Brachioradial pruritus (BRP) is a condition that causes a strong itching feeling usually in the forearm (occasionally the upper arm) and presents in either or both arms. The itch can be so intense that those with the condition may scratch their skin to the point of drawing blood.
BRP has a wide area of presentation but is most commonly reported on the outer & upper side of the upper arm and forearm. Adjacent areas that may be affected are the shoulders and neck.
You may experience and intense itch, pain, or a stinging/tingling sensation in the area affected. In 75% of cases, symptoms occur in both arms and could potentially present for 2-3 years before diagnosis is made (Atış & Bilir Kaya, 2017).
This condition can result from issues in the neck (cervical spine) which lead to compression of the nerve roots that supply sensation and motor function to the associated symptomatic regions of the arm(s). Compression of cervical nerve roots can result from numerous mechanisms including inter-vertebral disc wear & tear and Osteoarthritic age-related changes (the wearing down of cartilage & connective tissue in the joints) (Pereira et al., 2018).
It is more commonly seen in middle-aged females with lighter skin types. It is also more prevalent in summer months, usually in those who enjoy outdoor activity such as golf, sailing and hiking (Marziniak & Ständer, 2010).
Our skilled and experienced Physiotherapists will carry out a detailed history and thorough physical examination to produce an accurate diagnosis, so that the most suitable and effective treatment can be applied immediately, helping to achieve optimal outcomes. Your Physiotherapist will want to know how your condition is effecting you day to day so that your treatment can be tailored to your needs and will mean personalised goals can be established. Regular re-assessment will ascertain if your are making progress towards your goals and will allow adjustments to your treatment to be made.
The ‘ice-pack sign’ has been proposed as a useful tool to facilitate diagnosis as it increases the likelihood of BRP being present. The simple test comprises of placing an ice-pack to the affected area. The patient should feel an instantaneous reduction of symptoms which should then develop again a while after the ice-pack has been removed (Robbins & Schmieder, 2020).
The intense itch/scratch cycle can be alleviated by applying a topical skin coolant (or a substance containing menthol, camphor or other topical coolants) to affected itchy areas. To protect the affected skin, the consistent application of 100+SPF sunscreen is recommended. Other topical medications that may reduce symptoms include capsaicin, mild steroids, anaesthetics and antihistamines; all of which your GP can advise you on.
Your GP may also be able to provide you with neuropathic pain relief which has been previously found to be beneficial in patients with BRP (Yilmaz, Ceyhan, & Baysal Akkaya, 2010).
If the cervical spine (neck) is suspected to be driving your symptoms – which can be determined by your Physiotherapist based on your symptoms and physical examination, then you will be provided with a specific evidence-based exercise protocol to address this. They will be able to monitor your symptoms so that appropriate changes to your treatment and management can be made, helping to facilitate optimal recovery. We ensure that you receive ongoing support and advice so that you can effectively manage your symptoms and prevent re-occurrence.
Atış, G., & Bilir Kaya, B. (2017). Pregabalin treatment of three cases with brachioradial pruritus. Dermatologic therapy, 30(2), e12459.
Marziniak, M., & Ständer, S. (2010). Brachioradial Pruritus. In Pruritus (pp. 157-161). Springer, London.
Pereira, M. P., Lüling, H., Dieckhöfer, A., Steinke, S., Zeidler, C., & Ständer, S. (2018). Brachioradial pruritus and notalgia paraesthetica: a comparative observational study of clinical presentation and morphological pathologies. Acta dermato-venereologica, 98(1-2), 82-88.
Robbins, B. A. & Schmieder, G. J. (2020). Brachioradial Pruritus. Treasure Island (FL): StatPearls Publishing (Updated 2020 Apr 23) [Internet – accessed 4/6/2020].
Yilmaz, S., Ceyhan, A. M., & Baysal Akkaya, V. (2010). Brachioradial pruritus successfully treated with gabapentin. The Journal of dermatology, 37(7), 662-665.