Everything You Need To Know About Cryoneurolysis for Spasticity: Who, What, When, & How.

NeuroRehab Team
Thursday, December 4th, 2025

botoxcryoneurolysisspasticity

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Neurological conditions bring spasticity to many patients. The numbers are striking – 80% of spinal cord injury patients, 39.5% of stroke patients with paresis, and 84% of those with multiple sclerosis experience this condition. Traditional treatments like oral anti-spasmodics and botulinum toxin injections help patients find relief, yet they have their limitations. Botulinum toxin stands as a first-line treatment for focal spasticity, but its effects last only 3-4 months before requiring another treatment.

The medical field has found a promising solution in cryoneurolysis for managing spasticity. This technique uses controlled freezing and thawing of peripheral nerves. Patients can experience improvements in upper limb spasticity, function, and pain that last up to a year. The treatment targets multiple upper limb nerves and shows remarkable improvements in shoulder, elbow, and wrist spasticity and hand function from baseline.

As I wrote in this piece, you’ll learn about cryoneurolysis, its effectiveness for spasticity after stroke and other conditions, and key information to help you think over this treatment option. The content covers suitable candidates for this procedure and what patients can expect during and after treatment. This information could help you greatly, especially when you have spasticity that doesn’t respond well to standard treatments, as you start a journey toward better function and comfort.

What is spasticity and why is it hard to treat?

Spasticity shows up as a complex motor disorder with muscles that resist movement more strongly when moved faster ^[1]. This creates a challenging cycle for patients who try to perform their daily activities.

How spasticity affects daily life

Life becomes incredibly challenging when you have spasticity. More than 35% of multiple sclerosis patients say stiffness, spasms, or pain bothers them moderately or greatly ^[1]. The condition makes it hard to climb stairs, walk, or sleep properly ^[1]. These physical challenges take an emotional toll too.

The effects on daily life go beyond just movement problems:

• Increased muscle tone (hypertonia) and involuntary muscle spasms ^[2]
• Pain or discomfort in affected muscles and joints ^[2]
• Problems with hygiene, dressing, and other self-care activities ^[2]
• Sleep disruption due to painful spasms or muscle tightness ^[2]
• Abnormal postures that can lead to social stigma ^[1]

Untreated spasticity can lead to serious complications like muscle shortening, fibrosis, calcification, and fixed contractures ^[1]. These additional problems create huge costs for health and social care systems ^[3].

Common causes like stroke and MS

Spasticity affects over 12 million people worldwide ^[4]. Damage to the brain, spinal cord, or motor nerves causes this condition by disrupting normal signals that control muscle contraction and relaxation ^[5].

Different neurological conditions show varying rates of spasticity. About 80% of people with cerebral palsy deal with this condition ^[4]. The same percentage of multiple sclerosis patients develop it during their illness ^[1]. The condition also affects 40% of people with spinal cord injury, 35% of stroke survivors, and 50% of those with traumatic brain injury ^[1].

The pattern and severity change based on which parts of the nervous system get damaged ^[5]. Stroke survivors often experience leg and hip muscle spasticity. This results in either flexor spasticity where legs and hips stay bent, or extensor spasticity where legs remain straight and sometimes cross at the ankles ^[4].

Why current treatments often fall short

Less than half of patients say they’re happy with their current spasticity treatment ^[1]. Several basic problems with standard treatments explain this dissatisfaction.

Medications that reduce muscle tone often make patients drowsy, lethargic, and weak ^[1]. Drugs like baclofen and tizanidine work well but come with these unwanted effects ^[6].

Doctors usually start with safer treatments before trying riskier options ^[1]. This careful approach means patients might suffer longer while waiting for effective relief.

Getting treatment can be difficult too. Many patients with advanced conditions struggle to visit specialty clinics for treatments like botulinum toxin injections ^[3]. They end up relying on primary care doctors who may have limited experience with spasticity management ^[3].

Managing spasticity needs a careful balance. Doctors must reduce abnormal muscle tone while keeping necessary function ^[1]. Some patients actually use their spasticity to stand or support their weight despite weakness ^[7]. This makes each patient’s treatment unique and complex.

These limitations have sparked interest in new spasticity treatments that last longer and cause fewer side effects. Cryoneurolysis shows promise as an emerging treatment, especially for spasticity after stroke and other neurological conditions.

What is cryoneurolysis and how does it work?

Cryoneurolysis shows great promise as a minimally invasive procedure to treat focal spasticity. Scientists first developed it in 1961 using liquid nitrogen at temperatures of −190°C. Modern cryoneurolysis has grown substantially with a worldwide return to using cryogens at temperatures below −100°C ^[7].

The science behind cryoneurolysis

Cryoneurolysis uses very cold temperatures to temporarily disrupt nerve function. Doctors insert a specialized cryoprobe through the skin and place it against the targeted nerve. The device delivers liquid nitrous oxide within a closed-end probe, which makes the temperature at the tip drop faster between −60°C and −88°C ^[7].

This quick cooling creates a small ice ball from the body’s own interstitial fluid near the peripheral nerve ^[1]. This approach stands out because it doesn’t need any medication injected into the body. The controlled freezing process creates the therapeutic effect by itself ^[8].

Several critical factors determine how well cryoneurolysis works:

• Proximity of the probe to the targeted nerve
• Surface area of tissue covered by the probe
• Rate and duration of cold application
• Temperature applied ^[9]

Cryoneurolysis targets nerves with great precision because the ice ball stays contained – there’s no risk of liquid spreading to other nerves ^[1].

How freezing nerves helps reduce spasticity

Medical professionals call the process “secondary axonotmesis” or Wallerian degeneration. The controlled freezing temperatures used in cryoneurolysis (typically −88°C for spasticity treatment) cause this effect ^[7]. This process stops nerve conduction by temporarily damaging the axon and myelin sheath.

Cryoneurolysis differs from permanent nerve destruction techniques because it’s reversible. The freezing temperatures keep the nerve’s supporting structures intact – including the endoneurium, perineurium, and epineurium ^[7]. These structures work as a framework that lets the nerve grow back over time at about 1-2 mm per day ^[9].

This controlled, temporary disruption gives patients a big advantage: the effects last much longer than botulinum toxin injections yet eventually wear off as the nerve grows back. Patients usually feel relief for three to six months until their nerve naturally regenerates ^[8].

The process also protects surrounding tissues from damage. Blood vessels stay safe even during nearby procedures because flowing blood’s heat sink properties protect vascular structures ^[7]. Sir Herbert Seddon and Sunderland’s classification systems put cryoneurolysis in the 2nd-degree nerve injury category – serious enough to stop function temporarily but fully recoverable ^[9].

Types of nerves typically targeted

Researchers made a breakthrough in 2018 by introducing ultrasound-guided techniques that expanded potential targets ^[7]. While doctors once used cryoneurolysis only for sensory nerves in pain management, they now effectively target:

• Sensorimotor trunk nerves
• Motor branches to individual muscles
• Intramuscular nerve targets ^[7]

Doctors often target the ulnar and median nerve trunks to treat upper limb spasticity, especially for the common spastic claw hand contracture ^[7]. They target the femoral nerve in the lower limb to treat spasticity that causes stiff knee gait in multiple sclerosis patients ^[10].

Ultrasound guidance and electrical stimulation have transformed these procedures’ precision. These technologies help doctors find exact nerve locations while keeping nearby blood vessels safe ^[1]. Doctors also typically perform diagnostic nerve blocks (DNBs) with local anesthetics like lidocaine before cryoneurolysis to predict results and lower the risk of problems ^[1].

Research backs up this approach’s safety record. A study of 113 patients with 277 treated nerves showed about 96.75% of nerve treatments caused no pain or dysesthesias beyond the treatment itself ^[7]. Only about 1% of treatments for primarily motor nerves had side effects ^[1].

Who is a good candidate for cryoneurolysis?

Not everyone with spasticity makes a good candidate for cryoneurolysis. Medical teams need a full picture to find patients who will benefit most from this treatment.

Diagnostic nerve blocks and patient screening

The path to cryoneurolysis treatment starts with diagnostic nerve blocks (DNBs). These temporary blocks work as vital predictive tests to see if a patient will respond well to the actual cryoneurolysis procedure. During a DNB, doctors inject local anesthetic medications like lidocaine or bupivacaine around specific nerves. This blocks their function temporarily. The procedure shows what cryoneurolysis might do, but it only lasts a few hours.

Patients must show a strong positive response to the diagnostic block to move forward with cryoneurolysis. Many protocols need at least a 50% decrease in spasticity after the nerve block. Some clinics ask patients to go through two separate prognostic nerve blocks. Different anesthetics confirm consistent results before moving to cryoneurolysis ^[4].

The screening process has detailed clinical examinations before and after the nerve block. These tests help doctors tell the difference between spasticity and fixed contractures. A big improvement in muscle tightness after the nerve block points to spasticity rather than permanent muscle shortening or contracture ^[5]. Patients who show this response make good candidates for cryoneurolysis.

Conditions where cryoneurolysis works best

Cryoneurolysis shows great results in treating spasticity from neurological conditions of all types. Good candidates are patients with:

• Spasticity that doesn’t respond well to standard treatments like physical therapy or medications
• Spasticity after stroke, multiple sclerosis, or spinal cord injury
• Focal spasticity that affects specific muscle groups or limbs
• A need for longer-term relief without surgery ^[6]

Early pilot studies show that cryoneurolysis of motor and mixed nerve trunks in spasticity improves range of motion. Patients report high satisfaction and few side effects ^[3]. Patients with hip adductor spasticity also respond well to fluoroscopic-guided cryoneurolysis of the obturator nerve, which gives long-lasting relief ^[11].

Clinical evidence proves cryoneurolysis can tackle spasticity in both upper and lower limbs effectively. For upper limb spasticity, ultrasound-guided cryoneurolysis targeting the forearm shows promising results ^[12]. This helps patients who need relief from conditions like “spastic claw hand” that affect their daily life.

Contraindications and safety checks

Cryoneurolysis brings benefits but isn’t right for everyone. You can’t use it if you have:

• Bleeding disorders or take blood thinners without proper INR control
• Active infection where the procedure would happen
• Refused the treatment ^[13]

You should be careful with cryoneurolysis if you have:

• Raynaud’s syndrome
• Cryoglobulinemia
• Cold urticaria
• Pregnancy
• Severe psychiatric disorders ^[14]

Blood thinner patients need extra care before cryoneurolysis. Warfarin users must have their INR (International Normalized Ratio) in the right range, usually 2.0 to 3.0. This check happens no more than a week before the appointment ^[15]. Newer blood thinners like rivaroxaban or apixaban might need more testing.

Safety checks before treatment should look at medical history and use imaging to guide precise targeting. Doctors weigh potential risks against benefits. Patients should know that while generally safe, they might get temporary pain, swelling, bruising, and rarely, infection where the needle goes in ^[15].

Good screening and picking the right patients makes cryoneurolysis valuable for people whose spasticity hasn’t improved with regular treatments.

What to expect during the procedure

Patients need to know how cryoneurolysis works. This helps them get ready both mentally and physically. The treatment is simple but needs special equipment and expert guidance to freeze the nerves that cause spasticity.

Step-by-step overview of the treatment

Patient positioning comes first and depends on the area we’re treating. Knee-related spasticity patients lie face up, while shoulder treatments need patients to lie face down with their chest on pillows and the affected arm hanging off the side ^[16].

The procedure follows these steps:

1. We clean the treatment area with an antiseptic solution like chlorhexidine gluconate
2. A local anesthetic numbs the skin and insertion path
3. We place an introducer (usually a 14-18 gage catheter) to create a path for the cryoprobe
4. The specialized cryoprobe goes through the introducer to reach the target nerve under guidance
5. The freezing cycles start once we position the probe correctly, lasting 30 seconds to 3 minutes at temperatures between -70°C and -88°C ^[8]
6. The probe needs time to thaw before we take it out
7. We finish by removing all instruments and putting on a small bandage

A typical office visit takes about 30 minutes to complete the treatment ^[17]. The gas releases harmlessly, leaving no nitrous oxide or other cryogens in the body ^[17].

Use of ultrasound and nerve stimulation

Finding the exact nerve location is the life-blood of successful spasticity management through cryoneurolysis. Doctors now use advanced techniques to target the right spot.

Ultrasound guidance shows nerves and surrounding structures through up-to-the-minute visualization. Doctors can spot nerves using high-frequency ultrasound. These nerves look like dark nerve fascicles inside bright epineurium, creating a distinct honeycomb-like pattern when viewed in cross-section ^[2].

A nerve stimulation test confirms the exact location. The nerve gets progressively lower current from a transcutaneous electrical nerve stimulation probe ^[2]. Settings on the nerve stimulator switch between sensory (100 Hz) and motor (2 Hz) responses based on the nerve type ^[3]. This two-part approach improves accuracy and protects nearby structures.

The ultrasound keeps track of the ice ball forming around the nerve, making sure it covers all the right areas ^[18].

Pain management during the procedure

Patient comfort is our main goal during cryoneurolysis treatment. Most patients report minimal discomfort during the procedure thanks to our detailed pain management plan ^[19].

We start by numbing the skin and tissues underneath with medications like lidocaine (1-2%) with epinephrine ^[16]. This happens before we insert any probes to keep patients comfortable.

Deeper areas might need extra anesthetic around the target nerve before cryotherapy. Many doctors use ropivacaine (5 mg/ml) next to the nerve ^[2].

We protect skin from extreme cold during freezing through several methods:

• Heating pads on the skin balance out the freezing temperatures below
• Saline injection creates space between skin tissue and freezing temperatures ^[2]
• The probe goes in about 4-6 cm from where we target the nerve ^[2]

Patients stay awake during the procedure since they rarely need general anesthesia ^[2]. This lets them tell us right away if something feels off, so we can adjust as needed.

What are the results and how long do they last?

The results of cryoneurolysis in managing spasticity are evident in both measurements and patient feedback. Patients notice meaningful changes within days after their treatment.

Improvements in movement and pain

Clinical studies show remarkable functional gains after cryoneurolysis. Patients see immediate improvements in range of motion (ROM) in treated areas ^[20]. A study on upper limb treatments revealed sustained improvements in shoulder abduction (+9.7° at 12 months), shoulder flexion (+8.1° at 12 months), and elbow extension (+21.3° at 12 months) ^[9].

Spasticity reduction measured by the Modified Ashworth Scale (MAS) shows impressive results. Researchers documented average MAS score reductions at the 12-month mark: 2.0 points for shoulder abduction, 1.7 points for shoulder flexion, and 1.3 points for wrist extension ^[9]. Some patients’ targeted muscles show complete resolution of spasticity lasting through final check-ups at 9-12 months ^[21].

Pain relief is a vital benefit. Studies reveal:

• Daily pain drops at 1, 3, 6, and 12 months after treatment ^[9]
• Patients report better satisfaction with outcomes ^[9]
• Life quality improves with easier routine tasks ^[22]

Patients report better function in daily activities, such as “independent showering, no falls, and a significant decrease in muscle tone” ^[20].

How long the effects typically last

Benefits from cryoneurolysis last differently for each person and treatment area. Results usually last three to six months until nerves naturally regenerate ^[8]. Axons regrow at about 1-2 mm daily ^[23].

Pain reduction studies show 54.2% of patients had at least 30% less pain at 1 month. These numbers dropped to 13.8% at 3 months and 9.1% at 6 months ^[18]. Spasticity treatment lasts longer – benefits continue up to 9 months for some patients ^[20].

Recent research hints at longer-lasting benefits in certain cases. A multiple sclerosis case study showed shoulder and elbow improvements lasted up to 11 months, while knee improvements continued for 7 months ^[24].

When repeat treatments may be needed

Nerve function naturally returns, so most patients need repeat treatments. New treatment becomes necessary when spasticity returns or improvements fade.

Repeated cryoneurolysis in the same area is safe with no long-term problems ^[23]. Medical literature shows “no evidence indicating that the effect of cryoneurolysis diminishes with repeated use, or that it is associated with an increased risk” ^[18].

Previous results usually return when the procedure is repeated ^[20]. This makes cryoneurolysis an excellent option to manage chronic spasticity long-term. Some medical centers now offer regular repeat treatments based on when symptoms come back.

Are there any risks or side effects?

Cryoneurolysis, like most medical procedures, comes with certain risks, though its safety record remains strong for treating spasticity.

Common short-term side effects

Clinical data reveals that few patients experience temporary side effects from cryoneurolysis spasticity treatment. Studies show that local skin infections affected only 0.9% of patients, and bruising or swelling occurred in 1.78% of cases – all of which cleared up within a month ^[25]. Crusting at the insertion site emerges as the most common effect, with 53% of treatment areas showing mild cases and 9% showing moderate cases ^[26]. Patients usually feel temporary numbness when their sensory nerve signals get disrupted ^[27].

Other short-term effects include:

• Redness/inflammation around the treatment area
• Local discomfort that goes away within 30 seconds
• Mild tingling (12% of patients reported this) ^[26]

Managing post-procedure pain

Recovery after the procedure needs straightforward but essential care. Doctors usually recommend:

• Rest
• Ice application when needed
• Over-the-counter pain relievers ^[27]

Patient reports show that side effects barely affected their daily activities ^[26]. Most predicted treatment-related effects decrease substantially after the first week. By days 30 and 56, less than 10% of patients reported symptoms like redness, local pain, and itching ^[26].

Long-term safety and nerve recovery

The procedure’s long-term safety record stands as one of its key benefits. Research shows that 96.75% of nerve treatments caused no pain or dysesthesias beyond the treatment phase ^[25]. Pain management works through reversible neuronal injury (Wallerian degeneration), and the nerve recovers fully ^[3].

Studies of tissue samples confirm that multiple treatments don’t permanently change the nerve’s structure. The nerve recovers completely without inflammation, scarring, or neuroma formation ^[7]. The nerve’s supporting structures stay intact, which allows full function to return ^[3].

Conclusion

Cryoneurolysis marks a major step forward in managing spasticity, especially for patients who struggle with standard treatments. This procedure strikes a perfect balance by providing relief that lasts longer than botulinum toxin but doesn’t have the permanence of surgery. People dealing with spasticity from stroke, multiple sclerosis, or spinal cord injury can now access treatment that improves their range of motion, reduces muscle tone, and eases pain for months.

The reversible nature of this approach makes it valuable. The nerve’s supporting structures stay intact, unlike permanent treatments, which lets natural regeneration happen while symptoms improve. Nerves regenerate at about 1-2 mm daily, giving patients extended periods where they function better.

Safety stands out as another big advantage. Most patients experience only short-term discomfort and mild skin reactions that quickly go away. The treatment is safe to repeat when symptoms come back, making it an eco-friendly option for managing chronic spasticity long-term.

Patient selection is a vital part of successful treatment. Diagnostic nerve blocks help screen and identify people who will benefit most from cryoneurolysis. Precise targeting and the best outcomes come from this careful selection process, combined with ultrasound guidance and nerve stimulation methods.

Starting a journey to manage spasticity can overwhelm patients and their families. Yet cryoneurolysis brings new hope to those who haven’t found relief through traditional methods. The ability to shower alone, fall less often, and move with less muscle tension means real improvements in daily life.

While not a permanent fix for spasticity, cryoneurolysis fills an important gap in treatment options. This approach works well for patients who want longer-lasting relief without constant medication or repeated injections every few months. The science behind cryoneurolysis keeps evolving, and current evidence shows it deserves a place in a detailed spasticity management plan.

Key Takeaways

Cryoneurolysis offers a promising middle-ground treatment for spasticity patients seeking longer-lasting relief without permanent surgical intervention.

• Cryoneurolysis uses controlled freezing (-88°C) to temporarily disrupt nerve function, providing 3-6 months of spasticity relief compared to botulinum toxin’s 3-4 months.

• Diagnostic nerve blocks are essential screening tools – patients must show at least 50% spasticity reduction during testing to qualify for treatment.

• The procedure preserves nerve structure, allowing complete regeneration at 1-2mm per day while maintaining safety for repeated treatments when needed.

• Clinical studies show significant improvements: up to 21° increased elbow extension and 2-point reductions in spasticity scores lasting up to 12 months.

• Side effects are minimal with 96.75% of treatments causing no lasting pain or complications, making it safer than many traditional spasticity treatments.

This innovative approach bridges the gap between temporary injections and permanent surgery, offering hope for stroke, MS, and spinal cord injury patients who haven’t found adequate relief through conventional treatments.

References

[1] – https://pmc.ncbi.nlm.nih.gov/articles/PMC11561588/
[2] – https://pmc.ncbi.nlm.nih.gov/articles/PMC12061374/
[3] – https://pmc.ncbi.nlm.nih.gov/articles/PMC11931670/
[4] – https://www.choa.org/-/media/Files/Childrens/teaching-sheets/cryoneurolysis-for-spasticity-and-dystonia.pdf
[5] – https://www.ouh.nhs.uk/media/bpckkqbb/104073blocks.pdf
[6] – https://daradia.com/cryoneurolysis-of-sacroiliac-joint/
[7] – https://pmc.ncbi.nlm.nih.gov/articles/PMC9482954/
[8] – https://memorialhermann.org/services/treatments/cryoneurolysis
[9] – https://pmc.ncbi.nlm.nih.gov/articles/PMC12435237/
[10] – https://www.sciencedirect.com/science/article/pii/S2590109524000028
[11] – https://www.cureus.com/articles/337006-cryoneurolysis-a-comprehensive-review-of-applications-in-pain-management
[12] – https://journals.lww.com/ajpmr/fulltext/2025/11000/cryoneurolysis_for_the_forearm_in_spasticity.14.aspx
[13] – https://www.ncbi.nlm.nih.gov/books/NBK482123/
[14] – https://pmc.ncbi.nlm.nih.gov/articles/PMC7913284/
[15] – https://www.ouh.nhs.uk/media/2fkjjzzl/104072cryoneurolysis.pdf
[16] – https://pmc.ncbi.nlm.nih.gov/articles/PMC5645591/
[17] – https://maimo.org/new-cryoneurolysis-treatment-for-osteoarthritis-knee-pain/
[18] – https://www.tandfonline.com/doi/full/10.2217/pmt-2023-0053
[19] – https://www.tampapainmd.com/cryoneurolysis/
[20] – https://www.sciencedirect.com/science/article/pii/S2590109524000879
[21] – https://pmc.ncbi.nlm.nih.gov/articles/PMC12264415/
[22] – https://thomassportandregen.com/services/cryoneurolysis/
[23] – https://pmc.ncbi.nlm.nih.gov/articles/PMC10107282/
[24] – https://www.sciencedirect.com/science/article/pii/S2590109525000394
[25] – https://pubmed.ncbi.nlm.nih.gov/37104641/
[26] – https://www.dovepress.com/efficacy-and-safety-of-cryoneurolysis-for-treatment-of-chronic-head-pa-peer-reviewed-fulltext-article-LRA
[27] – https://www.asmcmd.com/in-office-procedures/cold-temperature-therapy

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