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Neurological Rehabilitation

Cryoneurolysis As A Novel Solution to Pain Induced Autonomic Dysreflexia from Shoulder Pain: A Case Report

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Case Report Theater

    Poster Presenter(s)

  • John Hesling, MD

    Resident
    University of Colorado PM&R Program
    Parker, Colorado

    • Co-Author(s)

  • GM

    George Marzloff, MD

    SCI/D Physician
    Spinal Cord Injury/Disorders Center Rocky Mountain Regional VA Medical Center
    Commerce City, Colorado

Disclosure(s):
John Hesling, MD: No financial relationships to disclose
Case Diagnosis: 82 year old male with C1 AIS C incomplete tetraplegia secondary to severe cervical spondylitis myelopathy from severe atlantoaxial dislocation and compression of the cervicomedullary junction complicated by recurrent autonomic dysreflexia (AD) from shoulder pain

Case Description or Program Description: Recurrent AD after ruling out common etiologies including bladder, skin, constipation, fractures, spasticity, and infection. Episodes correlated with shoulder pain.

Setting: Tertiary Care Hospital

Assessment/Results: Right suprascapular artery (suprascapular nerve is adjacent) was identified in the suprascapular notch using ultrasound guidance, and two 110-second freeze cycles were performed using a percutaneous cryoneurolysis probe resulting in immediate and lasting pain relief and no further AD.

Discussion (relevance): We offer a case report of successful AD treatment using cryoneurolysis to relieve right shoulder pain. Patients suffering from pain-induced AD with significant medical comorbidities that limit treatment options can be difficult to manage as many mainstays of treatment are contraindicated. Physical and occupational therapy caused pain and increased the risk for more AD. Acetaminophen and topicals were ineffective. NSAIDs were contraindicated with his chronic kidney disease. Corticosteroid injection was considered but deferred given his sensitivity to medications, history of dementia and encephalopathy requiring intubation after a small dose of baclofen.

Cryoneurolysis to the suprascapular nerve provided a novel solution to AD and effectively resolved it. Cryoneurolysis as a treatment of rotator cuff disease has been shown to provide 60% pain relief, while a 2023 case report showed clinically significant pain reduction at 170 day follow-up for a frail patient for whom surgery was impossible. More research is needed to better characterize the effectiveness of cryoneurolysis on rotator cuff disease though it should be considered as a tool in pain-induced AD.

Conclusions: Cryoneurolysis represents a novel approach to treating pain in patients with difficult-to-control AD caused by pain for whom alternatives are either not viable or have failed.