title: Shoulder morbidity after non-surgical treatment of the neck.
abstract: OBJECTIVE
  Reports on shoulder function after non-surgical treatment are not available. In the present study shoulder morbidity after surgical and non-surgical treatment of the neck is determined and compared.
  
  
  METHODS
  In 100 head and neck cancer patients 174 neck sides were treated by surgery (n=51) or (chemo)radiation (n=123). Abduction, anteflexion, endorotation and exorotation were assessed. Subjective measurements were performed using the Visual Analogue Scale for pain, the Shoulder Disability Questionnaire (SDQ) and stiffness reporting.
  
  
  RESULTS
  Predictive factors for SDQ-score>0 (n=54) were VAS pain score, stiffness, abduction, anteflexion, physiotherapy, low shoulder position and surgical treatment. The SDQ, stiffness and pain scores were significantly higher in the surgically treated group than in the non-surgical group (p<0.01). Anteflexion, abduction and exorotation were less impaired in the non-surgically treated group than in the surgically treated group (p<0.01). No differences between neck dissection and neck dissection with post-operative radiotherapy, and radiotherapy and chemoradiation were found for these movements.
  
  
  CONCLUSIONS
  Shoulder morbidity is often present after non-surgical treatment of the neck, but to a lesser extent compared to surgical treatment. Radiotherapy adds no morbidity to neck dissection and chemotherapy does not add extra morbidity to primary radiation.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Merian
authors.initials: M
authors.lastname: van Wouwe
authors.forename: Remco
authors.initials: R
authors.lastname: de Bree
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Kuik
authors.forename: Cees J T
authors.initials: CJ
authors.lastname: de Goede
authors.forename: Irma M
authors.initials: IM
authors.lastname: Verdonck-de Leeuw
authors.forename: Patricia
authors.initials: P
authors.lastname: Doornaert
authors.forename: C René
authors.initials: CR
authors.lastname: Leemans
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D007592:Joint Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D010147:Pain Measurement; D016059:Range of Motion, Articular; D012785:Shoulder Joint; D020069:Shoulder Pain / Q000209:etiology; D055815:Young Adult