{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T11:22:31Z","timestamp":1789039351147,"version":"build-2803163510"},"reference-count":26,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Shoulder spasticity is a common consequence of upper motor neuron lesions and may be associated with soft tissue contractures, limiting functional recovery. While both cryoneurolysis and tendon lengthening procedures are used individually in refractory cases, their combined effect has not been clearly established. It is consequently necessary to assess the efficacy of combining cryoneurolysis and percutaneous pectoral tenotomy in reducing shoulder spasticity and improving passive range of motion in patients with refractory shoulder spasticity and contracture. This retrospective, single-centre cohort study included 15 adults (\u226519 years) with chronic shoulder spasticity and clinically confirmed musculotendinous contracture, previously treated with botulinum toxin injections without sufficient functional response, and free of pharmacological effects (last injection &gt;4 months prior). All patients underwent cryoneurolysis targeting motor branches to the pectoral muscles. Outcomes included Modified Ashworth Scale (MAS) and shoulder Passive Range Of Motion (PROM). The combined approach provided significant improvements in spasticity severity for shoulder flexion (p &lt; 0.01) and abduction (p &lt; 0.01), and significant improvements in maximum PROM for shoulder flexion (p &lt; 0.0001) and abduction (p &lt; 0.0001). Combining cryoneurolysis and pectoral tenotomy appears feasible, safe, and clinically beneficial in selected patients with both spasticity and tendon contracture. Cryoneurolysis addresses the neural component, while tenotomy may restore mechanical excursion. This sequential diagnostic and therapeutic approach may enhance personalized management of mixed spastic\u2013contracture shoulder limitations and could be applicable to other joints.<\/jats:p>","DOI":"10.3390\/toxins18030137","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T09:00:37Z","timestamp":1773219637000},"page":"137","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Innovative Management of Spastic Shoulder Contractures: A Retrospective Cohort Analysis of Combined Percutaneous Cryoneurolysis and Tenotomy"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8403-6988","authenticated-orcid":false,"given":"Paul","family":"Winston","sequence":"first","affiliation":[{"name":"Vancouver Island Health Authority, Victoria, BC V8T 3P7, Canada"},{"name":"Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 2G9, Canada"},{"name":"Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, ON K7K 1Z6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4501-8840","authenticated-orcid":false,"given":"Mahdis","family":"Hashemi","sequence":"additional","affiliation":[{"name":"Vancouver Island Health Authority, Victoria, BC V8T 3P7, Canada"},{"name":"Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 2G9, Canada"},{"name":"Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, ON K7K 1Z6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7937-6251","authenticated-orcid":false,"given":"Fraser","family":"MacRae","sequence":"additional","affiliation":[{"name":"Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, ON K7K 1Z6, Canada"},{"name":"School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON N6A 3K7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Herzog","sequence":"additional","affiliation":[{"name":"Vancouver Island Health Authority, Victoria, BC V8T 3P7, Canada"},{"name":"Department of Microbiology and Immunology, Faculty of Science, University of British Columbia, Vancouver, BC V6T 1Z4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0979-2182","authenticated-orcid":false,"given":"Maxime","family":"Billot","sequence":"additional","affiliation":[{"name":"Centre Hospitalier Universitaire (CHU) de Poitiers, INSERM, Centre d\u2019Investigation Clinique Domaine d\u2019Innovation Technologique (CIC-IT) 1402, F-86000 Poitiers, France"},{"name":"Universit\u00e9 de Poitiers, CNRS, CeRCA, UMR 7295, F-86000 Poitiers, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4453-3095","authenticated-orcid":false,"given":"Romain","family":"David","sequence":"additional","affiliation":[{"name":"Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, ON K7K 1Z6, Canada"},{"name":"Centre Hospitalier Universitaire (CHU) de Poitiers, INSERM, Centre d\u2019Investigation Clinique Domaine d\u2019Innovation Technologique (CIC-IT) 1402, F-86000 Poitiers, France"},{"name":"Centre Hospitalier Universitaire (CHU) de Poitiers, Service de M\u00e9decine Physique et R\u00e9adaptation, F-86000 Poitiers, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1080\/09638280400014576","article-title":"Spasticity: Clinical Perceptions, Neurological Realities and Meaningful Measurement","volume":"27","author":"Pandyan","year":"2005","journal-title":"Disabil. 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