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jayjay
12-02-2000, 01:30 PM
Does anyone know why tetanus boosters hurt more than a regular shot? They usually aren't so bad at first, but after an hour or so the injection point is usually really tender and this lasts (on me at least) for a couple of days.

Is this the tetanus vaccine, the type of needle used, or just wimpy ol' me?

lolagranola
12-02-2000, 02:49 PM
I always thought that it was because, unlike some injections, it is shot into the muscle. I may, of course, be wrong.

peace
12-02-2000, 02:56 PM
"Regular" or "normal" nonwithstanding, both tetanus vaccine and tetanus "serum" inject proteins, not isotonic saline, into your tissues. Saline is absorbed fast. Protein is always foreign, causes inflammation. It hurts.

CC
12-02-2000, 03:19 PM
Peace - don't most injections contain proteins of some sort? Why wouldn't ALL vaccines, then, cause such discomfort? Don't they all contain viruses? And aren't viruses essentially protein? And who just gets saltwater injections? Thank you for your help.

peace
12-02-2000, 03:36 PM
CC, Jay didn't say yet what's meant by "normal" injections.
Viruses are mostly DNA or RNA in a protein "envelop". Most "injections" contain drugs dissolved in something. Then as much saline (0.9% NaCl in water) is added as possible to make the solution isotonic with tissues. The simpler (chemically) the drug and the closer the tonicity is to 0.9% NaCl, the less inflammation there is. I guess, Jay meant tetanus immune globulin, which is protein.

Yeah
12-02-2000, 03:54 PM
1. How much an injection of vaccine hurts probably depends the volume of the injection and on your body's reaction to whatever is in it. Tetanus vaccine contains tetanus toxoid which is a preparation antigenically similar to the toxin produced by a Clostridium tetani infection. ( By "antigenically similar" I means that the antibodies your body produces against the toxoid will neutralize any real toxin produced by the C. tetani bacteria if you get infected. It is the toxin that causes the muscle spasms called lockjaw.) Some other vaccines seem to cause less discomfort. For example most people don't complain much about hepatitis B vaccine which is a purified fragment of hepatitis B virus. A vaccine notorious for its side effects is injectable typhoid vaccine which is, IIRC, made of ground up, dead typhoid bacteria. You can expect that it will make your arm sore for a day or two and many people have a fever and other symptoms for 24 hours or so.

2. It's safe to say that anything injected into your muscle is likely to hurt more than anything injected into your fat.
When vaccines are injected into upper arms, they are usually intended to go into muscle (there are exceptions) and they usually do go into muscle and this has to make the muscle sore, at least for a while. Injections into the buttocks, on the other hand, usually go into fat. Unfortunately, some vaccines (e.g., hepatitis B) won't work (as well) if you inject them into fat, they have to be injected into muscle.

peace
12-02-2000, 04:20 PM
Yeah, some of your statesments are yeah, and some nah, e.g., whatever is injected in your butt, goes into the muscle. It's just easier to inject there without hitting anyting important, like big vessels or nerves.
An inflammation at the site of injection depends on many factors.
The direct comparison of effects is moot, as all vaccines, as you noticed, are different. Normally, formalin treated Clostridium tet. preparation does not get into the human muscle. Neither does Hepatatis virus, but this route is closer to the natural infection through microtrauma. So, the reactions are different. The reaction to the TB bacillus is probably similar (my guess), whether introduced with the air to the lung or as a vaccine to the skin. And so on, and on, and on...

kinoons
12-02-2000, 04:32 PM
Peace,

do you care to elaborate on the statement that...

"formalin treated clostridium tet. preparation does not get into the human muscle. Neither does the Hepatitus virus, but this rote is closer to the natural infection through microtrauma."

Now, there is no "normal" route of infection for any virus or bacteria. There are routes that are more infectious than others, but Hep C can infect you if it finds any way through the skin, be it sexual contact, a needle stick, or through a break in the skin via splashed blood.

Also, from what I understood you are saying that the tetnus bacteria does not often get into human muscle. If that was the case why do patients often recieve tetnus boosters when they, for example, step on a nail? The nail would most deffinately place the bacteria into the muscle of the patient.


From what I remember (I'm reaching back a little for this) the tetnus booster is a relatively large injection. That would be part of the reasion for discomfort if my memory serves me well. Also, it depends on the body's response to the injection, and depends on how the injection is made.

peace
12-02-2000, 04:58 PM
Q: Now, there is no "normal" route of infection for any virus or bacteria

Yes, there is. You may not like it, but still. Cold viruses "normally" infect through the nose. Hepatitie virus infects as you said (needle stick is not exactly "normal", but the mechanism is not different).
Rusty nails did not exist untill recently. Stepping on such may or may not deliver Clos. tet. into the muscle.
In civilized countries each child is given tetanus "toxoid" shortly after birth. The body produces antibodies against it, so it is "ready" when the real Clos. tet. comes. This immunity does not last forever and that's why a "booster" is given in cases of trauma. The booster contains the antibodies already made and ready to act, there is no virus. So, again: it's a large amount of protein which is normally does not occur in muscle, it's "out of place" there. So, the body reacts.

jb_farley
12-02-2000, 05:15 PM
wait one "second". Isn't the discomfort of a shot mainly caused by the immune system's response to foreign bodies? quotes such as these make it seem as if the pain is caused by infection.

The reaction to the TB bacillus is probably similar (my guess), whether introduced with the air to the lung or as a vaccine to the skin

Normally, formalin treated Clostridium tet. preparation does not get into the human muscle. Neither does Hepatatis virus, but this route is closer to the natural infection through microtrauma. So, the reactions are different.

am I way off base here?

jb

kinoons
12-02-2000, 05:21 PM
Normal route of infection of a cold


sure, it can enter through the nose.
It can also enter through the mouth. Ever drink after someone and get sick?

how about using a towel after someone and getting sick.


Saying that the "normal" route of getting sick is through the nasal or oral openings to the body is not quite a true statement. The nasal and oral passages may be the most common, simply because they are constantly open to the outside environment. However, if the cold virus was to enter through a break in the skin, then the patient would have a good chance of getting sick.

I dont specifically recall if the "booster" contains the antibodies, or if it contains the again deactivated bacteria or virus. I'd have to pull up the specific injection to find that out (I'm searching for it)

peace
12-02-2000, 05:35 PM
Yes. The discomfort is caused by the "bulge": 10cc or so in the middle of muscle. Anything will cause it. But normal saline will be quickly absorbed, while the globuline sits there and causes inflammation. It is absorbed eventually.
To dot the ii, the pain is not caused by "infection". Tetanus infection causes muscle spasm.

Kinoons, viruses in general are very specific. Only a few will cause disease by several routes. Some cold viruses may cause "stomach cold", but I do not know whether they enter the body by ingestion. They do, however, by nasal mucosa, whether they enter via the nose or mouth.

kinoons
12-02-2000, 05:45 PM
Per The Merck Manual of Diagnosis and Therapy


Tetanus toxoid is combined with diphtheria toxoid in tetanus and diphtheria toxoids adsorbed(Td). Although tetanus is rare, it has a high mortality rate. Since 1/3 of cases result from only minor injuries, universal vaccination remains necessary. Adults who missed the primary series of three tetanus injections in childhood should receive an initial dose, followed by a 2nd dose 1 mo later, and a 3rd dose 6 mo later. Thereafter, a booster of q 10 yr maintains lifelong immunity (all doses 0.5 mL IM). Alternatively, some authorities recommend a single booster at age 50 because of excellent long-term protection from the primary immunization.

A toxoid is a modified bacterial toxin that has been rendered nontoxic but retains the ability to stimulate the formation of antibodies.

however, the same manual states that an immunoglobulin is available for tetanus. This is made of specific human antibodies. The manual does not seem to state if this is the commonly used booster (I wouldnt think so. The antibodies will die at some point, and this injection would not "retrain" the body to produce antibodies. The first listed injection would). This form of injection would be useful in the acute case of tetanus that the patients own immune response is not being completely successful.

As I read further on...

The initial series of three primary doses of DTwP or DTaP is followed by a booster at age 15 to 20 mo and another at 4 to 6 yr. Subsequent routine tetanus boosters (indicated for all children and adults) every 10 yr should maintain protection; use of adult-type tetanus and diphtheria toxoids,adsorbed (Td), is preferred for these boosters, and studies are underway to assess the use of DTaP in adolescents and adults. Because adverse reactions to toxoid may occur, more frequent Td boosters are unwarranted. At any interval after initial immunization, immunity can be reestablished by a single booster dose; however, after an interval of > 10 yr from the last injection of tetanus toxoid, the rate of antibody rise to the booster response may be somewhat slower.

okay, so the booster in a non acute case is again the toxoids. Let me see if I can find the acute case

heres the best I could find...

Hyperimmune globulin is prepared from the plasma of persons with high titers of antibody against a specific organism or antigen. It is derived from artificially hyperimmunized donors or from persons convalescing from natural infections. Available hyperimmune globulins include those for hepatitis B, rabies, tetanus, and varicella-zoster. Administration is painful, and anaphylaxis may occur.

Againt the above does not provide prolonged protection. This injection is used in the acute sense.

elucidator
12-03-2000, 01:10 AM
1. Tetanus injections are usually done on little kids.

2. Doctors hate little kids.

Q.E.D.

Yeah
12-03-2000, 08:10 AM
peace: "Yeah, some of your statesments are yeah, and some nah, e.g., whatever is injected in your butt, goes into the muscle. It's just easier to inject there without hitting anyting important, like big vessels or nerves."

Your misconception is shared by a lot of people, probably including many medically trained people. In fact, the 1.5" 22 gauge needle traditionally used for "intramuscular" injections into the buttocks of adults doesn't reach the buttocks in most American adults. Investigators in the early 1980s showed this. IIRC, a review of X-rays found a lot of calcifications (which can be caused by injections) in the fat overlying the gluteal muscles of a lot of adults and a review of CAT scans showed that the thickness of the fat overlying the gluteus maximus of American adults was usually greater than 1.5". I can't get my hands on the article (which I think was "Injections into fat instead of muscle" N Engl J Med. 1982 Dec 16;307(25):1580-1) but IIRC the authors found that something like 70-90% of women had more than 1.5" of fat and something like 60-80% of men had that much fat. This is a good thing. Back when people used to get "gamma globulin" injections (typically 5 cc) in the buttock as prophylaxis against hepaptis A, most had only moderate pain because the 5 cc went into the fat where there is a fair amount of room for it. I pity the slim men with less than 1.5" of fat protecting their gluteal muscle because when they got such an injection from an earnest health care provider, they got 5cc crammed into solid muscle. It hurts just thinking about it.

kinoons
12-03-2000, 01:52 PM
Yeah,


Now it may me true that most injections given in the butt are given subq -- they are intended to go into the muscle, seeing as how an IM neddle is a 1.5" - 2.0" 22 gauge needle. a SQ injection uses a 25ga 5/8" needle.

also, a larger amount of fluid can be given intramuscularly than in the SQ region, unless my entire paramedic class was taught wrong.

I dont remember the book answers, I'll have to get back to you on that. In general we were taught to not give more than 1cc SubQ or 3cc's IM.

CC
12-03-2000, 02:19 PM
Here's an aside (which will probably engender its own thread none the less)...
It's enlightening to a layman such as myself(not bragging here)to see the degree of disagreement and overlapping understandings and misunderstandings among members of the medical community. I know that that's what the journals are all about, but I don't read those with enough frequency to detect the slowly unfolding issues which are debated. This little thread presents what, on the surface, was an interesting question, mutating into a discussion on just exactly is in an innoculation, what causes pain, how much does what, etc. It reminds me that knowledge is alive - it's transitory, it's somewhat relative, it grows, it's in the eye of the holder. Hey, now I'm out on a limb. Perhaps one of these experts can perform an emergency epistomology on me. xo C.

Yeah
12-03-2000, 02:28 PM
The volume you can inject reasonably comfortably depends not only on the tissue but the site. When you give a subq injection, it is usually in the muscle overlying the deltoid where there is not a lot of room. One cc shouldn't be much of a problem but more could be. When you give an injection into muscle, more than one cc or so hurts a lot no matter where it is injected because it mechanically disrupts the muscle tissue. (There are some research articles on this.) However, when you inject in a large mass of fat, such as that of most American adults' buttocks, there is plenty of room to accommodate a large volume.

peace
12-03-2000, 02:48 PM
A "simple" question caused a lot of interset. So, I thought I'll try to explain once again. (The Merck's quote is mostly correct, but confusing).
A baby is born somewhat protected my the antibodies it received from the mother. So, a series of vacinations is done. The purpose: to introduce attenuated pathogens (harmful microorganisms) in the way sufficient to induce the production of antibodies but insufficient to cause the full blown disease. Sometimes, an abortive (minor) desease occur. So, in the case of tetanus a "toxoid" is given together with diphteria and pertusis (whooping couph). It induces the "natural" production of antibodies. They last several years. After that, a repeat injection, a "booster" is needed. If an open trauma occured, an injection of "immune globulin" is done. Immune globulin contains already made antibodies, as natural production is slow and at this point a "toxoid" injection is too late and may, in fact, be harmful.

About injections and needles. There are several medications which MUST be administered a certain way (e.g.,CaCl2: only in the bloodstream, it will cause solid tissue necrosis). Most meds are better absorbed (resorbed) when injected into muscle or fat. Injection in the bloodstream is done sometimes to speed the action. A med injected into muscle, will "leak" into fat, even if injected correctly. The Yeah's info is interesting. Personally, I always use 2.5cm needles and/or do IM injections into the external femur (thigh), instead of butt. Even a 10cc water based IM injectin is not painful. The are more small blood vessels (capillaries) in the muscle, than in fat. But fat-soluble meds might be better resorbed from fat. Anyway, inflammation with subsequent calcification is possible, is not usually dangerous.
If you "stepped on a rusty nail", the chances of frequently lethal tetanus are sufficient to justify suffering from bearable pain for a few days.

Yeah
12-03-2000, 03:24 PM
A few clarifications re the last post:

"So, a series of vacinations is done. The purpose: to introduce attenuated pathogens (harmful microorganisms) in the way sufficient to induce the production of antibodies but insufficient to cause the full blown disease."

A few vaccines are like this, such as the Sabin (but not Salk) polio vaccine which uses "live virus." But most vacines do not contain anything "live."

"So, in the case of tetanus a 'toxoid' is given together with diphteria and pertusis (whooping couph)."

The reason that diptheria and pertussus vaccine is given with tetanus vaccine to small children is for convenience. Just as the measles, mumps, and rubella are often given together.

"If an open trauma occured, an injection of 'immune globulin' is done."

Tetanus immune globlulin is only given to people not fully immunized against tetanus, regardless of what kind of trauma they experienced.

"Personally, I always use 2.5cm needles and/or do IM injections into the external femur (thigh), instead of butt."

A 2.5 cm (1 inch) needle won't make it into an adult's femur. Not just because it's too short but also because the femur is a bone.

KarlGauss
12-03-2000, 03:36 PM
Originally posted by peace

The booster contains the antibodies already made and ready to act,...

What? Don't think so. The booster is simply more of the tetanus toxoid antigen.

kinoons
12-03-2000, 04:33 PM
The booster, as Karl has stated, is more antigen.

There is an injection that exists that has the immunoglobulin. That appears to be used in acute exposures when the person has not had recent boosters.

it would be tough to bounce a 1" needle off of an adults femur, you'd have half the syrenge in too. the needle would not penatrate the bone, but damn it would hurt.

kinoons
12-03-2000, 04:35 PM
excuse me, syringe... not syrenge.

Hail Ants
12-03-2000, 10:20 PM
Having worked in at a hospital for 12 years I've had to get a tetanus shot twice, once when I first started and again 10 years later (and I dreaded it coming the whole decade!) I asked the nurse why it hurt so much. She said that if the serum is mixed thoroughly before injecting it doesn't. And she was right.

peace
12-03-2000, 11:10 PM
I made two inadvertant mistakes:
One of them was corrrected in my subsequent post, about the "booster": it is an ANTIGEN. About the needle: I'd use 5cm for IM into thigh (femur*), and 10cm (2') into butt.

Yeah: attenuated means live, but weakened. The pathogen itself could be inactivated. Or dead. In the case of tetanus, it's dead. The immunogenicity of a vaccine is usually, but not necessarily less than that made of live pathogen. The whole point is irrelevant to the OP. What is relevant is what the nurse in Ant's hospital said. She did not say, though, what it should be mixed with. I'd be interested to know, is it an antiinflammatory something or a pain killer?
------------------------
*Femur has two meanings. Femur is a bone. It is also the proximal part of the lower member of the body, situated between the pelvis and the knee. That's why I put "thigh" in parentheses, next to it. But some people here are just as thick.

KarlGauss
12-03-2000, 11:15 PM
Originally posted by peace
I made two inadvertant mistakes:

Yeah: attenuated means live, but weakened ... In the case of tetanus, it's dead.

Looks like you're up to three. In tetanus the vaccine is the toxoid (the attenuated form of the toxin). It's neither dead nor alive. How can you call a protein "dead"?

kinoons
12-03-2000, 11:37 PM
I've never heard of an injection into the femur, I have heard of injections into the femoral region.

Unless you plan on going for an IO injection, but then you are braver than I.

peace
12-04-2000, 12:49 AM
I've got into a company of purists. I tought we answered the OP, just the Antnurse's clarification. Or do you guys want to nail me on anything? It's the TTA, USP, the absorbed toxoid. The point is that it's a foreign protein, foreign body and causes inflammation.
I do not know why any cop who stopped me for speeding (not for rating) said: "You went at a high rate of speed, sir". I thought it was just high speed. I do not know why you were taught to inject into femoral area. I do not know why and how the femoral region is different from the femur. Perhaps, it was lateral upper femoral region. Your teachers shortened it to femoral region.
If I recall correctly, I said that's how I inject myself./ It is my leg and I reserve the right to call it by its name, femur. If you prefer, Kinoons, you may inject into the femoral region. Or femoral area. Or femoral zone. Or whatever. I will allow you to use the names you like, as long as I understand them, E.g., you can call the nose the nasal region, the eyes - eye or visial region, the penis - penile-, or for short, dick region, etc. Your parner will be impressed if you say: "And now, honey, I want you to suck on my penile region". It will have class. It will certanly beat vulgar "dick".

kinoons
12-04-2000, 12:53 AM
That's great that you want to say you are putting your injection into your femur, but in terms of two words or less....

your not!

In the spirit of eliminating ignorance, I am not going to let an oversight like that pass. You may know what you mean, but not everyone else will. There is a big difference between the soft tissue in the femoral region and the femur itself.

edwino
12-04-2000, 02:51 AM
You are all wrong, BTW. :)

The reason the tetanus toxoid vaccine is such a bitch is because it contains an adjuvant. This is a chemical which causes inflammation (on purpose). The tetanus toxoid IIRC is not that antigenic, and the body doesn't form a great reaction to it. The adjuvant spurs it on a bit -- it activates antigen-presenting cells (monocytes in that particular place IIRC) by non-specific inflammation. The monocytes become sensitized, and present any foreign things they find in the area to B cells in order to make antibody.

And you can thus develop a resistance to the tetanus toxin.

peace
12-04-2000, 10:31 AM
Tx, Edwino. I hope, it will help Jay.
Kinoons still takes "femur" as "thighbone" and ignores its other deinition. I'm not going to argue this issue, the life (mine) is too short. I will continue to inject into the upper lateral femur, he may continue to inject into femoral region, or femoral area, or femoral zoe, or sector, or segment, or belt, or district or whatever he likes. As long as we do IM injection into the anatomically correst location, it does not matter. Still hurts.

omni-not
12-04-2000, 10:45 AM
Are you sorry you asked?

CC
12-04-2000, 06:48 PM
well, even if he is, I'm not. Very enlightening. Thank you, all.

kinoons
12-05-2000, 02:54 AM
"Kinoons still takes "femur" as "thighbone" and ignores its other deinition"

Lets see -- webster's dictionary

Main Entry: fe·mur
Pronunciation: 'fE-m&r
Function: noun
Inflected Form(s): plural fe·murs or fem·o·ra /'fe-m&-r&, 'fem-r&/
Etymology: New Latin femor-, femur, from Latin, thigh
Date: circa 1771
1 : the proximal bone of the hind or lower limb -- called also thighbone
2 : the segment of an insect's leg that is third from the body

how about cambrige --

femur noun [C] SPECIALIZED
the long bone in the upper part of the leg

maybe the Academic Press Dictionary of Science and Technology --

femur [f´mr] ( pc | mac ) plural, femora [fem´r ]. Anatomy. the large long bone of the thigh or upper leg that articulates with the hip joint above and the tibia and patella below; the longest and largest bone in the body. Also, THIGH BONE. Invertebrate Zoology. 1. the third segment from the base of an insect's leg, often greatly enlarged.the third segment from the base of an insect's leg, often greatly enlarged. 2. the large fourth segment from the base of the legs of some crustaceans. Also, MEROPODITE.the large fourth segment from the base of the legs of some crustaceans. Also, MEROPODITE.

lycos' online dictionary -- fe•mur (), n., pl. fe•murs, fem•o•ra (femr ).

1. the long upper bone of the hind leg of vertebrates, extending from the pelvis to the knee; thighbone.

2. the often enlarged third segment of an insect leg, between the trochanter and the tibia.

the newbury house online dictionary --

fe·mur n. femurs or femora the bone in the leg that is above the knee: The skier broke his femur. -adj. femoral .

Okay, I'm going to stop there -- Peace the ball is in your court. Care to provide a source for using the noun femur to descrive the soft tissue surrounding the bone by the same name?

peace
12-05-2000, 10:33 AM
Dorland's Illustrated Medical Dictionary, 26th Ed.,p.491.

You appear to belong to this loosely defined group of people who think they know everything and are always right. You may think that in this particular case I made a no-no mistake and said that the (tetanus) injection is done into the thighbone (femur). If you assumed that I am such an idiot and do not understand the difference between soft tissue (muscle) and bone, why did you spent all this time discussing fine points here, like what is "booster" and immune globulin and trying to answere the OP about pain?

As far as the terminology goes, as I said, you may call every part of the body as you want, as long as I unferstand it. I gave you some examples. You may also call me: "Thick head region", or say: "My stomach region hurts", or "I can't believe my ear regions" or "Use your brain region, Peace".

kinoons
12-05-2000, 11:42 AM
Thankyou very much for the cite.


No, I'm not one of those people who must know everything about everything, but when I do hear something that is contrary to everything I have been taught, I'd just like to know where it came from.

peace
12-05-2000, 10:53 PM
Kinoons, I reread my last post: it is rude. So, pardon me. I was surprised myself, when I tried to find the ref for you, and I could not. That's why I gave you my 1981 dictionary. I ain't that old, but that's (femur) the name I learned initially and used all my live (and thigh, and even akward upper lower extremity; I never actively used "lower member", although it's in dictionaries and some books). At one point you sounded almost sarcastic, that I was about to inject into the femoral bone. By now you know that I know better than that.

kinoons
12-06-2000, 02:04 AM
Apology accepted...


I didn't mean to imply that you were injecting into the femur, however, someone with just enough knowledge of the human body and medicine to be dangerous may have gotten the wrong idea. Once that issue had been resolved (probably about 2 posts earlier than I continued to peruse the issue) I just became curious about where you had been taught to call the femoral region the femur in general.

It can be awkward to describe the extremities. It gets wordy real quick. Femoral region, left superior lateral lower extremity. Talk about crazy

ronnietet
09-22-2011, 02:23 PM
Some people seem to say that getting a tetanus shot feels like just a little prick. They're lucky! Getting a tetanus really hurts! That's because of several things. (1) the tetanus needle generally is longer than other needles, about an inch to an inch and a half long (2) it sticks deep into your deltoid muscle up high by the shoulder (3) when the doctor or nurse pushes down on the syringe they do it so fast, in just a second the tetanus shot is on your muscle all of a sudden and it bruises your muscle (4) the tetanus shot they usually give is a dip-tet booster with diphtheria and tetanus all in one needle, and the dip-tet toxoids burn your muscle when the booster shot pushes in because dip-tet is a muscle irritant (5) usually the doctor or nurse will grab your deltoid muscle and give it a few squeezes to try to relax your muscle before sticking the needle in, but then when they give you the tetanus on your muscle they let go of your muscle and with the same hand that was squeezing your muscle so it relaxed, they grab the syringe to hold it steady while they push the dip-tet onto your muscle. without their hand squeezing your muscle into a large sort of relaxed mass, your muscle reacts to the burning of the dip-tet pushing in by constricting, and this just makes the tetanus shot hurt even more when your muscle tightens because about a teaspoon [0.5cc] of dip-tet gets forced deep into your deltoid muscle really fast in a narrow stream, and it pushes your tightened muscle tissue apart.
I hope that answers the question fully. If you do need a tetanus shot it's best to wear a tank top so your deltoid muscle is exposed and the doctor or nurse can give the tetanus way up high by the shoulder. That's where the most muscle mass is. Believe it or not, it's best to get the tetanus on the arm that you use a lot, so that after you get the tetanus on the your muscle you have to move that arm around and use the deltoid muscle for basic arm movements--and that helps work the tetanus into your muscle a bit faster.
I guess the tetanus shot goes deep in the deltoid muscle up by your shoulder because the deltoid muscle usually has the best mass of muscle on your arm, and the tetanus shot has to go really deep into your muscle so it's absorbed quickly.
Your muscle will probably ache for a day or two where the doctor or nurse puts the tetanus up by your shoulder. But the muscle ache does go away! Just be glad you only have to get a tetanus needle every ten years or so, or whenever you do something careless like step on a rusty nail!

Shmendrik
09-22-2011, 02:34 PM
Just be glad you only have to get a tetanus needle every ten years or so, or whenever you do something careless like step on a rusty nail!

If you got it within ten years, I don't think you need one if you step on a rusty nail. Incidentally, anyone who hasn't had a tetanus booster since this thread was opened is overdue for another one now.

John Mace
09-22-2011, 02:38 PM
It hurts because it is injected into your braaaaaaains!

elbows
09-22-2011, 05:20 PM
tetanus - ouch!

typhoid -zowie!, X 3

cholera - even awfuller, X 3

Yellow Fever - WTF? By far the worst shot of them all! Swoon, sweat, feel like shit for 24-48hrs. Arm swells like a tennis ball for 3 days! Sole redeeming feature - it's good for 10 yrs!

Hail Ants
09-22-2011, 10:44 PM
I skimmed thru the responses so forgive me if this was already said, but I worked at a hospital for twenty years and was required to get a tetanus shot every ten years. The first one hurt so bad that I actually started dreading my ten year anniversary! But when I went for it the employee nurse said that it only hurt the first time because that nurse didn't mix it well enough before injecting.

Turned out she was right, she mixed it good and it didn't burn at all! For what it's worth...

Shmendrik
09-22-2011, 10:46 PM
I skimmed thru the responses so forgive me if this was already said, but I worked at a hospital for twenty years and was required to get a tetanus shot every ten years. The first one hurt so bad that I actually started dreading my ten year anniversary! But when I went for it the employee nurse said that it only hurt the first time because that nurse didn't mix it well enough before injecting.

Turned out she was right, she mixed it good and it didn't burn at all! For what it's worth...

Not only was it already said, but it was already said by you (http://boards.straightdope.com/sdmb/showpost.php?p=937871&postcount=24). Ten years ago.

Only once, though. For twenty minutes.