Notalgia Paresthetica Relieved by Cervical Traction

Abstract

Notalgia paresthetica is a syndrome of unilateral, chronic pruritis that is associated with burning pain, paresthesia, numbness, and hyperesthesia localized to the medial and inferior scapula. The condition does not respond to anti-inflammatory drugs or traditional antipruritic agents and has variable responses to numerous other reported pharmacologic and nonpharmacologic therapies. Although the etiology is thought to be nerve impingement, neurologic and musculoskeletal causes are often not considered in the differential diagnosis. We present a report of a woman with a 2-year history of refractory notalgia paresthetica. Notalgia paresthetica, first described in 1934, is a unilateral pruritus located medial or inferior to the scapula.1 Burning pain, paresthesia, numbness, and hyperesthesia may accompany the itch. 2 The condition is more prevalent in middle-aged women and is often chronic, lasting for years. 1 The condition is similar to other forms of neuropathic itch or neurocutaneous dysesthesias, such as meralgia paresthetica and brachioradialis syndrome. Notalgia paresthetica is not believed to be rare, although it is not frequently reported or studied. 3 A number of physical and pharmacologic therapies have been described, with variable results. Herein, we report a case of notalgia paresthetica that responded to cervical traction with permanent resolution of symptoms. Case ReportA 49-year-old woman presented with a 2-year history of increasing pruritus and skin sensitivity. She had a history of atopy and initially attributed the cause of the condition to a clothing allergy. The pruritus was localized to the left midscapular region, extending to the posterior and medial upper arm and axilla. The itch was present most of the day, occasionally wakening her from sleep at night, and was aggravated by hot weather and hot showers. Topical corticosteroid, ketamine, lidocaine, and menthol therapies provided only temporary relief. On examination, there was slight hyperesthesia of the involved skin and a few excoriations but no evidence of dermatitis, induration, warmth, or swelling. A punch biopsy of the involved skin showed no pathologic findings. A computed tomographic scan of the patient's cervical spine revealed a small C5-C6 central disk herniation, not impacting the thecal sac. At the C7-T1 level, there was a mild to moderate, left-sided bony neuroforaminal stenosis with a possible C8 root compromise.The patient was prescribed a 6-week course of cervical mechanical traction of the C4 -C7 vertebrae and exercises to release the left upper trapezius and posterior shoulder capsule and to strengthen the lower trapezius, as well as posture education.

Notalgia paresthetica

“…Many small studies and case reports have varying levels of therapeutic success using different treatments, including one case report where a patient with neuroforaminal stenosis had complete resolution of pruritus from notalgia paresthetica with cervical traction. 19…”

“…Treatment of symptoms in notalgia paresthetica is a challenge for clinicians and while there are many proposed remedies available, there is yet to be one option that works for the majority of patients with notalgia paresthetica. Many small studies and case reports have varying levels of therapeutic success using different treatments, including one case report where a patient with neuroforaminal stenosis had complete resolution of pruritus from notalgia paresthetica with cervical traction 19…”

Notalgia paraesthetica – Ein Review mit Fallbeispiel

“…bildgebende Verfahren von der Thoraxregion [11]. In vielen Fällen führten die daraus folgenden Therapien zu einer sofortigen Besserung [12]. Erfolge wurden mit Training der Rückenmuskulatur oder elektrischer Nerven-und Muskelstimulation beschrieben [13].…”

Notalgia paresthetica: clinical features, radiological evaluation, and a novel therapeutic option

“…Although the etiology of NP has not yet been completely elucidated, degenerative changes of the cervical spine are considered to be associated with its pathogenesis [4,5]. NP mostly occurs in women aged 54 to 62 years [6].…”