Shoulder complaints after neck dissection; is the spinal accessory nerve involved?
Section snippets
INTRODUCTION
Neck dissections are either elective or therapeutic procedures in the treatment of cancer of head and neck. Ewing was one of the first to describe shoulder complaints after radical neck dissection.1 These complaints consisted of reduced range of motion, reduced strength in the trapezius muscle, pain, disfigurement, and disability in daily activities. In that study of 100 patients, 47% developed shoulder complaints after radical neck dissection. These were attributed to resection of the spinal
PATIENTS AND METHODS
Patients who had a neck dissection done by the multidisciplinary Head and Neck Oncology Group of the University Hospital Groningen, during the period 1994–2000, were invited to participate in the study. A week before they visited the hospital for a regular follow-up appointment, all patients were sent a letter telling them about the study. During the appointment they were asked by the physician to participate in the study. After given written informed consent they were included in the study.
RESULTS
In total 122 patients participated in the study, (41 females/81 males) mean age 61 (13) years, and mean follow up of 3 (1–7) years. All patients with shoulder complaints before operation (n=7), and patients who could not remember whether they did or did not (n=2) were excluded from further analyses. Of the remaining 113; 5 underwent radical, 43 modified radical, 48 supraomohyoid, 16 posterolateral, and 1 lateral neck dissection. Before statistical analyses the patient with the lateral neck
DISCUSSION
Dysfunction of the spinal accessory nerve occurs in all cases after neck dissection with resection of the nerve and in about 22% when it is preserved. It may cause shoulder pain but such pain may also be present in 49% of the cases without signs of dysfunction. Shoulder pain can be attributed to dysfunction of the spinal accessory nerve in only 51% of patients.
As well as by a physical examination the function of the nerve can also be investigated by an electromyography (EMG), which provides
Acknowledgements
This study was supported by a grant from the University Hospital Groningen.
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