Case Report of Herpes Zoster Infection of the Cervical Dermatome – A Rare Cause of Acute Shoulder Pain

Abstract

Introduction:

Acute shoulder pain is among the most common presenting complaints in the clinic. Clinicians may find it challenging with the myriad of potential etiologies to explain for the presenting complaint. We present a unique case, where a herpes zoster infection in the C6 dermatome mimicked the presentation of rotator cuff pathology and was admitted to the care of orthopedics. We have also included a detailed literature review on the topic in our study.

Case Report:

The patient was a 38-year-old Chinese female who presented with acute atraumatic right-sided shoulder pain and weakness which was potentially confounded by an attempt of traditional Chinese medicine. Clinical examination revealed that the range of motion was globally reduced and painful in all directions with equivocal impingement testing. Examination of the skin revealed the presence of polymorphous eruption of erythematous papules and vesicles in the right shoulder and C6 region. In this paper, we discuss a possible algorithm to aid clinicians in an acute shoulder pain history with accompanying red flags to look out for. This is accompanied by a detailed literature review on the topic which demonstrates the rarity of this presentation which eventually confounded the initial management of the patient.

Conclusion:

A thorough history and physical examination must remain the cornerstone of a clinician’s diagnostic algorithm. Zoster neuropathy at the level of the cervical spine is a rare entity. This case report also emphasizes the need for cognizance of local traditional remedies practiced and their interactions with clinical diagnosis and treatment.