Interventional Physiatry in the Complex Regional Pain Syndrome of the Upper Limb Following Herpes Zoster

A 44-year-old male patient experienced persistent radiating pain from the elbow to the hand following herpes zoster vesicular eruptions three months earlier. His examination met the Budapest Clinical Criteria for Complex Regional Pain Syndrome (CRPS), revealing sensory, motor, vasomotor, and sudomotor signs and symptoms. Despite conservative treatments, the pain persisted. The patient received an ulnar and median nerve block using a mixture of 10 mg methylprednisolone and 2% lignocaine (30 mg). The ulnar nerve block was administered at two sites: Guyon's canal and one fingerbreadth distal to the ulnar styloid for the cutaneous branch. The median nerve block was performed at the carpal tunnel. Seven days post-intervention, the patient reported significant pain relief, and by day 15, pain remission was complete. The patient's range of motion improved and the swelling decreased notably. Post-herpetic CRPS in the upper limb is an uncommon complication of herpes zoster. Previous studies have shown "CRPS-like" symptoms following herpes zoster, and this case highlights the value of a multimodal treatment approach that combines interventional techniques with physical therapy. This case illustrates the rarity of post-herpetic CRPS and the effectiveness of peripheral nerve blocks, medication, and exercise in achieving significant pain relief and functional recovery.