Intramuscular Injection May Lead to Nerve Damage

Intramuscular Injection May Lead to Nerve Damage

injection in the arm
Intramuscular injections resulting in nerve damage are fairly common, especially in children.

Drug and biological product administration via intramuscular injections using hypodermic needles has been a common medical practice for several centuries and is not going anywhere soon—from vaccines, antibiotics and insulin to an experimental injectable male contraceptive in development.1 The main issue with intramuscular injections is that if the hypodermic needle containing the drug or biological is injected incorrectly into a muscle or another part of the body, it could cause serious harm.

Hitting the Sweet Spot

Once administered exclusively by physicians, nurses began to take on the duties of giving intramuscular injections starting in the 1960s as children were being injected with an increasing number of vaccines. Normally, injection 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.2 And while it does depend on the agent injected, specific injection sites can decrease the risk of injection-related injuries. The first rule of thumb is that shorter, higher gauge needles minimize complications.

Secondly, guidelines recommend administering shots in the upper outer quadrant of a person’s buttocks: the ventrogluteal muscle of the hip. 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.3

Nerve Damage Resulting From Gluteal Intramuscular Injections

Intramuscular injections resulting in nerve damage are fairly common, especially in children. According to a 2000 retrospective study, 86.2 percent of study subjects experienced gluteal sciatic nerve injuries caused by intramuscular injection.4

A review of claims in New Zealand’s Accident Compensation Coorporatoin between 2005 and 2008 reveals that eight claims were for sciatic nerve injury as a result of intramuscular injection. A literature review in the same study identified 17 reports of 1506 patients—most of which were children—with sciatic nerve injury from intramuscular injections.5

A 2006 case study presented a 25-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.6

Nurses Commonly Using Wrong Injection Site

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 2007 survey among registered nurses from outpatient settings, 99 percent reported using the dorsogluteal (buttocks) site versus 9 percent using the ventrogluteal site.7

A larger 2011 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 20-24 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.8 9

No injection site may be without hazard, but the data indicate there is an unused best practice. “The implications for nurses include the need to learn and practice safe injection technique,” the researchers wrote. “Proper training and an anatomical understanding of the sciatic nerve course are essential.”10


References:

1 Behre HM, Zitzmann RA, Anderson DJ, et al. Efficacy and Safety of an Injectable Combination Hormonal Contraceptive for Men. The Journal of Clinical Endocrinology & Metabolism Oct. 27, 2016.
2 Cafasso J. What Are Intramuscular Injections? Healthline Oct. 5, 2015.
3 Omoigui S, Ogbechie C and Fadare A. Reinventing IM and Procedural Injections: The Sota Omoigui Short Needle Technique. Practical Pain Management Feb. 9, 2016.
4 Huang Y, Yan Q, and Lei W. Gluteal sciatic nerve injury and its treatment. Chinese Journal of Reparative and Reconstructive Surgery 2000;14:83-86
5 Mishra P and Stringer MD. Sciatic nerve injury from intramuscular injection: a persistent and global problem. International Journal of Clinical Practice July 27, 2010.
6 Ramtahal J, Ramlakham S and Singh K. Sciatic nerve injury following intramuscular injection: a case report and review of the literature. Journal of Neuroscience Nursing 2006;38:238-40.
7 Floyd S and Meyer A. Intramuscular injections—What’s best practice? Kai Tiaki Nursing New Zealand 2007;13:20-22.
8 Walsh L and Brophy K. Staff nurses’ sites of choice for administering intramuscular injections to adult patients in the acute care setting. Journal of Advance Nursing 2011;67:1034-40.
9 Wiley-Blackwell. Most nurses don’t use recommended intramuscular injection site despite potential risks, study finds. Science Daily May 9, 2011.
10 See Footnote 6.

14 Responses to "Intramuscular Injection May Lead to Nerve Damage"

  1. Jo   January 4, 2017 at 3:37 pm

    I see plenty of nurses smoking cigarettes outside my local hospital buildings. It isn’t surprising they don’t know (and likely don’t care to know) about safer injection sites. After all, most in the ‘health’ field don’t know the first thing about vaccines, so why would they wish to know about injection sites?

    Reply
  2. Debra D Swanner   January 4, 2017 at 9:32 pm

    My son has damage to his right hip
    In regards to being given a shot to the hip. She but his sciatica nerve and hurts all the time. Some days all he can do is limp. Is there someone that I can talk to regarding this issue?

    Reply
  3. James   January 4, 2017 at 10:45 pm

    What does their smoking have to do with whether or not they don’t know or don’t care about safer injection sites? You are correct in your remark about most in the health field not knowing about vaccines, but whether or not they wish to know about injection sites is most likely not their preference, but their ignorance of there being a best site for injections.

    Reply
  4. barbara   January 5, 2017 at 12:50 pm

    I had an injection into my left forearm in Feb. 2001, that has done considerable damage to my body (the contents of the injection were the issue, and also that it was injected into a vessel). The response was instant, I could not talk, walked out of the office like a zombie, had tachycardia 10 minutes later while driving on a freeway. This so called nurse did it with intent because I irritated her by asking too many questions, at a Public Health Dept in San Diego. The manufacturer of the product representative told me I was given an overdose. It was an inch of fluid in the needle, I watched, and when I protested that it was too much she jammed it in hard. I had no voice as it was very difficult to speak and walk for years.
    Yet no doctor wants to deal with my issues. No attorney wanted to deal with this sort of case. Still have pain in the site on left arm, plus whole body, especially head pain involving ears.
    And yes I do try to avoid doctors by taking good care of what I have left of myself.

    Reply
    • Maria L   June 24, 2017 at 7:43 pm

      I’ve had very similar issue. If you have interest in exchanging information, let me know by text and we can exchange contact info.

      I’ve have great legal representation on my impending complaint.
      And I’ve gotten references to the top 3 doctors in the country to address recovery.

      Thanks
      Maria

      Reply
      • Ila kang   September 25, 2017 at 12:50 am

        Please email me the drs you have information on regarding IM gluteal injections.

        Reply
      • Jay B   August 25, 2018 at 2:48 pm

        Hi Maria
        I had a similar experience, and the doctor was irritated because I had complained about the previous doctor because that doctor doubted my regular Neurologist’s (who was on maternity leave) decision to give me the series of Botox injections when I did not have spastiscity on that arm.

        I live in San Diego, and would like to share info. I think I might have nerve damage. The doctor refused to give me a gown, and told me to roll up my long sleeve, and although I protested, he went on and gave me the injection anyway. The was standing on my left side and gave the injection 30 degree inclined, from the top of my arm. The area was squished and the injection was administered high on my shoulder. Now I have tremors like seizures of my left hand, in the mornings I need help to get up, I feel electrical shocks and numbness. I wake up several times in the night and feel very tired in the morning. My primary doctor said I have Frozen Shoulder but refused to give me an MRI because the X-Ray looked fine. Yesterday I got the trembling while I was working on my computer. I’m about to start looking for a job and certainly would not want to have this hand seizures at work, or worse yet, at the interview…

        Reply
      • Virginia   October 12, 2018 at 10:42 pm

        Hello my name is Virginia. I had a shot in my butt in May 2018 and have had problems ever since then. I can tell it`s the nerve, it burns and hurts all the time. I went to a Chiropractic Dr. and that did not help. I`m loosing time from work, I can not do anything. Could you please refer me to a lawyer who is not scared of the Dr`s?

        Reply
  5. Winslow Ching   October 10, 2017 at 10:13 am

    Hello, I too would like the names of the medical doctors and lawyers that Maria mentioned. Thank you.

    Reply
  6. Marilyn Cassidy   November 18, 2017 at 8:31 pm

    I took great intrest in all the comments made and bad experence everyone has to shear. I have kinda been in the situation myself. This was not related to any vaccine. In 1979 I was at the age of 22yrs and very pregnant. What really annoyed me was when they gave me a so call pain relief in my right thigh to carlm my contractions down, only to end up hitting the nerv, I live with this everyday since then, with nothing but pain 24/7 and was told that it will
    NEVER HEAL. I was not even aloud to claim ACC back then and still Caint,to this day. How much longer do you have to suffer.

    Reply
    • Jay B   August 25, 2018 at 2:49 pm

      Have you heard of SIRVA VACCINES COMPENSATION?

      Reply
  7. wise Jacob C   March 4, 2018 at 4:46 pm

    In our case a student reported to have numbness over the injected site following Analgesic ,The case was reported after four months of injection.Is it possible to give a reply on this delayed response

    Reply
  8. jay b   September 12, 2018 at 11:45 am

    Watch for Botox injections for pain. Sometimes you even don’t need it, but there is a botox scam out there. I had one in my arm, and am alarmed with the hand seizures I have in the mornings, and the deep pain I’m getting 3.5 months after I got the left arm injection. My doctor refuses to give me an MRI, saying, “it sounds like a nerve damage” but what can you do? What is done is done, and you can’t sue them because you signed a consent/release form.

    I cannot believe that if this was from a vaccination, either flu, or anything considered a “vaccine”, then there would be resources, to go after the doctor who injured you.

    Reply

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