Physiotherapy after neck dissection

What is a neck dissection?

Neck dissection is an operation to remove lymph nodes on one side of the neck because of your cancer has the potential to spread to them. If the lymph nodes involved the surrounding tissues, neck dissection may include removal of certain neck muscles, nerves or blood vessels. 

How does this affect shoulder function?

As part of neck dissection, the lymph nodes need to be removed from around the spinal accessory nerve and cervical plexus nerves, which control the muscles of the upper back and shoulder. When these nerves have to be cut because of invasion by disease, the chance of developing shoulder issues is 80%, while those in whom lymph node levels I-V without cutting the nerves are removed, this risk drops to 30%, and only 5% when levels I-IV are removed without cutting the nerves. 

What are the signs and symptoms?

After neck dissection, symptoms that develop can be shoulder pain, restriction in shoulder movement (especially lifting the arm), and in late stages there can de drooping of the shoulder, loss in size and tone of the muscles around the shoulder and upper back, and finally, permanent disability. 

How is it treated?

Prevention is better than cure. For patients who require the spinal accessory nerve to be cut during surgery because of cancer, it can be reconstructed to avoid permanent shoulder issues. All patients who undergo neck dissection require regular neck and shoulder physiotherapy in order to prevent deterioration and permanent loss of shoulder function. For those who have nerve damage from surgery, a set of exercises called ‘progressive resistance training’, are the best treatment option. These are a specific set of graded shoulder exercises, performed at least initially under the supervision of physiotherapist, which are designed to improve exercise capacity over time. Even in those with permanent nerve damage, this set of exercises can improve shoulder function and reduce pain over time.