Neck and shoulder function after neck dissection
Summary
Pain and neck & shoulder function after neck dissection: a systematic review
Objective: To review systematically the published literature regarding pain in the shouldergirdle and neck and shoulder functioning in patients who underwent a neck dissection in the treatment of head and neck cancer.
Data sourch: A search strategy was conducted in the following databases: Cumulative Index to Nursing and Allied Health Literature, the Cochrane library, Experta Medica and Pubmed.
Review methods: Neck dissections performed in de included studies were classified. Studies were evaluated regarding experience of pain and functioning of neck and shoulders. Fysioning of neck and was evaluated according to the symptoms of the ‘shoulder syndrome’: posture, range of motion, strength, disability and electrophysiological evaluation. Also the development of the symptoms over time was evaluated.
Results: The initial search returned 244 studies, with 13 studies meeting the in- and exclusion criteria. Studies showed that more extensive neck surgery is associated with more experience of pain and more restrictions in posture, reduced range of motion, less muscle strength, increased disability and worse electrophysiological evaluation compared to less extensive neck surgery. All outcomes showed the most severe disturbances in pain and function of neck and shoulders and less recovery over time after more extensive surgery. Over time patients with less extensive neck surgery showed more recovery.
Conclusion: The literature indicated that more extensive surgery involves more pain and dysfunction of neck and shoulders compared to less extensive surgery. Less extensive surgery is associated with better recovery results compared to more extensive surgery.
Range of motion of neck and shoulders after neck dissection in patients with cancer in the oral cavity: a research article
Objective: To explore the influence of neck surgery on range of motion of neck and shoulders in patients with cancer in the oral cavity.
Study design: Prospective cohort study
Setting: University Medical Center Utrecht
Patients and methods: Lateral flexion of the neck and forward flexion and abduction of the shoulder were measured at baseline, 4 to 6 weeks after intervention, 6 and 12 months after intervention in 93 patients who had neck surgery in the treatment of oral cancer.
Results: After intervention lateral flexion of the neck decreased significantly in in the non-operated side of the (M)RND. Shoulder forward flexion and abduction decreased significantly after intervention in both (M)RND and SND in the operated sides and in the non-operated side in SND. After intervention shoulder abduction in the operated side improved significantly in (M)RND and SND. 12 Months after intervention values of range of motion were still lower compared to baseline measures.
Conclusion: Neck dissection has a negative impact on the range of motion of neck and shoulders. After intervention range of motion of neck and shoulders improves but values were still lower compared to baseline.