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1310 - Case Report: Cryoneurolysis as a Novel Procedure to Manage Upper Limb Spasticity in Patients with Multiple Sclerosis

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Co-Author(s)

AH

Ava Hughes, BSc

Medical Student
The University of British Columbia
North Vancouver, British Columbia, Canada
Paul J. Winston, MD,FRCPC

Associate Professor
Vancouver Island Health Authority
Victoria, British Columbia, Canada

Presenting Author(s)

MH

Mahdis Hashemi, MD

Physiatrist / Research Coordinator
Vancouver Island Health Authority
Victoria, British Columbia, Canada

Case Diagnosis: Multiple Sclerosis (MS) is a chronic autoimmune neurodegenerative disease that can impact various body systems leading to muscle weakness, decreased coordination, motor impairment and spasticity, which is found in up to 90% of individuals with MS. Spasticity is considered one of the most disabling symptoms of MS that leads to pain, reduction in mobility and a hindrance to completing tasks of daily living.

Case Description: This study is a retrospective chart review of two patients with MS who received cryoneurolysis between 2018 to 2023 to their musculocutaneous, medial and lateral pectoral and radial nerves, or the nerve branch to brachioradialis to manage their upper limb spasticity. Assessment for active and passive range of motion (AROM, V1 respectively) and tone based on the Modified Ashworth (MAS) scale was done at baseline and up to 346 days after the procedure.

Discussions: For both patients, there was an improvement on the MAS across the shoulder and elbow movements in all directions, which was maintained up to a maximum of 346 days. In addition, for both patients shoulder flexion, abduction, and external rotation V1 significantly increased and was maintained up to 346 days post procedure. V1 improved significantly for elbow extension at the one and a half month follow-up, which then led to a mild decrease at the final assessment, which was still an overall increase from baseline.

Conclusions: This study suggests that cryoneurolysis can be used as a minimally invasive approach to manage upper limb refractory spasticity in patients with MS, however more studies with a larger sample size is recommended.