herpes zoster

[emad]

Today i encountered patient with no reference from his Neurologist , i asked him he told me the following :

I suffered severe pain since 2 months around whole my left upper limb , i could not move any part ,was exteremely severe ,with skin pigmentation around the left shoulder ,My docotor treaded me as Herpes zoster .then referred me to physiotherapy.now my pain decresed by 80%.

My examination revealed the following ;

ULNT 1,2,3 Negative
Shoulder moyions are limited in abduction and adduction
Pain with movement around lateral upper 1/3 arm .


What are your views with patient like that ??

Emad

[Diane]

Poosible entrapment of the axillary nerve. Maybe he had HZ as well.. but I'd rule out axllary nerve entrapment.

[emad]

First of all HZ could cause /associted by neuropathic pain which is called postherpatic a link to its descripation ,http://en.wikipedia.org/wiki/Postherpetic_neuralgia, a point i can NOT pass which is infection because i touched that patient with my hands , so that i will ask a specialist docor in dermatology .
Back to Auxillary nerve ,may be or may be not i do not know ,but it worth to be ruled out ,however i can not remember a procedure to rule it out !?
I can say that shoulder (GH) limitation is due to long period and pain severity is more logic .

It is my first time to encounter HZ because of pain , i can remember difficulty that the patient describes the pain extends to back .

Emad

[emad]

The second time this patient visited me ,there is great progress within shoulder motions ,all what i did ,were breathing ex ,touch around GH and simple neurodynamics ,in addation to educating the consumer regarding what could evoke pain .

Emad

[nari]

emad,

HZ can develop into some very persistent and nasty neuropathic pain that can be hard to resolve, so you're doing well!! Keep on with what you are doing, I reckon. Neurodynamics is really the best approach here,as far as I know.

Nari