Cryoneurotomy as a Percutaneous Mini-invasive Therapy for the Treatment of the Spastic Limb: Case Presentation, Review of the Literature, and Proposed Approach for Use.
Paul Winston, Patricia Branco Mills, Rajiv Reebye and 1 others
PMID 33543059WHAT IT FOUND
In three patients with chronic spasticity, cryoneurotomy of specific motor nerves improved range of motion and reduced muscle tone.
In two elbow cases, this procedure allowed botulinum toxin doses to be redistributed to other muscles, yielding further functional gains.
Key findings
01Cryoneurotomy of the brachialis motor branch in a patient with stroke-related elbow spasticity increased active range of motion and reduced the Modified Ashworth Scale score from 3 to 1+.
02In a patient with multiple sclerosis and ankle spasticity, cryoneurotomy of tibial nerve branches eliminated ankle clonus and improved gait mechanics during pregnancy after botulinum toxin was stopped.
03Following cryoneurotomy, botulinum toxin units were redistributed from treated muscles to other spastic muscle groups in two patients, which facilitated further improvements in range of motion.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This is a case series of only three patients, so the findings cannot be generalized to the broader spasticity population. The study is observational with no control group, making it impossible to determine the true effect of cryoneurotomy versus natural history or concurrent therapies. Long-term outcomes are unknown, and there is a risk of nerve regeneration and return of spasticity. The procedure requires specialized skills in ultrasound and electrical stimulation guidance for nerve localization. Not all muscles can be safely targeted due to the proximity of sensory nerves, which limits the applicability of this technique.
The easy way to misread this
Do not assume cryoneurotomy is a proven standalone treatment for spasticity. These results come from three patients who also received botulinum toxin and physiotherapy, so the specific contribution of cryoneurotomy cannot be isolated from these concurrent interventions.