Shoulder complaints after neck dissection; is the spinal accessory nerve involved?

https://doi.org/10.1016/S0266-4356(02)00288-7Get rights and content

Abstract

The purpose of the current study was to investigate the relation between shoulder morbidity (pain and range of motion), and the function of the spinal accessory nerve after neck dissection. Identifying dysfunction of the nerve gives insight in the mechanisms of post-operative shoulder complaints. In total 112 patients after neck dissection (73 males/39 females), mean (SD) age 61 (13) years, participated in the study. The mean duration of follow up was 3 (2) years. Five patients had radical, 43 modified radical, 48 supraomohyoid, and 16 posterolateral neck dissection. Thirty-nine complained of shoulder pain of whom 20 (51%) had dysfunction of the spinal accessory nerve, and 19 (49%) did not. In total 29 patients (26%) had dysfunction of the spinal accessory nerve of whom 20 (69%) had shoulder pain. Shoulder pain was significantly related to dysfunction of the nerve (P<0.001).

Twenty-three patients had a difference in active range of motion in shoulder abduction of ≥40°, of whom 22 (96%) had dysfunction of the nerve. A difference in active shoulder abduction of ≥40° was significantly related to loss of function of the spinal accessory nerve (P<0.001).

Conclusion: Shoulder pain after neck dissection can only be attributed to dysfunction of the spinal accessory nerve in about 50%. If patients experience shoulder pain after neck dissection examination of the trapezius muscle and active bilateral abduction of the shoulder should be made to find out if the spinal accessory nerve is 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.

References (27)

  • H.R. Krause

    Shoulder-arm-syndrome after radical neck dissection: its relation with the innervation of the trapezius muscle

    Int. J. Oral Maxillofac. Surg.

    (1992)
  • K.T. Robbins et al.

    Standardizing neck dissection terminology. Official report of the Academy’s Committee for Head and Neck Surgery and Oncology

    Arch. Otolaryngol. Head Neck Surg.

    (1991)
  • C. Carenfelt et al.

    Occurrence, duration and prognosis of unexpected accessory nerve paresis in radical neck dissection

    Acta Otolaryngol.

    (1980)
  • Cited by (84)

    • Chronic cancer pain syndromes and their treatment

      2022, Neurological Complications of Systemic Cancer and Antineoplastic Therapy
    • Prevalence, incidence, and risk factors for shoulder and neck dysfunction after neck dissection: A systematic review

      2017, European Journal of Surgical Oncology
      Citation Excerpt :

      For example, several studies did not specify whether their measurement of shoulder range of motion was active or passive.16,25,36,52,53 Shoulder droop was observed as a dichotomous variable (present/not present),4,5,19,20,22,24,54,55 but only one study employed an objective, quantitative procedure of this measure.56 Three different questionnaire-based outcomes measuring shoulder dysfunction were used across four studies,40,49,50,56 giving a different impression of patient experience in each case, hence pooling of results was considered implausible.

    • Pattern of neck recurrence after lateral neck dissection for cervical metastases in papillary thyroid cancer

      2016, Surgery (United States)
      Citation Excerpt :

      Although our data suggest that the ipsilateral neck recurrence rate is less in patients who had CLND (3%) compared with SND (9%), one may argue that the rates of recurrence for SND are still acceptable and may potentially avoid any complications that may occur from a more comprehensive neck dissection. It is widely accepted that complications, such as chyle leak, hematoma, and shoulder dysfunction resulting from damage either to the accessory nerve or to the nerve supply to the posterior triangle neck musculature, are more common after CLND.14-18 In our own series, we did not observe any statistically significant differences in complication rates for chyle leak, hematoma, and hypoglossal or marginal nerve injury.

    View all citing articles on Scopus
    View full text