FOTO Rehab Outcomes

Think Regional Interdependence after a Person has a Neck Dissection

I haven't treated anyone post neck dissection. I thought this study nicely tied in the concept of regional interdependence.

Even though a neck dissection seems like a very localized procedure, this study highlights the importance of considering the arm, along with the cervical spine. 

Below you will find a quick view of the abstract.

neck-surgery

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

 

Abstract

Objective: To measure patient-perceived upper limb and neck function following neck dissection and to investigate potential associations between clinical factors, symptoms, and function.

Study Design: Cross-sectional. Setting Two tertiary hospitals in Brisbane, Australia.

Subjects and Methods: Inclusion criteria: patients treated with neck dissection (2009-2014). Exclusion Criteria: aged <18 years, accessory nerve or sternocleidomastoid sacrifice, previous neck dissection, preexisting shoulder/neck injury, and inability to provide informed consent (cognition, insufficient English). Primary outcomes were self-reported function of the upper limb (Quick Disabilities of the Arm, Shoulder, and Hand) and neck (Neck Disability Index). Secondary outcomes included demographics, oncological management, self-efficacy, and pain. Generalized linear models were prepared to examine relationships between explanatory variables and self-reported function.

Results: Eighty-nine participants (male n = 63, 71%; median age, 62 years; median 3 years since surgery) reported mild upper limb and neck dysfunction (median [quartile 1, quartile 3] scores of 11 [3, 32] and 12 [4, 28], respectively). Significant associations were found between worse upper limb function and longer time since surgery (coefficient, 1.76; 95% confidence interval [CI], 0.01-3.51), having disease within the thyroid (17.40; 2.37-32.44), postoperative radiation therapy (vs surgery only) (13.90; 6.67-21.14), and shoulder pain (0.65; 0.44-0.85). Worse neck function was associated with metastatic cervical lymph nodes (coefficient, 6.61; 95% CI, 1.14-12.08), shoulder pain (0.19; 0.04-0.34), neck pain (0.34; 0.21-0.47), and symptoms of neuropathic pain (0.61; 0.25-0.98).

Conclusion: Patients can experience upper limb and neck dysfunction following nerve-preserving neck dissection. The upper quadrant as a whole should be considered when assessing rehabilitation priorities after neck dissection.

 2017 Jul 1:194599817721164. doi: 10.1177/0194599817721164. [Epub ahead of print]