Measuring the Efficacy of Percutaneous Cryoneurolysis in Participants With Refractory or Plateaued Shoulder, Elbow, Wrist, or Finger Spasticity.

Objective: To investigate novel, minimally invasive cryoneurolysis for refractory or plateaued upper extremity spasticity.

Design: This was a repeated-measures, single-center, observational pilot study (NCT04670783). Percutaneous cryoneurolysis was applied to the upper extremity nerves and intramuscular branches of 59 adults with upper extremity spasticity refractory to or plateaued on botulinum therapies. Maximal passive range of motion (ROM; V1), active ROM (AROM), and Modified Ashworth Scale (MAS) score were measured during shoulder flexion, abduction, and external rotation and elbow and wrist extension at baseline and follow-up to 1 year. Additional outcomes included pain, participant satisfaction, and upper extremity disability.

Results: Overall, 59 participants received cryoneurolysis in ≥1 region targeting nerves that innervate muscles supporting shoulder (n = 47), elbow (n = 33), wrist (n = 18), and fingers/thumb (n = 29) movement. At 12 months, there was significant change from baseline in V1, AROM, and MAS score for shoulder flexion and abduction and in V1 and MAS score for external rotation. Similar results were observed for elbow extension V1, AROM, and MAS score and wrist extension MAS score. Average daily pain, participant satisfaction, and upper extremity disability improved.

Conclusion: Participants with plateaued or refractory spasticity had improvements in upper extremity regions; future evaluations of cryoneurolysis treatment for spasticity are warranted.