Skip to content
Other Pain Articles
Doctors know it as zoster, but up to a million Americans are stricken each year by the infection they call shingles. By either name, it's an unsightly, often painful process that can be prevented by a vaccine that was approved in 2006.
The culprit is varicella-zoster virus (VZV), the same virus that causes chickenpox (varicella in children). The vast majority of children recover completely, but that's not the end of the story. Instead of being killed and eliminated from the body, VZV goes into hibernation, hiding out in the part of the nervous system known as the sensory nerve ganglia. In most people, the virus remains dormant and harmless for life, but in up to 15%, VZV becomes active and causes shingles.
Most patients with shingles are older than 60, and some have weakened immune systems. The virus spreads along the sensory nerve to form a line of blisters on one side of the body. Most patients recover fully, but a few develop serious complications, and up to a third develop long-lasting pain (post-herpetic neuralgia). Antiviral medicines, which are often prescribed with steroids, can reduce the risk of pain.
Tennis elbow is the common term for lateral epicondylitis, an inflammatory condition of the tendon that connects the extensor muscles of the lower arm to a bony prominence on the outside of the elbow called the lateral epicondyle. The condition causes pain at the point where the tendon attaches to the epicondyle. The pain may radiate to the forearm and wrist, and in severe cases, grip strength may lessen. It can become difficult to perform simple actions like lifting a cup, turning a key, or shaking hands.
As many as half of all people who play racket sports have the condition, but most people who have tennis elbow didn't acquire it by playing tennis, squash, or racquetball. It can result from any activity that involves twisting or gripping motions in which the forearm muscles are repeatedly contracted against resistance, such as pruning bushes or pulling weeds, using a screwdriver, or playing a violin. Tennis elbow is an occupational hazard for professional gardeners, dentists, and carpenters.
There are many treatments for tennis elbow but not much high-quality evidence about their effectiveness.
Do you have a history of chicken pox?
Does your skin hurt, itch, or feel numb?
Is the pain sharp, dull, or piercing? How long have you had it?
Do you have a rash? If so, for how long?
Is the rash in more than one place on your skin?
Is the rash on one side of your body only?
Has the rash at any time looked like small blisters?
Do you still have pain even if the rash is gone?
What triggers the pain (for example, a light touch)?
Do your symptoms interfere with your ability to sleep or perform activities of daily living?
Do you have any risk factors for infection with human immunodeficiency virus (HIV)?
Are you taking any medications?
Careful skin exam
Skin scraping to examine under the microscope, or for viral culture, immunofluorescence, or polymerase chain reaction testing