Guidelines for Complications of Cancer Treatment Vol VIII Part B

EMG studies on scapulo-humeral and gleno-humeralmusclesUse of questionnaires like Constant ModifiedQuestionnaire can also be usedPreventionFollowing steps should be taken to minimize the incidence ofshoulder dysfunction after neck dissection.1. Selective node dissection rather than comprehensiveneck dissection in N0 neck.2. Modified Radical Neck dissection (MRND) withpreservation of spinal accessory nerve rather thanRadical Neck dissection (RND), provided it isoncologically safe, in N+ neck.3. Minimal handling of nerve to avoid traction injury,4. Avoid thermal injury by using bipolar cautery.5. Avoid de-vascularisation of nerve.6. Clearance of level V nodes only in N+ neck.7. Clearance of level IIb nodes only when nodes at otherlevels positive for metastasis (recommended by some)8. Post-operative shoulder physiotherapyTreatment Early post-operative shoulder physiotherapy includingboth active and passive movements Progressive Resistance Exercise Training (PRET) isfound to be more effective than routine physiotherapy.(LOE-1) In advanced cases with muscular atrophy, capsularadhesions and fibrosis, no treatment is found to beeffective.239