortex.

But thanks to your own efforts, you are in a good position and over time the symptoms should fade further.

I think… A sneaky tactic to avoid seeing a specialist

Do patients need a second opinion about a GP’s decision to refer them? Those in power seem to think so too; rumor has it that the Department of Health and Social Care is expanding the ‘advice and guidance (A&G) programme’.

Currently, rather than referring a patient directly for specialist hospital care, a GP can send details of a potential referral to a specialist team and ask them for advice about a patient, which may or may not mean the patient seeing the specialist .

When introduced in 2015, this was a discretionary service, but objectives are increasingly being used. Firstly, 12 out of 100 patients who GPs wanted to refer for outpatient appointments had to be tested through this system, rising to 16 in January last year.

It is now believed that a further increase in this target will be announced next month.

It feels like a strategy to reduce pressure on hospital services and waiting lists.

Because are we really to believe that GPs, after years of training and experience, do not think carefully before referring?

The A&G process is a sinister way to ration health care.

• Write to Dr. Scurr from Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email: drmartin@dailymail.co.uk. Dr. Scurr cannot enter into personal correspondence. Answers should be taken in a general context. If you have health problems, consult your own doctor.