Shoulder Dysfunction and Disability Secondary to Treatment for Head and Neck Cancer

Abstract

Surgical treatment of head and neck cancers may often be performed with a need for various degrees of neck dissection (ND). The extent of ND may vary from relatively local approaches to those that are more extensive. Additionally, ND may be done either unilaterally or bilaterally dependent upon the site and extension of the primary tumor. While ND is performed in order to achieve oncological safety, one of the more commonly reported postsurgical deficits is that related to changes in shoulder mobility. Further, decreases in the range of shoulder movement may often be associated with pain with subsequent limitations in functioning with secondary influence on quality of life. Collectively, restrictions in shoulder function may result in considerable levels of disability that limit the individual’s capacity to undertake a variety of tasks. While such changes may directly influence day-to-day physical activities and potentially vocational and avocational demands, shoulder deficits and the secondary disability can also create challenges for individuals who use the artificial electrolarynx or those who select tracheoesophageal puncture voice restoration as a postlaryngectomy alaryngeal communication option. This chapter addresses the structure and function of the shoulder complex, shoulder disability secondary to head and neck cancer treatment, and its potential consequences on a broad range of physical activities, providing information on its potential influence on postlaryngectomy voice and speech rehabilitation.