In this feature, AAOS Now publishes a series of images, challenging readers to diagnose the condition depicted.
This month’s challenge was submitted by Marc Biggers, MD, a resident member at the University of Tennessee–Campbell Clinic. The patient is a 60-year-old male with a history of chronic low back pain who came to the clinic with a 5-day history of worsening low back pain. He also has begun to notice a burning pain radiating down his medial thigh to his knee. He has full motor strength with no paresthesias and a negative straight leg raise. The rash shown in the photo to the right appeared 2 days prior to the clinic visit. What’s your diagnosis?
See Answer below
This month’s challenge appears on page 17. According to Marc Biggers, MD, who submitted the case, the answer is shingles. Herpes zoster causes this typical vesicular rash in a dermatomal distribution. The rash is commonly found on the torso, but may be located anywhere on the body. Patients may experience a prodromal syndrome followed by burning pain along the affected dermatome. The rash usually appears 1 or 2 days after the onset of pain, but may be delayed up to 3 weeks. Recovery may be hastened by a course of an anti-viral medication. A shingles vaccine is available and is recommended for all individuals 60 years of age or older.
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