Clinical Sciences/Health Conditions
Vania Rezaei, n/a
Medical Student
University of British Columbia
Victoria, British Columbia, Canada
Mahdis Hashemi, MD
Researcher
Vancouver Island Health Authority
Victoria, British Columbia, Canada
.jpg "Paul J. Winston, MD photo")
Paul J. Winston, MD
Physiatrist and Researcher
Vancouver Island Health Authority
Victoria, British Columbia, Canada
A 42-year-old male with Williams Syndrome (WS) and a history of a left hemispheric stroke presented with chronic right spastic hemiparesis and contractures. Individuals with WS commonly experience hypertonia, impaired postural control, and reduced stability which can limit their independence in daily activities. Despite prior treatment with oral agents and repeated botulinum toxin injections, spasticity and pain persisted, prompting consideration of cryoneurolysis for tone and mobility management.
Case Description:
The patient underwent ultrasound-guided percutaneous cryoneurolysis. The first intervention was performed in February 2022 targeting the medial and lateral pectoral nerves. At baseline, shoulder flexion was 75° (V1) with a V3 catch at 65° and active ROM (AROM) at 70°on the Modified Tardieu Scale (MTS) and MAS 3. Within one month all measures improved with a V1 of 104° and MAS score of 0. A second cyroneurolysis was performed in March 2023 to manage recurrence of tone due to a fall. It resulted in improved V1, V3 and AROM with shoulder flexion reaching 105° (V1). A third cryoneurolysis was performed in June 2024. The patient experienced immediate improvements and at the follow-up in July 2025, shoulder flexion V1 exceeded pre-treatment values, measuring 100°. The patient reported greater ease with hygiene and dressing and overall satisfaction with the results.
Discussions:
This case demonstrates the ability of cryoneurolysis to reduce focal spasticity and pain in a complex neurological patient with WS. The intervention produced clinically significant and sustained improvements in MTS, MAS, mobility and comfort. Patient satisfaction was consistently high at the three-year follow-up.
Conclusions:
Cryoneurolysis represents a safe, minimally invasive option for long-term management of spasticity in patients with neurological and genetic disorders. Repeated treatments maintained functional gains and reduced reliance on other therapies. This highlights its potential as a valuable alternative or complement to the other available treatments.
