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Published on: September 23, 2018
Exploratory Use of Proximal Cryoneurolysis and Distal Botulinum Toxin Type A for Upper-Limb Spasticity: A Case Report
Di Lorenzo Luigi1,2, De Meo Bruno2, Forte Alfonso Maria3
1Department Vita, Salute e Professioni Sanitarie, Università Campus Link, 00165 Rome, Italy.
Background:
Upper-limb spasticity involving the shoulder girdle and elbow flexors often impairs functional hand use, and although Botulinum toxin type A (BoNT-A) is a first-line therapy, severe proximal synergies may persist while higher doses risk distal weakness.
Methods:
We report a case of a 47-year-old woman with neurodegenerative tetraparesis and marked shoulder and elbow flexor spasticity treated with bilateral percutaneous cryoneurolysis of the lateral pectoral, thoracodorsal, and musculocutaneous nerves, followed by distal BoNT-A injections, and we conducted a scoping review following Arksey and O'Malley, Levac, and PRISMA-ScR methods to contextualize the current evidence.
Results:
At one-month follow-up, the patient showed a reduction in MAS from 4 to 1-2, complete resolution of pain, improved passive shoulder abduction and elevation, preserved distal dexterity, and high satisfaction with no adverse events. The scoping review identified consistent MAS and range-of-motion improvements across multiple case reports and small series involving similar proximal nerve targets.
Conclusions:
The combined proximal cryoneurolysis-distal BoNT-A approach appears to be a feasible dual-modulation strategy for complex upper-limb spasticity when the preservation of hand function is essential, and the emerging literature supports its further investigation.
