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Clinical Care and Rehabilitation in Head and Neck Cancer pp 397–411Cite as

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

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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.

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Notes

  1. 1.

    Tom Lennox, Luminaud Inc., Mentor, OH, personal communication.

  2. 2.

    Because the postlaryngectomy neck wound is fresh with sutures/staples and may have included some type of flap reconstruction, in additional to potential swelling of the neck postsurgery and lymphedema, pain or tenderness, etc., neck-type EL devices are seldom introduced to individuals until sufficient healing has occurred. Hence, intraoral EL devices are the preferred option of choice early in the rehabilitation process.

  3. 3.

    One of the simplest approaches to understanding the demands associated with the acquisition of speech with either a neck-type or intraoral EL is for the clinician to learn the behavior themselves. When one who is likely to have normal shoulder mobility, no pain, and adequate fine motor skills for positioning a device and activating it requires substantial practice, the impact of shoulder deficits is often very well understood.

  4. 4.

    It is also important to point out that in some instances, the use of the non-dominant hand may be required, and consequently, additional challenges to achieving desired positioning of the arm and hand may be observed.

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Authors and Affiliations

  1. Fowler-Kennedy Sports Medicine Clinic, Western University, London, ON, Canada

    Angelo Boulougouris

  2. Voice Production and Perception Laboratory & Laboratory for Well-Being and Quality of Life, Department of Otolaryngology – Head and Neck Surgery and School of Communication Sciences and Disorders, Western University, Elborn College, London, ON, Canada

    Philip C. Doyle

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  1. Angelo Boulougouris
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Editors and Affiliations

  1. Department of Otolaryngology Head and Neck Surgery and School of Communication Sciences & Disorders , Western University, London, ON, Canada

    Philip C. Doyle

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Boulougouris, A., Doyle, P.C. (2019). Shoulder Dysfunction and Disability Secondary to Treatment for Head and Neck Cancer. In: Doyle, P. (eds) Clinical Care and Rehabilitation in Head and Neck Cancer. Springer, Cham. https://doi.org/10.1007/978-3-030-04702-3_23

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  • DOI: https://doi.org/10.1007/978-3-030-04702-3_23

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