Using cryoneurolysis to relieve pain in patients with hand contracture

Effect of the Cryoneurolysis on Pain and Positioning in Patients With Wrist and Hand Contractures.

This study is testing if a new cooling treatment can help relieve pain and improve movement in people with stiff wrists and hands who haven't found relief with other methods.

Quick facts

• Study type: Observational
• Enrollment: 25 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Vancouver Island Health Authority (Academic / other)
• Locations: 1 site (Victoria, British Columbia)
• Trial ID: NCT06051656 on ClinicalTrials.gov

What this trial studies

This observational project investigates the effects of cryoneurolysis on pain and range of motion in patients suffering from wrist and hand contractures. Cryoneurolysis is a novel technique that cools targeted nerves to -88° to disrupt nerve function while preserving the surrounding structures for potential regeneration. The study will systematically assess outcomes in patients who have not responded to conventional pain management methods and are candidates for this procedure. By isolating nerves with ultrasound guidance and temporary paralysis, the study aims to provide detailed insights into the effectiveness of cryoneurolysis in managing severe pain and spasticity.

Who should consider this trial

Good fit: Ideal candidates include adults with severe claw hand and refractory pain who have not responded to standard pain management treatments.

Not a fit: Patients with mild contractures or those who have not experienced significant pain may not benefit from this intervention.

Why it matters

Potential benefit: If successful, this approach could significantly reduce pain and improve mobility for patients with severe hand contractures.

How similar studies have performed: While cryoneurolysis is a novel approach, similar nerve-targeting techniques have shown promise in managing pain, suggesting potential for success.

Eligibility criteria

Inclusion Criteria:

1. Adult patients(at least 18 years old).
2. Severe claw hand with less than 4 cm distance between the pulp of the fingers and palm of the hand.
3. MAS\>= 3 in wrist and hand muscles interfering with function or causing a clinical problem, due to any neurological condition.
4. Have refractory pain in wrist and hand areas with no response to the usual pain management methods including oral medication or botulinum toxin injection.
5. Patients are already candidate for cryoneurolysis to manage the pain and spasticity in their hand and wrist, based on their response to diagnostic nerve block test (DNB).
6. Ability to attend testing sessions, comply with testing protocols and provide written informed consent. For patients who physically are not able to complete the consent process, a witness may be asked to sign and confirm their willing for participation. Legal representative may be asked to help with consent process for participants who cognitively are not able to consent on their behalf.

Exclusion Criteria:

1. Have undergone any previous peripheral nerve procedures in their affected side, for the treatment of spasticity, including previous cryoneurolysis, chemical neurolysis, neurectomy or arthroplasty.
2. Patients who received botulinum toxin in past 4 months in the same targeted muscles for cryoneurolysis, however, they may enter the study at the 4-month mark.

Where this trial is running

Victoria, British Columbia

• Victoria General Hospital — Victoria, British Columbia, Canada (Recruiting)

Study contacts

• Principal investigator: Paul Winston, MD — Vancouver Island Health
• Study coordinator: Mahdis Hashemi, MD

Conditions Contracture; Spasticity, Muscle; Wrist contracture; Severe spasticity; Pain; Cryoneurolysis; Hand contracture