Abstract
The aim of this study is to investigate soft tissue disorders of affected shoulders after nerve-sparing selective neck dissection (SND) in patients with head and neck cancers (HNCs) by sonography. Eighteen HNCs patients with shoulder disability after SND were enrolled. Shoulder motions, pain, and the sonographic findings were measured and analyzed. Significantly decreased flexion, abduction, and increased pain were found on affected shoulders compared with normal shoulders. There were significant decrease in thickness of trapezius muscle (p=0.001), abnormal findings of supraspinatus tendon (p=0.022), and subdeltoid bursa (p=0.018) on surgical side. The ratio of trapezius muscle atrophy was related to shoulder pain (p=0.010). Patients with subdeltoid abnormalities had significant limitation on shoulder flexion and abduction. Abnormalities of supraspinatus tendon and subdeltoid bursa on sonography and trapezius muscle atrophy may play a key role in shoulder pain and shoulder flexion and abduction limitations.
Highlights
Spinal accessory nerve (SAN) injury is a common comorbidity after neck dissection in patients with head and neck cancers (HNCs) [1, 2]
To preserve the SAN, a more selective operation, the nerve-sparing technique of selective neck dissection (SND) was in turn developed to presumably limit the morbidity of the procedure based on the potential topographical tumor subsites-lymph node relationship, and it has become more popularly performed in patients with HNCs with no lymph node metastasis (N0) or limited metastasis (N1) [6, 9,10,11]
We considered that SND complicated with trapezius muscle atrophy may have some associations with soft tissue injuries of the shoulder leading to shoulder pain and dysfunction in patients with HNCs
Summary
Spinal accessory nerve (SAN) injury is a common comorbidity after neck dissection in patients with head and neck cancers (HNCs) [1, 2]. Radical neck dissection [3] has been the standard surgical method for patients with HNCs with neck lymph node metastasis [4] This technique led to complete SAN injury, which is associated with considerable ipsilateral shoulder pain and dysfunction, and might have negative impacts on life quality [5,6,7,8]. After SND, shoulder droop was reported to occur in 13% of patients [2], and decreased active abduction range was seen in 5–25% of patients [16] These biomechanical deficits lead to BioMed Research International shoulder pain [11, 17, 18] and shoulder dysfunction [19], which are associated with reduced quality of life [7, 20] in long-term HNC survivors
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