iovera° cryoneurolysis in Green Bay, WI — performed in your home

Who iovera° helps

We use iovera° for:

• Osteoarthritis pain of the knee, hip, shoulder and ankle.
• Before a total knee replacement, to reduce post-operative pain and opioid use.* See preparing for knee replacement.
• Before shoulder surgery — total shoulder replacement, reverse total shoulder replacement or rotator cuff repair. This is one of the most common reasons patients come to us for iovera°.† Read more below.
• A painful knee replacement — persistent pain after a knee arthroplasty.
• Chronic nerve pain of the hip, knee, shoulder, foot and ankle (excluding diabetic peripheral neuropathy).
• Phantom limb pain after amputation.
• Morton's neuroma of the forefoot.

Before shoulder surgery: total shoulder, reverse total shoulder and rotator cuff repair

Alongside knee replacement, pre-surgical shoulder treatment is one of the most common reasons patients come to us for iovera°. If you have a date for a total shoulder replacement, a reverse total shoulder replacement or a rotator cuff repair, a single iovera° treatment beforehand targets the sensory nerves that carry pain from the shoulder, so you go into the operation — and come out of it — with less pain to manage.†

The shoulder is a particularly logical place to do this because of what happens immediately afterwards. Shoulder surgery is followed quickly by passive range-of-motion work, and pain is the single most common reason people do not do it. A shoulder that hurts too much to move in the first two weeks is a shoulder that stiffens.

iovera° is applied to sensory nerve targets rather than to the nerves that drive the muscles. Cryoneurolysis of the shoulder's sensory branches has been described in the peer-reviewed literature specifically as a motor-sparing approach to rotator cuff disease, which is what distinguishes it from a nerve block that takes the whole arm out of action for a day. You keep the arm you need for rehabilitation.

The idea is not new or experimental. The first published description of a single pre-operative cryoneurolysis treatment producing multiple weeks of analgesia covered exactly two operations: rotator cuff repair and total knee arthroplasty.

Pre-surgical shoulder treatment is self-pay, like all of our iovera° work — see cost and coverage below for why.

What a visit is like

1. Examination and target identification

   Eric examines the joint, reviews your history and imaging if you have it, and identifies the nerve target or targets responsible for your pain. You will hear what he is finding as he goes.

2. Consent and skin numbing

   You get a plain-language explanation of the treatment, the alternatives and the risks before anything happens. The skin over each target is then numbed with local anaesthetic.

3. The treatment

   The probe is placed and the controlled cold cycle runs — a matter of minutes per target. Most patients sit in their own chair throughout and talk their way through it.

4. Dressing and aftercare

   Small dressings go on, you get written aftercare instructions and a phone number, and the sharps and packaging leave with Eric.

What to expect afterwards

You can normally get up and walk immediately. It is common to have some local tenderness, bruising or swelling at the probe sites for a few days, and some patients notice a patch of altered or reduced skin sensation over the treated area that resolves as the nerve recovers.

Onset of relief and its duration vary between patients and between nerve targets, because nerves regenerate at different rates. Repeat treatment is possible when the effect wears off. What we will not do is promise you a number: individual results vary and no treatment guarantees complete or permanent relief.

Questions worth asking on the screening call

• Is my pain coming from a nerve iovera° can reach?
• Have I already had a steroid or gel injection, and what did it do?
• Am I on a blood thinner, and does that change anything?
• Do I have a knee replacement scheduled, and when?

Cost and coverage

iovera° is a self-pay (cash-pay) treatment. It is not billed to Medicare or to your Medicare Advantage plan. There is no claim, no prior authorization and no explanation of benefits — and no surprise bill afterwards, because you know the price before anyone drives out.

Your HSA or FSA can pay for it. iovera° is treatment of a diagnosed condition by a licensed clinician, which is what the IRS means by a medical expense — “the costs of diagnosis, cure, mitigation, treatment, or prevention of disease” (IRS Publication 502). We give you an itemized paid receipt with the diagnosis and procedure code on it, which is the document your plan administrator asks for. See HSA and FSA payment.

Corticosteroid and hyaluronic acid injections are handled differently — those are billed to Medicare Part B and to the Medicare Advantage plans we are credentialed with.

* Reported reductions in post-operative pain and opioid use after total knee replacement come from iovera° clinical efficacy data published by the manufacturer: ioverapro.com/tka-clinical-efficacy-data. Individual results vary, and no treatment guarantees complete or permanent relief.

† The iovera° System is cleared by the FDA to destroy tissue during surgical procedures and to produce lesions in peripheral nervous tissue by the application of cold for the blocking of pain (510(k) K161835); the manufacturer lists the shoulder among the areas treated (iovera.com). The manufacturer's published post-operative pain and opioid data is specific to total knee replacement, not to shoulder surgery. Use before shoulder surgery is supported by published case reports and clinical series rather than by a large randomized trial. Individual results vary, and no treatment guarantees complete or permanent relief.