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Herpes zoster in the ulnar nerve distribution
G S Athwal1, S A Bartsich, A J Weiland
1Hand and Upper Limb Centre, University of Western Ontario, London, Ontario, Canada.
Journal of Hand Surgery (Edinburgh, Scotland)
|June 14, 2005
Summary
Varicella zoster virus can reactivate as shingles, rarely presenting solely in the upper extremity. Early recognition of zoster infection, even without a rash, is crucial for hand surgeons to prevent complications.
Area of Science:
- Neurology
- Infectious Diseases
- Dermatology
Background:
- Varicella zoster virus (VZV) causes chickenpox in children and remains dormant in dorsal root ganglia.
- Reactivation of VZV leads to herpes zoster (shingles), which can manifest years later.
- Shingles typically presents with a rash, but atypical presentations occur.
Observation:
- Herpes zoster rarely presents exclusively in the upper extremity.
- Neuralgia in a dermatomal distribution in the upper limb may indicate zoster infection.
- A case of herpes zoster isolated to the ulnar nerve distribution in a young woman is presented.
Findings:
- The study highlights the importance of considering zoster infection in cases of upper limb neuralgia.
- Early diagnosis of zoster, with or without a rash, is key for effective treatment.
- Prompt treatment can reduce the risk of complications associated with zoster reactivation.
Implications:
- Hand surgeons must be aware of atypical zoster presentations in the upper limb.
- Recognizing zoster early can lead to better patient outcomes and fewer long-term complications.
- This case underscores the need for a broad differential diagnosis in upper extremity neuropathic pain.
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