Neck and Upper Limb Dysfunction in Patients following Neck Dissection: Looking beyond the Shoulder

Area of Science:

• Oncology
• Rehabilitation Medicine
• Neurosurgery

Background:

• Neck dissection is a common surgical procedure for head and neck cancers.
• Patient-perceived function is a critical outcome measure following treatment.
• Understanding factors influencing functional recovery is essential for effective rehabilitation.

Purpose of the Study:

• To quantify upper limb and neck function after neck dissection from the patient's perspective.
• To identify clinical factors and symptoms associated with functional outcomes.
• To inform rehabilitation strategies for patients undergoing neck dissection.

Main Methods:

• Cross-sectional study conducted at two tertiary hospitals.
• Included patients who underwent neck dissection between 2009 and 2014.
• Assessed upper limb function using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and neck function using the Neck Disability Index (NDI).
• Generalized linear models analyzed associations between clinical factors, symptoms, and function.

Main Results:

• Eighty-nine participants reported mild dysfunction (QuickDASH median 11, NDI median 12).
• Worse upper limb function correlated with longer time since surgery, thyroid cancer, postoperative radiation, and shoulder pain.
• Worse neck function associated with metastatic lymph nodes, shoulder/neck pain, and neuropathic pain symptoms.

Conclusions:

• Nerve-preserving neck dissection can result in persistent upper limb and neck dysfunction.
• Rehabilitation should consider the entire upper quadrant, including shoulder and neck structures.
• Pain and oncological factors significantly impact functional outcomes post-surgery.