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muscle weakness with shingles
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muscle weakness with shingles

Dear Doctor

I came down with shingles at the beginning of April this year. The rash started on my buttock, went down my right thigh and shin. About three weeks after the start of the illness I developed a sudden weakness in my right quad and my leg would not bear my weight if the knee was even slightly bent. I have had several falls so have started physical therapy and there is a weak response in the quad muscle but the exercises are extremely painful. I am assuming there has been a partial denervation of the quad to cause this weakness.

Should I be doing physical therapy? Is it helpful? Harmful? Useless?  Will the nerves come back? Should I be waiting for that to happen before I begin exercise? The PT is using electrical stimulation. I have read that that can inhibit the chemical processes necessary for the nerves to regrow. I am quite frustrated that of two family doctors, a neurologist and the physical therapist, no one can tell me anything other than this weakness is very unusual.

I would be very grateful for any information as to prognosis and treatment for this weakness.

Thank you
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Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.

It sounds like you have weakness in the leg extensors, the quadriceps. These muscles are innervated by the femoral nerve, but the cause of the weakness could either be in this nerve or higher up, where the nerves first start forming from the spinal cord. The virus that causes shingles, VZV (the same virus that causes chicken pox) resides in specific parts of the nervous system, and can cause nerve problems, often pain and sensory loss, but in some cases weakness too.

In general, physical therapy would be helpful, and if your doctors have recommended it, I suggest you continue it, but only with a trained PT and with a doctor's prescription, because if the inappropriate physical therapy is done, you could injure yourself doing the exercises directly, or by example by falling. Electrical stimulation has been shown in some research to be helpful in the short term, but the benefits are not long-lasting once the stimulation is stopped.

To best understand what the nature of your weakness is, if it is related to the VZV infection or otherwise, it is advisable to see a neurologist to have a test called EMG/NCS, which tests how nerves conduct electricity and how the muscles respond (I am not sure if you have had this test by your neurologist). If you have already had it, then an MRI of the lumbosacral area, and possibly even the lumbar plexus (the collection of nerves that eventually gives the femoral nerve) may be indicated. Based on this information, the neurologist can better understand the cause of the weakness, the extent of injury, and therefore help prognosticate what the recovery will be.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
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