Rehabilitation Management of Post-Herpetic Brachial Plexopathy: A Case Report

BACKGROUND: Herpes zoster may occasionally affect the brachial plexus, leading to motor deficits, sensory loss, and functional impairment. Early identification is often challenging when dermatological manifestations are absent or delayed. CASE PRESENTATION: A 75-year-old male developed acute upper-limb pain initially misdiagnosed as glenohumeral osteoarthritis. After progression of weakness and dermatomal sensory deficits, neurological assessment and electrodiagnostic studies confirmed brachial plexopathy secondary to herpes zoster. The diagnosis was established by a physician prior to referral to physiotherapy. Examination revealed severe proximal weakness, profound loss of active shoulder range of motion (ROM) despite full passive mobility, and sensory deficits in radial and median nerve territories. Functional impact was considerable. INTERVENTION: The rehabilitation program targeted neuromuscular deficits and impaired shoulder control through progressive exercise, with neuromuscular electrical stimulation used to facilitate muscle activation. A home-exercise program was continuously adapted to recovery milestones. OUTCOMES AND FOLLOW-UP: Improvements in strength, motor control, and ROM were observed over 34 sessions across 9 months, with near-complete functional recovery at discharge and maintenance of these gains at 1-year follow-up. CONCLUSION: This case highlights that a structured physiotherapy program may support recovery following post-herpetic brachial plexopathy; however, given the natural course of the condition, causality cannot be definitively established.