Yesterday, i injected a tetanus shot to a patient and now patient is feeling burning sensation in his both hand fingers , is there something wrong?
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tetanus shot burning sensation both hands fingers after injection neurological side effect
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Yes, this is a concerning post-vaccination symptom that warrants clinical attention. Here is a structured breakdown:
Burning Sensation in Both Hands After Tetanus Injection
Is This Normal?
No, bilateral burning in the fingers is not a typical side effect. Common expected reactions after a tetanus shot are:
- Local pain, redness, swelling at the injection site
- Mild fever, headache, fatigue, nausea
Bilateral hand/finger involvement suggests a neurological or systemic process, not just local inflammation.
Most Likely Explanations
1. Brachial Neuritis (Parsonage-Turner Syndrome) - Rare but Recognized
According to Park's Textbook of Preventive and Social Medicine, brachial neuritis is a documented rare reaction to tetanus toxoid/DT vaccine, with an onset window of 2-28 days post-vaccination and a rate of 5-10 per million doses.
- Symptoms: sudden burning or severe pain, which can radiate down the arm to the fingers
- Typically starts unilaterally, but bilateral cases have been reported
- May progress to muscle weakness and atrophy
- It is listed on the U.S. Vaccine Injury Compensation Program (VICP) table
2. SIRVA (Shoulder Injury Related to Vaccine Administration)
The Red Book 2021 explicitly states that nerve injury and SIRVA can occur from inadvertent injection into the wrong tissue plane, especially if the vaccine was given too high on the arm (into the subdeltoid bursa or near the brachial plexus).
- If the injection was not given in the correct IM deltoid location, it can irritate nearby nerves
- This can cause referred burning or paresthesia down the arm and into the fingers
3. Inadvertent Subcutaneous or Intravascular Injection
Per Rosen's Emergency Medicine, tetanus vaccines containing adjuvants (aluminum salts) must be injected deep into the muscle. If given subcutaneously or intradermally, they cause local irritation, inflammation, granuloma formation, and potentially tissue necrosis. This local reaction could spread and compress nearby nerves.
4. Anaphylaxis / Systemic Allergic Reaction (Rule Out First)
Though bilateral paresthesias without other symptoms make this less likely, it should still be ruled out. Signs of anaphylaxis include urticaria, dyspnea, hypotension, angioedema. If any of these are present, this is a medical emergency.
What You Should Do Now
| Priority | Action |
|---|---|
| Urgent | Rule out anaphylaxis - check BP, pulse, skin, breathing |
| Examine | Check the injection site - is it too high on the shoulder? Swollen? |
| Neurological exam | Assess grip strength, reflexes, sensation in both upper limbs |
| Monitor | Track if symptoms are spreading, worsening, or associated with weakness |
| Document & Report | Report to your national pharmacovigilance system (AEFI - Adverse Event Following Immunization) |
| Refer | If neurological symptoms persist beyond 24-48 hours, refer to neurology |
Key Clinical Concern
The fact that both hands are involved (bilateral) is unusual for SIRVA or brachial neuritis (typically unilateral). Bilateral symptoms raise the possibility of:
- A systemic immunological response affecting peripheral nerves (rare post-vaccine peripheral neuropathy)
- A coincidental pre-existing condition (e.g., carpal tunnel, cervical radiculopathy) that was aggravated by the stress/positioning during injection
- Hyperventilation or vasovagal response at the time of injection causing transient bilateral paresthesias - if the sensation appeared immediately and resolved/is fading, this is the most benign explanation
Bottom line: Do not dismiss this symptom. Perform a focused neurological examination, rule out anaphylaxis, check the injection technique and site, and arrange follow-up. If burning persists or worsens beyond 48 hours, or if weakness develops, neurology referral is warranted and an AEFI report should be filed.
Sources: Rosen's Emergency Medicine 9e | Park's Textbook of Preventive & Social Medicine | Red Book 2021 (AAP)
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