As an outpatient orthopedic and aquatic therapy clinic, we primarily get referrals from primary care physicians and orthopedic surgeons. Imagine our surprise when we started getting regular referrals from a dermatologist.

Imagine, you go to your dermatologist complaining of an itch on your arm that just will not go away. Maybe it is on your shoulder blade. The more you scratch it, the worse it gets, and pretty soon you have scratched yourself raw. Being in the sun tends to make it worse. Ice seems to be the only thing that helps but it always comes back. The dermatologist does their exam and tells you that you that there is nothing wrong with your skin (raw patches aside) but in fact the itching is coming from a problem in your neck and writes a referral for you to see a physical therapist. I know what you are thinking… WHAT?!?! The problem is the itch on your arm, you don’t even have neck pain so how can physical therapy help you???

To understand this, you first must understand a little bit about the anatomy of your neck. Your spinal cord travels from your head down to your low back region, and at each level of your spine, nerves come out of the spinal cord and travel to the limbs. In the neck, or cervical spine, those nerves travel to your arms, and in the low back, or lumbar spine, those nerves travel to your legs. These nerves have both sensory components, which send information to your brain about sensation of the limb (touch, tickle, pressure), and motor components which give the muscles in your limbs the message to contract. When there is any sort of compression on these nerves, either due to prolonged positions or degeneration of the joints of the spine, then the function of these nerves can become impaired. The muscles in the limb may not work as well and the sensation of the limb may be compromised. This compromised sensation commonly presents itself as numbness or tingling, but it can occasionally present as itchiness in the limb. These conditions are called Brachioradial Pruritus when the itchiness is on the arm and Notalgia Paresthetica when the itchiness in in the shoulder blade region.

How exactly can physical therapy help?

Well, since the problem is compression on the nerves coming out of the neck, we start there. Often people with either of these two conditions have a history of neck pain or tend to have poor postural habits. After a comprehensive physical therapy evaluation, we can determine the potential cause of the compression of the nerves, address any joint or muscles restrictions that may be contributing to the compression, and educate the patient on postural exercises so that they learn how to hold their spine in the optimal position to avoid further compression on the nerves. How cool is that?

So, if you have an itch in your arm or shoulder region that just won’t go away, and a medicine cabinet full of creams, discuss the possibility of physical therapy with your physician or dermatologist. Better yet, call our office and find out about seeing one of our physical therapists through direct access, no referral necessary.

References and further reading:
https://www.mdedge.com/cutis/article/67624/contact-dermatitis/brachioradial-pruritus-case-report-and-review-literature
Brachioradial Pruritus: A Case Report and Review of the Literature.Lane JE McKenzie JT Spiegel J Cutis. 2008 January;81(1):37-40