title: Prevalence, incidence, and risk factors for shoulder and neck dysfunction after neck dissection: A systematic review.
abstract: BACKGROUND
  Shoulder pain and dysfunction may occur following neck dissection among people being treated for head and neck cancer. This systematic review aims to examine the prevalence and incidence of shoulder and neck dysfunction after neck dissection and identify risk factors for these post-operative complications.
  
  
  METHODS
  Electronic databases (Pubmed, CINAHL, EMBASE, Cochrane) were searched for articles including adults undergoing neck dissection for head and neck cancer. Studies that reported prevalence, incidence or risk factors for an outcome of the shoulder or neck were eligible and assessed using the Critical Review Form - Quantitative Studies.
  
  
  RESULTS
  Seventy-five articles were included in the final review. Prevalence rates for shoulder pain were slightly higher after RND (range, 10-100%) compared with MRND (range, 0-100%) and SND (range, 9-25%). The incidence of reduced shoulder active range of motion depended on surgery type (range, 5-20%). The prevalence of reduced neck active range of motion after neck dissection was 1-13%. Type of neck dissection was a risk factor for shoulder pain, reduced function and health-related quality of life.
  
  
  CONCLUSIONS
  The prevalence and incidence of shoulder and neck dysfunction after neck dissection varies by type of surgery performed and measure of dysfunction used. Pre-operative education for patients undergoing neck dissection should acknowledge the potential for post-operative shoulder and neck problems to occur and inform patients that accessory nerve preservation lowers, but does not eliminate, the risk of developing musculoskeletal complications.
authors.affiliation: Division of Physiotherapy, School of Health and Rehabilitation Sciences, Therapies Building 84a, The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia; Centre for Functioning and Health Research, Metro South Hospital and Health Service, P.O. Box 6053, Buranda, Brisbane, QLD 4102, Australia. Electronic address: e.gane@uq.edu.au.
authors.forename: E M
authors.initials: EM
authors.lastname: Gane
authors.affiliation: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom; Musculoskeletal Division, The George Institute for Global Health, Level 3, 50 Bridge Street, University of Sydney, Sydney, NSW 2000, Australia. Electronic address: z.michaleff@keele.ac.uk.
authors.forename: Z A
authors.initials: ZA
authors.lastname: Michaleff
authors.affiliation: Division of Physiotherapy, School of Health and Rehabilitation Sciences, Therapies Building 84a, The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia. Electronic address: m.depaauw@uq.edu.au.
authors.forename: M A
authors.initials: MA
authors.lastname: Cottrell
authors.affiliation: Centre for Functioning and Health Research, Metro South Hospital and Health Service, P.O. Box 6053, Buranda, Brisbane, QLD 4102, Australia; School of Public Health and Social Work and the Institute of Health and Biomedical Innovation, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, QLD 4059, Australia. Electronic address: steven.mcphail@health.qld.gov.au.
authors.forename: S M
authors.initials: SM
authors.lastname: McPhail
authors.affiliation: Division of Physiotherapy, School of Health and Rehabilitation Sciences, Therapies Building 84a, The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia. Electronic address: a.hatton1@uq.edu.au.
authors.forename: A L
authors.initials: AL
authors.lastname: Hatton
authors.affiliation: School of Medicine, Herston Road, The University of Queensland, Herston, Brisbane, QLD 4006, Australia; Otolaryngology-Head and Neck Surgery Department, Princess Alexandra Hospital, 196 Ipswich Road, Queensland Health, Woolloongabba, Brisbane, QLD 4102, Australia. Electronic address: ben@panizza.com.au.
authors.forename: B J
authors.initials: BJ
authors.lastname: Panizza
authors.affiliation: Division of Physiotherapy, School of Health and Rehabilitation Sciences, Therapies Building 84a, The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia; Physiotherapy Department, Royal Brisbane and Women's Hospital, Butterfield Street, Queensland Health, Herston, Brisbane, QLD 4029, Australia. Electronic address: s.oleary@uq.edu.au.
authors.forename: S P
authors.initials: SP
authors.lastname: O'Leary
mesh_terms: D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D015994:Incidence; D009333:Neck / Q000503:physiopathology*; D037981:Neck Dissection / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D011788:Quality of Life; D016059:Range of Motion, Articular; D012785:Shoulder Joint / Q000503:physiopathology*; D020069:Shoulder Pain / Q000453:epidemiology* / Q000209:etiology; D020886:Somatosensory Disorders / Q000453:epidemiology / Q000209:etiology
keywords: Head and neck neoplasms; Neck dissection; Neck pain; Quality of life; Risk factors; Shoulder pain