title: Denervation of the infraspinatus and release of the posterior deltoid muscles in the management of dyskinetic external shoulder rotation in cerebral palsy.
abstract: OBJECTIVE
  The dyskinetic subtype of cerebral palsy is difficult to manage, and there is no established gold standard for treatment. External rotation of the shoulder(s) is often managed nonsurgically using injections of botulinum toxin A into the external rotator muscles. This article reports a new surgical technique for managing external rotation when botulinum toxin A treatment is not sufficient or possible.
  
  
  METHODS
  Six patients with dyskinetic cerebral palsy underwent denervation of the infraspinatus muscle and release of the posterior part of the deltoid muscle. Postoperative questionnaires were given to the patients/caregivers, and video recordings were made both pre- and postoperatively. Preoperative and postoperative Assisting Hand Assessment was possible in only 1 case.
  
  
  RESULTS
  Five patients were very satisfied with their outcome. Four patients' video recordings showed improvement in their condition. One patient developed postoperative complications.
  
  
  CONCLUSIONS
  The results indicate that denervation of the infraspinatus muscle and posterior deltoid release can be an option for patients with dyskinetic cerebral palsy to manage external rotation of the shoulder when other treatment alternatives are insufficient.
authors.affiliation: Department of Hand and Plastic Surgery, University Hospital of Northern Sweden, Umeå, Sweden.
authors.forename: Izabela
authors.initials: I
authors.lastname: Blaszczyk
authors.forename: Anna Cecilia
authors.initials: AC
authors.lastname: Granström
authors.forename: Mikael
authors.initials: M
authors.lastname: Wiberg
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D002547:Cerebral Palsy / Q000503:physiopathology / Q000601:surgery; D057645:Deltoid Muscle / Q000503:physiopathology* / Q000601:surgery*; D003714:Denervation; D020820:Dyskinesias; D005260:Female; D006801:Humans; D008297:Male; D009465:Neuromuscular Agents / Q000627:therapeutic use; D012399:Rotation; D012782:Shoulder; D012785:Shoulder Joint / Q000503:physiopathology* / Q000601:surgery*; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: AHA = Assisting Hand Assessment; BTX-A = botulinum toxin A; CP = cerebral palsy; DBS = deep brain stimulation; GMFCS = Gross Motor Functional Classification System; ITB = intrathecal baclofen; MACS = Manual Ability Classification System; SPN = selective peripheral neurotomy; botulinum toxin A; cerebral palsy; dyskinesia; external shoulder rotation; functional neurosurgery; infraspinatus denervation; upper limb neurotomy