Cryoneurotomy to Reduce Spasticity and Improve Range of Motion in Spastic Flexed Elbow: A Visual Vignette

Rubenstein, Jonathan N.; Harvey, Alexandra; Vincent, Daniel; Winston, Paul

doi:10.1097/phm.0000000000001624

Cited by 8 publications

(5 citation statements)

References 3 publications

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“…The MAS remained reduced at 9 months with much greater ease in passive ROM of the shoulder. This is consistent with findings of cryoneurotomy for flexed elbow spasticity (14) and the tibial nerve (3).…”

Section: Comfortsupporting

confidence: 90%

“…This procedure has been shown to have a clinically significant impact on spasticity reduction, even in cases refractory to other therapeutic strategies ( 3 ). Cryoneurotomy for the flexed elbow spasticity was shown to maintain the improved ROM and reduced MAS at a mean follow-up interval of 12.5 months in 11 patients including maintenance in the longest follow at over 2 years ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

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Case Report: Perspective of a Caregiver on Functional Outcomes Following Bilateral Lateral Pectoral Nerve Cryoneurotomy to Treat Spasticity in a Pediatric Patient With Cerebral Palsy

Scobie

Winston

2021

Front. Rehabilit. Sci.

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Spasticity is common and difficult to manage complication of cerebral palsy that significantly affects the function and quality of life of patients. This case study reports a 15-year-old male with quadriplegic cerebral palsy, Gross Motor Function Classification System 5 (GMFCS 5), who presented with significant bilateral adducted and internally rotated shoulders as a component of generalized spasticity. Spasticity in the lower limb of the patient had been treated with botulinum toxin A (BoNT-A) injections; however, the shoulder region was spared due to concerns of toxin spread and aspiration risk. Following diagnostic nerve blocks, the patient underwent bilateral cryoneurotomies of the right and left lateral pectoral nerves (LPNs) lasting 3.5 min for each lesion. One month after the cryoneurotomies, the range of motion (ROM) had improved from 86° to 133° on the right and 90° to 139° on the left. Improvements in ROM were retained at 9 months post-procedure. At 8.5 months following the cryoneurotomies, the caregiver reported improvements in upper body dressing, upper body washing, transferring, and the ability of the patient to remain sitting in his wheelchair for extended periods. Cryoneurotomy may be an effective procedure for improving shoulder ROM and specific functional outcomes for caregivers of patients with spasticity arising from cerebral palsy.

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Section: Comfortsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Case Report: Perspective of a Caregiver on Functional Outcomes Following Bilateral Lateral Pectoral Nerve Cryoneurotomy to Treat Spasticity in a Pediatric Patient With Cerebral Palsy

Scobie

Winston

2021

Front. Rehabilit. Sci.

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“…Spasticity affects a wide range of patients including stroke, multiple sclerosis, spinal cord injury, cerebral palsy, and other neurological conditions. Percutaneous cryoneurolysis is a novel neurolytic technique for spasticity management 3–5 . Cryoneurolysis for spasticity stems from cryoneurolysis of purely sensory nerves, an established pain procedure involving freezing nerves connecting pain generators to the brain 6–8 .…”

mentioning

confidence: 99%

“…There are no published studies on cryoneurolysis for spasticity. Case reports suggest that the effects will last months to years 3–5 …”

mentioning

confidence: 99%

Analysis of side effects of cryoneurolysis for the treatment of spasticity

Winston¹,

MacRae

Rajapakshe³

et al. 2023

Am J Phys Med Rehabil

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Objective The aim of the study is to report adverse effects from clinical studies on ultrasound-guided percutaneous cryoneurolysis for spasticity. Design Patients were prospectively enrolled in three studies at a single institution. Cryoneurolysis was performed to primarily motor nerve branches (medial and lateral pectoral, musculocutaneous, radial, median, ulnar, tibial, obturator) and mixed motor sensory nerve trunks (median, ulnar, suprascapular, radial, and tibial). Results Cryoneurolysis was performed for 277 nerves (99 mixed motor sensory), on 113 patients (59 F, 54 M, average age 54.4 yrs). One patient had a local skin infection and two patients had bruising or swelling; all resolved within 1 mo. Nine reported nerve pain or dysesthesia (two motor, seven mixed motor sensory nerves). Four received no treatment, four oral or topical medications, two perineural injections, one botulinum toxin. Three patients’ symptoms remained until 3 mos and one had numbness at six. One patient had botulinum toxin injections for cramping. All had at minimum 3-mo follow-up; seven withdrew (x̄ = 5.4 mos), four passed away. None of these 11 reported adverse effects. Conclusions A total of 96.75% of nerve treatments had no pain or dysesthesias beyond treatment. Few had pain or numbness beyond 3 mos. Cryoneurolysis has potential to be a safe spasticity treatment with manageable adverse effects.

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“… 5 Recent case studies have shown that increases in range of motion can persist for an extended period, lasting from months to years in numerous etiologies. 6 , 7 , 8 Cryoneurolysis of afferent nerves is an established technique for pain management that has been in use for decades. 9 , 10 …”

mentioning

confidence: 99%

A Case Report of Cryoneurolysis for Dorsal Foot Pain and Toe Clawing in a Patient With Multiple Sclerosis

MacRae

Speirs²,

Bursuc

et al. 2023

Archives of Rehabilitation Research and Clinical Translation

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Cryoneurotomy to Reduce Spasticity and Improve Range of Motion in Spastic Flexed Elbow: A Visual Vignette

Cited by 8 publications

References 3 publications

Case Report: Perspective of a Caregiver on Functional Outcomes Following Bilateral Lateral Pectoral Nerve Cryoneurotomy to Treat Spasticity in a Pediatric Patient With Cerebral Palsy

Case Report: Perspective of a Caregiver on Functional Outcomes Following Bilateral Lateral Pectoral Nerve Cryoneurotomy to Treat Spasticity in a Pediatric Patient With Cerebral Palsy

Analysis of side effects of cryoneurolysis for the treatment of spasticity

A Case Report of Cryoneurolysis for Dorsal Foot Pain and Toe Clawing in a Patient With Multiple Sclerosis

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