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The member was in the skilled nursing facility following a hospital

stay for influenza. An orthopedic consultation had been scheduled
to evaluate the members complaint of shoulder and neck pain.
During the assessment, it became clear the pain was not
orthopedic in nature. He described his pain as excruciating. He
said it was a constant aching, burning and, at times, stabbing in
an area of skin from the side of his neck to his shoulder and chest
wall.
The physical exam revealed a normal range of motion in his
shoulder and neck. There were no visible lesions on his skin. With
the recent bout of influenza, the nursing staff was alerted to
watch for shingles in the member. They contacted the primary
care physician and appropriate precautions were instituted.