Slide 1: Efficacy of Percutaneous Cryoneurolysis for Wrist or Hand/Finger Spasticity
Efficacy of Percutaneous Cryoneurolysis for Wrist or Hand/Finger Spasticity Paul Winston,1,2 Mahdis Hashemi,2 Eve Boissonnault,3 Daniel Vincent,1 Fraser MacRae,2,4 Jia Song,5 Sandy Shi5 1The University of British Columbia, Vancouver, BC, Canada; 2Vancouver Island Health Authority, Victoria, BC, Cana
Slide 2: Disclosures
DISCLOSURES Paul Winston declares that he has had educational grants and has acted on advisory boards and as a consultant for Pacira BioSciences, Inc.; AbbVie; Merz Therapeutics; and Ipsen. Mahdis Hashemi has received honoraria from Pacira BioSciences, Inc. Eve Boissonnault declares that she has rec
Slide 3: Introduction
INTRODUCTION • Upper extremity spasticity can result in deformities of the Liquid N2O wrist, hand, and fingers that may require surgical cartridge intervention1,2 >850 psi boiling point • Percutaneous cryoneurolysis is a minimally invasive (−88° C) technique that can be used to treat upper extremity
Slide 4: Methods: Study Design
METHODS: STUDY DESIGN • This repeated-measures pilot study (NCT04670783) Outcome Measure* included adults who had refractory spasticity with less AROM AROM during extension than full ROM in the wrist or the hand and fingers MAS score Muscle tone during extension – Percutaneous cryoneurolysis was app
Slide 5: Methods: Eligibility Criteria
METHODS: ELIGIBILITY CRITERIA Inclusion criteria Exclusion criteria • Adults who had refractory spasticity with less than full ROM in • Being unable to attend the treatment schedule the wrist or the hand and fingers • Clinical examination demonstrated that further ROM in the • Prior neurolytic proce
Slide 6: Results: Baseline Characteristics
RESULTS: BASELINE CHARACTERISTICS • 29 participants received Outcome Value cryoneurolysis for hand/finger Demographic and baseline characteristics flexor muscles, and 18 of these Age, mean (SD), y [n] 59.7 (16.8) [29] participants also received Sex, n (%) cryoneurolysis for wrist flexor Male 14 (48.
Slide 7: Wrist Extension MAS Scores
RESULTS: WRIST EXTENSION MAS SCORES • MAS scores numerically decreased at Day 180 compared with baseline* • MAS scores significantly decreased at Day 90 and 365 compared with baseline Day 90 mean (SD) Day 180 mean (SD) Day 270 mean (SD) Day 365 mean (SD) change from baseline: change from baseline: c
Slide 8: Wrist Extension V1
RESULTS: WRIST EXTENSION V1 • V1 increased at Day 90, 180, and 365 compared with baseline* Day 90 mean (SD) Day 180 mean (SD) Day 270 mean (SD) Day 365 mean (SD) change from baseline: change from baseline: change from baseline: change from baseline: 3.6° (25.6°); P=0.22 2.0° (31.0°); P=0.38 –1.0° (3
Slide 9: Wrist Extension AROM
RESULTS: WRIST EXTENSION AROM • Change in wrist extension AROM from baseline was evaluated for participants with active movement at baseline (n=7) • AROM increased at Day 90, 180, and 365 compared with baseline* Day 90 mean (SD) Day 180 mean (SD) Day 270 mean (SD) Day 365 mean (SD) change from basel
Slide 10: Change in V1, AROM, and MAS from Baseline
RESULTS: CHANGE IN V1, AROM, AND MAS FROM BASELINE Outcome Mean (SD) change from baseline P value Wrist extension MAS Day 90 –1.0 (1.1) 0.01 Day 180 –0.1 (1.2) 0.29 Day 270 0.1 (1.2) 0.61 Day 365 –1.3 (0.8) 0.03 Wrist extension V1 Day 90 3.6° (25.6°) 0.22 Day 180 2.0° (31.0°) 0.38 Day 270 –1.0° (38.
Slide 11: Results: Hand Function and Thumb Deformity
RESULTS: HAND FUNCTION AND Hand functional scale THUMB DEFORMITY 180 days (n=14) mean (SD) 0.1 (1.2); P=0.43 change from baseline • There was an improvement in hand 365 days (n=4) mean (SD) function based on House functional 0.5 (1.0); P=0.5 change from baseline classification at Day 180 and 365 com
Slide 12: Manual Dexterity and Upper Extremity Function
RESULTS: MANUAL Manual dexterity change from baseline DEXTERITY AND 40 P=0.5 Blocks/min, mean (SD) UPPER EXTREMITY 30 20 P=0.6 FUNCTION 10 0 Day 30 Day 90 Day 180 Day 270 Day 365 • The number of blocks moved by (n=4) (n=7) (n=3) (n=6) (n=2) participants at Day 180 and Day 365 were numerically increa
Slide 13: Conclusions
Percutaneous cryoneurolysis of the wrist and/or hand, finger flexor muscles, or the innervating nerves was associated with improvements in wrist active and passive range of motion and spastic tone 365 days CONCLUSIONS after treatment There were improvements in thumb-in-palm deformity House classific