Cryoneurolysis for the management of pain secondary to obstetrical brachial plexus injury: a case report

We report the use of percutaneous cryoneurolysis to manage significant chronic pain and dysfunction in a patient with complex obstetrical brachial plexus injury (OBPI). A 42-yr-old female with a history of right OBPI presented to an outpatient multidisciplinary interventional pain clinic with persistent, progressive pain, and dysfunction of the neck, right shoulder, and right arm. She tried multiple treatments, including topical agents, physiotherapy, steroid injection, and prolotherapy, which provided minimal benefit. With no surgical options available and little relief found in conservative treatment, the patient was considering medical assistance in dying (MAID). Following pain clinic consultation, therapeutic peripheral nerve blocks with local anesthetic of the right suprascapular and axillary nerves produced significant short-term improvement in pain symptoms (up to 8-point reduction in numerical rating of pain). Following the effective nerve blocks and with informed consent, we performed cryoneurolysis of the right suprascapular and axillary nerves. Seven weeks after the procedure, the patient's numerical rating scale pain score was 0/10 (previous baseline, 7-8/10). She reported greater independence in activities of daily living. Following cryoneurolysis, the magnitude of benefits to the patient's pain and function, combined with the progress from allied health teams, improved her quality of life to a point where she ceased contemplating MAID. This case report highlights cryoneurolysis as a potentially valuable treatment option in the management of chronic pain and functional impairments resulting from OBPI. Future studies with adequate sample sizes as well as longitudinal data will help establish the efficacy of this intervention for pain related to OBPI.