Effects on the neck and shoulders after treatment

Surgery to the neck may cause changes in your neck and shoulder. Some of these changes may occur immediately after surgery. Others may develop months afterwards. Possible changes may include:

  • a feeling of numbness, pain or ‘pins and needles’ around the scar
  • ear pains
  • stiffness or tightness in the neck and shoulder
  • weakness in the shoulder
  • being sensitive to touch, heat or cold
  • swelling in the face and neck caused by a build-up of fluid (lymphoedema).

Tell your doctor or specialist nurse as soon as possible if you notice any of these symptoms or any other changes. This can often help to prevent problems from becoming worse. Your doctor or specialist nurse may suggest things that can help or arrange for you to see a physiotherapist.

Treatments for neck and shoulder problems include:

  • pain relief
  • massage to reduce lymphoedema or relieve tightness
  • neck and shoulder exercises
  • changes to how you sit and stand.

Managing neck and shoulder changes

It is good to familiarise yourself with how your neck feels after surgery for head and neck cancer. Skin in this area can feel tighter once it has healed. It can also be uneven and lumpy to the touch. If you feel anything new in this area, you should contact your specialist nurse or consultant to discuss it further.


Neck scars

Surgery to remove lymph nodes in the neck, called a neck dissection, can cause changes in the neck and shoulder.

After your operation, as the scar heals, it becomes tighter and thicker. Radiotherapy after surgery can also cause changes to tissue in the treatment area.

Your neck may feel stiff when you move your head. It may be numb in places, especially around the scar. This often improves over time but does not always go away completely. Some people have neck or ear pains. The pain may come as spasms, lasting a few seconds before going away. As the scar heals, you may have some ‘pins and needles’ sensation as the nerves repair. Your neck may also be more sensitive to touch, heat or cold.

Gentle massage with a non-perfumed cream or oil will keep the skin supple and help with flattening the scar line.

Removing lymph nodes in the neck can sometimes cause a build-up of fluid in the tissues, leading to stiffness and swelling. This is called lymphoedema.

Sometimes, during surgery to lymph nodes in the neck, the spinal accessory nerve is injured. Normally, this nerve sends messages to the shoulder muscle. If it is damaged, the shoulder may feel stiff, painful or weaker than before.

If the nerve was only bruised, it usually heals within a few months. But if it was removed, the shoulder muscle gradually gets smaller and weaker. This can cause long-term changes in the shape and position of your shoulder blade.

Changes in your neck and shoulders can take up to six months to develop. It is common for stiffness in the neck and shoulders to develop before you have any pain. It is important to get any stiffness checked as early as possible. This will reduce the risk of developing a frozen shoulder. This is when the tissue around the shoulder becomes inflamed, stiff and painful.

If you have neck or shoulder symptoms, your doctor may arrange tests to find out the cause so they can give you the right treatment. They can prescribe painkillers if needed and refer you to a physiotherapist.

The physiotherapist may suggest:

  • neck or shoulder exercises
  • changes to your posture
  • massage
  • pain relief
  • safe ways of returning to physical activity.

If you are having restorative dental treatment after cancer treatment, you may find long periods of lying flat in the dentist’s chair uncomfortable. Talk to your dentist about working in a more comfortable position, or breaking the treatment up into shorter appointments.

I have an ear-to-ear neck dissection scar and even after almost eight years it can still feel tender and tight (more so in cold weather). The nerves in my face and neck can still ‘tingle’ too. My district nurse recommended using Bio-Oil on the scars and it does help.

Joyce


Neck and shoulder exercises

Muscles around the head and neck can become overworked and tight after surgery. Your physiotherapist will assess them and show you exercises that can help. Stretches and massage may help to reduce tension and pain. They work best when done regularly. If you have neck stiffness after radiotherapy, you will need to do neck exercises for the rest of your life.

Your physiotherapist may show you shoulder exercises to improve movement and reduce pain. Doing these exercises regularly can help prevent a frozen shoulder. You may be given an elastic tension band or light weights to exercise with. As your strength and movement improves, you can gradually increase the elastic tension or weight. This is called progressive resistance training.

The effects on your shoulder may be more severe if the spinal accessory nerve, which sends messages to the shoulder muscle, was removed or is permanently damaged. A physiotherapist may use specially designed strapping or a brace (an orthosis) to support your arm and hold your shoulder in the right position. This can reduce any pain and help you to use your arm.


Posture

After your operation, it may feel easier to sit in a slumped position. Try not to do this as it can encourage muscle weakness and tightness. Good posture is important and will help movement in your neck and shoulders.

You can do things to help your posture. Look at yourself in the mirror, to check the position of your head and shoulders. Then sit with your lower back supported, or stand up straight with your shoulders back but relaxed. This will put your joints and soft tissues in a good position. Practise doing this until it feels like your normal posture.


Massage

Once the scar tissue has healed, regular and firm massage will help relieve tightness. Use a non-perfumed oil or cream. Your nurse or physiotherapist can show you, or a relative or friend, how to do the massage.


Pain relief

Your doctor can prescribe regular painkillers for you. Tell your doctor if your pain does not get better. They can increase the dose or change your painkillers. If the pain is due to tightness in your neck or shoulder, physiotherapy and exercise may also help.