1632 - Segmental Zoster Paresis with Comorbid Carpal Tunnel Syndrome

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Corresponding Author(s)

RB

Rachel Bristow, BS

Medical Student
NYITCOM-AR
Whitmore Lake, Michigan, United States

Presenting Author(s)

CW

Charis F. Won, BS

OMS IV
New York Institute of Technology College of Osteopathic Medicine
Conway, Arkansas, United States
NL

Nissy Lee, BA

Medical Student
New York Institute of Technology College of Osteopathic Medicine
St. Louis, Missouri, United States

Co-Author(s)

JB

Joseph Brooks, DO

Attending physiatrist
AOCPMR
Davenport, Iowa, United States

Submitter(s)

RB

Rachel Bristow, BS

NYITCOM-AR
Whitmore Lake, Michigan, United States

Case Diagnosis: Segmental Zoster Paresis and Carpal Tunnel Syndrome

Case Description: This case report involves a 63-year-old male that presented with acute right upper extremity symptoms of right deltoid weakness following a shingles outbreak in the C6 dermatome, with a chronic history of carpal tunnel syndrome. Notably, the patient had an overuse injury to his shoulder and received a cortisone injection prior to the shingles outbreak. Electrodiagnostic (EDX) testing initially revealed right C6 acute/subacute cervical radiculitis and right severe median neuropathy at the wrist with significant axonal loss. Repeat EDX five months following onset of shoulder paresis showed improved motor recruitment and reinnervation of the C6 lesion, while the median neuropathy findings remain unchanged.

Discussions:

This case highlights the diagnostic complexity of concurrent proximal and distal nerve pathologies, often referred to as double crush syndrome, as well as considerations for management and natural history of segmental zoster paresis.

Conclusions:

Sequential EDX studies are pivotal for distinguishing overlapping upper extremity nerve pathologies, particularly in cases of double crush syndrome complicated by post-herpetic motor involvement. These studies provide objective data to track recovery, guide management, and ensure that interventions, such as surgical timing and anesthesia choice, are tailored to protect vulnerable nerves. This case highlights the importance of recognizing segmental zoster paresis in the context of concurrent neuropathies and underscores the role of conservative management and staged decision-making in optimizing patient outcomes.