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Case Reports
. 2020 Mar 9;4(3):e19.00178.
doi: 10.5435/JAAOSGlobal-D-19-00178. eCollection 2020 Mar.

Disabling Pruritus in a Patient With Cervical Stenosis

Stephan N Salzmann  1 , Ichiro Okano  1 , Jennifer Shue  1 , Alexander P Hughes  1
Affiliations
Case Reports

Disabling Pruritus in a Patient With Cervical Stenosis

Stephan N Salzmann et al. J Am Acad Orthop Surg Glob Res Rev. .

Abstract

Brachioradial pruritus is a rare condition characterized by chronic localized itching of the dorsolateral upper extremities. Although the exact pathophysiology is still unknown, cervical nerve compression is thought to be a cause. We present the case of a 56-year-old man with a 6-year history of disabling chronic bilateral upper extremity pruritus and pain as well as concurrent neck pain. The patient presented to our office after multiple inconclusive diagnostic evaluations (dermatology, rheumatology, neurology, and psychiatry) and unsatisfactory multimodal conservative treatment attempts. His symptoms markedly impeded his ability to get restful sleep. Imaging of the cervical spine revealed multilevel cervical spondylosis, spinal stenosis with cord compression, and multilevel foraminal stenosis. The patient underwent successful multilevel anterior cervical decompression and fusion and was instantly symptom-free. The present case highlights that patients complaining of itching of the dorsolateral forearms of seemingly unknown etiology should undergo a workup of the cervical spine. If conservative treatment fails, surgical decompression may be considered in select patients.

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Conflict of interest statement

Dr. Hughes or an immediate family member has received research or institutional support from 4WEB Medical, NuVasive, Inc., and Pfizer, Inc. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Salzmann, Dr. Okano, Ms. Shue.

Figures

Figure 1
Figure 1
Photograph showing the typical region of pruritus demarcated in pen.
Figure 2
Figure 2
Illustration showing the areas affected by burning (indicated by x) and aching (indicated by >) as marked by the patient at his preoperative office visit.
Figure 3
Figure 3
Radiographs of the cervical spine showing (A) preoperative (left) and postoperative (right) AP views and (B) preoperative (left) and postoperative (right) lateral view.
Figure 4
Figure 4
MRI scan of the cervical spine showing (A) sagittal view: (left) preoperative image demonstrating central spinal canal stenosis at C3-4 and C4-5 without obvious cord signal change, (right) postoperative. B, Axial view of the C4-5 level: (left) preoperative image demonstrating right-side dominant foraminal stenosis and central spinal canal stenosis with cord compression, (right) postoperative.
See this image and copyright information in PMC

References

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