400 Section - Sequential cryoneurolysis and percutaneous needle tenotomy for refractory wrist flexor contracture: A retrospective case series in stroke and spinal cord injury.

Tuesday, May 19, 2026

6:00 PM - 7:30 PM PT

Presenting Author/Autor expositor(s)

HP

Hendrik L. Pepler, BS

Medical Student
University of British Columbia
Victoria, British Columbia, Canada

Corresponding Author/Autor a quien dirigir la corr(s)

Paul J. Winston, MD

Physiatrist and Researcher
Vancouver Island Health Authority
Victoria, British Columbia, Canada

Co-Author/Coautor(s)

Mahdis Hashemi, MD

Researcher
Vancouver Island Health Authority
Victoria, British Columbia, Canada

Objectives :

Upper limb spasticity following stroke or spinal cord injury (SCI) can lead to fixed wrist flexion contractures that limit hygiene, splinting, and functional positioning. Cryoneurolysis can effectively reduce wrist flexor tone; however, when longstanding contracture is present, residual mechanical restriction often persists. Percutaneous needle tenotomy (PNT) offers a minimally invasive method to release structurally shortened musculotendinous units and restore passive mobility.

Objective

To describe the outcomes of wrist flexor PNT performed following prior cryoneurolysis in patients with refractory upper limb spasticity.

Design:

This retrospective case series included four adults with chronic upper limb spasticity secondary to stroke or SCI, who underwent wrist flexor cryoneurolysis followed by PNT for persistent contracture limiting passive range of motion (ROM). Passive wrist extension ROM and tone graded using the Modified Ashworth Scale (MAS) were compared before and after intervention. Clinical rationale for transitioning from cryoneurolysis to PNT was qualitatively documented.

Results:

Across all four cases, cryoneurolysis produced meaningful tone reduction; however, passive wrist extension remained limited due to fixed end-range contracture. Following PNT, all patients demonstrated immediate and sustained gains in passive wrist extension ROM, with improvements ranging from moderate to substantial. MAS scores remained stable or demonstrated mild improvement post-tenotomy, consistent with tone reduction achieved by preceding cryoneurolysis. No major adverse events were reported.

Conclusion:

Sequential use of cryoneurolysis followed by PNT may be effective for managing refractory wrist flexion contracture, where tone reduction alone is insufficient. Larger prospective studies using standardized functional and patient-reported outcomes are warranted to guide optimal treatment sequencing.