Pneumonia vaccine can be administered in thigh

DEAR DR. ROACH: I have a badly torn rotator cuff on my left shoulder, so that arm is basically a constant problem. In January 2017, my physician suggested that I would benefit from the pneumonia vaccine and that it would take two applications, one year apart, to complete. I agreed to have the vaccine, which was administered into my upper left arm. Ever since then, I have had pain in the muscle area and at times do not have use of that arm. I have talked with the nurse, the physician assistant and also with my orthopedic doctor about this problem. They all have given me blank looks and no answer to the situation. Do you have any suggestion or remedies for this? Should I have the second injection? -- M.P.

ANSWER: I think the problem is the torn rotator cuff, and that it was exacerbated by your reaction to the vaccine.

The rotator cuff is a group of four muscles that keep the arm in place in the shoulder during movement of the arm. If the rotator cuff is damaged, either by inflammation or from a mechanical tear, the arm will not move normally. Complications, including a frozen shoulder, are common.

I suspect that the temporary sore arm from a vaccine immobilized your arm long enough that you developed further inflammation in the shoulder. Although I have seen cases where the vaccine is given near a nerve and causes temporary numbness or pain, it should not last for longer than a few days -- certainly not weeks or months. A sore arm for a day or two is a typical reaction to a pneumonia vaccine. However, even a day of not using your arm can reduce mobility in someone with a rotator cuff tear.

My advice is to speak to the orthopedic doctor about the torn rotator cuff, but I would not get the second pneumonia vaccine in the bad arm. It can be injected into the good arm; or, if you have rotator cuff problems on the other side too (many people do), the pneumonia vaccine also may be given in the thigh. The pneumonia vaccine saves lives.

DEAR DR. ROACH: I wanted to know about the risk of cervical cancer with a partner who has HPV or herpes. Also, is there a correlation between either of these infections and cancer of the uterus? -- Anon.

ANSWER: Human papillomavirus is the major risk factor for cervical cancer, responsible for about 99 percent of cervical cancer. It was known for decades that there was an infectious component to cervical cancer: Women who married widowers whose previous wives had died of cervical cancer faced a high rate of developing cervical cancer themselves.

Herpes simplex virus type 2, the major cause of genital herpes, was looked at as a possible cause of cervical cancer. However, HSV-2 by itself is not thought to increase the risk for cervical cancer. Women with both HSV and HPV may be at higher risk than women who have only HPV.

The major risk factors for cancer of the uterus are estrogen exposure without progestin, as in women who are treated with estrogens and not given a progestin hormone. However, there are genetic risk factors, such as Lynch syndrome. Neither HSV nor HPV is thought to be a major risk factor.

Now that there is a vaccine to prevent HPV, the rates of cervical cancer should continue to fall. Countries with high rates of vaccine adherence have seen 90 percent drops in HPV rates. It’s possible that HPV-related cancers could be eliminated in the future.