200 Section - Cryoneurolysis in Post Stroke Spasticity: A Case for Rethinking Assessment Metrics

The patient was a 40-year-old woman who developed right-sided hemiplegia following aneurysm clipping complicated by ischemic stroke in 2005. Nineteen years later, she presented with chronic focal spasticity of the right upper and lower limbs, marked by resistance to movement, elbow–wrist–finger flexor posturing, restricted ankle dorsiflexion with clonus and foot drop, and impaired dexterity that limited daily function. Despite extensive rehabilitation–including inpatient and outpatient physiotherapy, CIMT, strengthening and stretching, acupuncture, and supervised and home-based FES–she had never received targeted spasticity management. Examination showed increased tone with limited but preserved AROM at the wrist and ankle. Diagnostic nerve blocks produced immediate reductions in resistance and improved functional quality, confirming a predominantly spasticity-driven pattern amenable to cryoneurolysis.

 

Case Description:

Nerve block responses identified key contributors to movement restriction, producing immediate improvements in wrist control, finger extension, balance, and ankle dorsiflexion. Guided by these findings, she underwent ultrasound- and stimulation-guided percutaneous cryoneurolysis to median nerve branches supplying FDS and FCR, the ulnar branch to FCU, and tibial nerve motor branches to the medial and lateral gastrocnemius. Following treatment, she demonstrated meaningful improvements in voluntary movement, coordination, dexterity, balance, and functional activity engagement.

Discussions:

Tone-based measures such as MAS and MTS showed minimal change, yet the patient displayed clear functional gains, highlighting their limitations in capturing outcomes of cryoneurolysis. Diagnostic nerve blocks enabled precise targeting of reversible neural contributors, supporting recovery nearly two decades post-stroke. Patient-centred tools such as GAS-Light, ArmA, and LegA more accurately reflected her improvements and emphasized the need for multidimensional assessment frameworks.

Conclusions:

Cryoneurolysis produced sustained functional benefits in chronic post-stroke spasticity, with meaningful improvements best represented through patient-centred measures rather than tone scales. Integrating such tools may provide a more accurate understanding of recovery and guide individualized spasticity management.