Shoulder dysfunction is common after neck dissection and includes shoulder pain, limited abduction and scapular winging. Modifications of the radical neck dissection were designed to limit morbidity, however, even with accessory nerve-sparing neck dissections, shoulder dysfunction can be seen. Shoulder syndrome is thought to be multifactorial. The extent of dissection in level II and V causes shoulder morbidity, but the effects of radiation therapy and chemotherapy when added adjuvantly to surgery remains questionable. In this study 167 spinal accessory nerve sparing neck dissections were evaluated. Their data suggest that increased treatment, either in the form of increased surgical dissection or use of radiation therapy and / or chemotherapy is correlated with poorer shoulder function and quality of life. Importantly, poorer shoulder function appears to confer disability with respect to leisure activities and employment status after neck treatment. This study has confirmed the fact that shoulder dysfunction is common after neck dissection and adjuvant therapy; what they failed to asses was effect of physiotherapy on shoulder dysfunction. It’s high time that multiple randomised studies should be carried out to better quantify the minimum duration and intensity of physiotherapy necessary to improve shoulder function after neck dissection.

Association between multimodality neck treatment and work and leisure impairment: a disease-specific measure to assess both impairment and rehabilitation after neck dissection.
Gallagher KK, Sacco AG, Lee JS, et al.
2015; 141(10):888-93.
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Shabbir Akhtar

Department of Surgery, The Aga Khan University and Hospital, Karachi, Pakistan.

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