Brachioradial pruritus (BRP) is a nerve-related condition that causes persistent itching, tingling, or burning sensations, most commonly on the outer forearms and arms. BRP often originates from irritation or compression of nerves in the cervial spine (neck). Prolonged sun exposure may play a role in triggering symptoms. While BRP itself is not dangerous, you should consult a provider if you notice additional symptoms like a rash or weakness, numbness, or pain radiating into the arms.
One unique feature of brachioradial pruritus is that cold therapy often relieves symptoms, distinguishing it from other causes of chronic itch. (1,3,5) The ice pack sign, considered a hallmark diagnostic feature of brachioradial pruritus, involves applying an ice pack to the affected area. Patients typically experience immediate relief from itching, which returns shortly after the ice pack is removed. (3,6)
Effective brachioradial pruritus treatment focuses on addressing cervical spine-related dysfunction, improving neurodynamics, and providing symptom relief. Conservative options include cervical manipulation, manual therapy, traction, modalities, and therapeutic exercise. (1,2,4)
What are some in-office treatments for brachioradial pruritus?
-
Manipulation of cervical and thoracic joint restrictions
-
Myofascial release and soft tissue mobilization (STM) targeting paraspinal and upper extremity muscles
-
Nerve release techniques for the radial and/or median nerves
-
Acupuncture (8)
-
Cervical traction
-
TENS therapy (7)
What are some at-home treatments for brachioradial pruritus?
-
Arm and neck exercises such as the radial nerve floss, median nerve floss, cervical retractions and pectoral stretch
-
Use SPF 30+ sunscreen and wear protective clothing to minimize sun-induced flare-ups
-
Manage stress by using techniques like meditation or deep breathing exercises
-
Apply ice packs to itchy areas for temporary relief
- Optimize your seated, standing, and laptop workstations to reduce spinal stress and improve posture
Conclusion
Brachioradial pruritus is a frequently overlooked but treatable condition. This complaint of itchy arms arises from chronic physical irritation and a dysregulated itch control mechanism. Chiropractors can effectively diagnose and manage this challenging complaint by addressing cervical spine dysfunction with spinal adjustments, promoting healthy posture, and incorporating targeted exercises for relief.
Check out the infographics on optimal workstations!
References
1. Eskandar T, Chaudhary F, Agrawal DK. Orthopedic Dermatopathies: Skin Manifestations in Orthopedic Conditions. Journal of orthopaedics and sports medicine. 2024 Aug 30;6(3):171.
2. Kavanagh KJ, Mattei PL, Lawrence R, Burnette C. Brachioradial pruritus: an etiologic review and treatment summary. Cutis. 2023 Aug 1;112(2):84-7.
3. Robbins BA, Schmieder GJ. Brachioradial Pruritus. 2022 Sep 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 29083620.
4. Miller LH, Akita J, Martelli AC, Kirchner DR, Salgado MH, Garbino JA. Avaliação neurofisiológica de pacientes com prurido braquiorradial. Arquivos de Neuro-Psiquiatria. 2021;79:900-3
5. Golden KJ, Diana RM. A case of brachioradial pruritus treated with chiropractic and acupuncture. Case Reports in Dermatology. 2022 May 2;14(1):93-7.
6. Bernhard JD, Bordeaux JS. Medical pearl: the ice-pack sign in brachioradial pruritus. Journal of the American Academy of Dermatology. 2005 Jun 1;52(6):1073.
7. ŞAVK E, ŞAVK Ö, ŞENDUR F. Transcutaneous electrical nerve stimulation offers partial relief in notalgia paresthetica patients with a relevant spinal pathology. The Journal of dermatology. 2007 May;34(5):315-9.
8. Stellon A. Neurogenic pruritus: an unrecognised problem? A retrospective case series of treatment by acupuncture. Acupuncture in Medicine. 2002 Dec;20(4):186-90.
9. Bertelsman, Tim. Brachioradial Pruritus: The Neuropathic Itch Every DC Should Recognize. ChiroUp website and blog. January 01, 2025
