Neck and shoulder problems after head and neck cancer treatment

Some treatments for head and neck cancer may cause changes to your neck and shoulders. Several things can help.

Effects on the neck and shoulders

After treatment for a surgery for a head and neck cancer, it is important to contact your specialist doctor or nurse if you notice any changes in the treated area.  They can tell you if the symptoms are caused by your treatment and give you advice on how they can be managed.

Skin and sensation changes

Surgery to remove lymph nodes in the neck (neck dissection) can cause changes in the neck and shoulder. After surgery, the skin in the area becomes tighter and thicker as the scar heals. As the scar heals, you may feel pricking, tingling or numbness on the skin 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. This can also help make the scar line smoother.

Radiotherapy, especially after surgery, can also cause tightness in the skin and tissue in the treated area.

After treatment it is important to get to know how the skin on your neck feels. This is so you can notice any changes in the area. If you notice anything new or it feels different, contact your specialist doctor or nurse or consultant.

Neck and shoulder stiffness

After these treatments 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 recover completely. Some people have pain in their neck or ear that lasts a few seconds before going away. These are known as spasms. 

It is important to get any stiffness checked and treated as early as possible. This reduces the risk of developing a frozen shoulder. This is where the tissue around the shoulder becomes inflamed, stiff and painful. Stiffness in the neck and shoulder usually develop before any pain. 

Changes in your neck and shoulders can take up to 6 months to develop

Nerve damange

During surgery to remove lymph nodes in the neck (neck dissection) the spinal accessory nerve is sometimes injured. This nerve usually sends messages to the shoulder muscle.  If it is damaged, the shoulder may feel stiff. Some people find that shoulder movement can be painful, more difficult or weaker than before. Others find that they cannot move their arm as much as before.

If the nerve was only bruised during surgery, it usually recovers within a few months. But if the nerve 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. Surgeons try to avoid damage to the nerve.


After surgery and radiotherapy, it is common to have some swelling in your face or neck. This usually goes away within a few weeks.  

Some people might develop a long-term swelling called lymphoedema (lymphedema). This can happen if the lymphatic system which normally drains fluid away, has been damaged by treatment.  

There may be more risk of developing long-term swelling if you:

  • had surgery to remove lymph nodes from your neck
  • had radiotherapy after surgery.

If you had any lymph nodes in your neck removed it is important to look after the skin on your head, face and neck. This may help to reduce the risk of developing lymphoedema. 

Lymphoedema can also affect tissues inside the neck, such as the throat or larynx (voicebox). This can cause problems with speaking, swallowing or breathing.  Lymphoedema may be worse in the morning and improve as the day goes on.

Always tell your cancer doctor, nurse or GP if you notice swelling in your face or neck or tightness in the muscles. They can assess you to find out the cause.  Lymphoedema is usually treated by a lymphoedema therapist.

One of the main treatments for lymphoedema is a type of massage called manual lymphatic drainage (MLD). It encourages lymph fluid to drain away from the swollen area. 

Managing neck and shoulder changes

If treatment has affected your neck or shoulders, your doctor may arrange tests to find out why. This is so they can give you the right treatment. If needed, they can prescribe painkillers and refer you to a physiotherapist.

If you have changes in your neck and shoulders, you may find lying down for long periods of time uncomfortable. Your physiotherapist can give you advice on managing this. 

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 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 will show you exercises to improve movement and reduce pain. 

Doing your exercises regularly can help prevent your shoulder becoming stiff.  Your physiotherapist may give you 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.

If the spinal accessory nerve was removed or is permanently damaged, the effects on your shoulder will be more severe. A physiotherapist may use specially designed strapping or a brace called an orthosis. These support your arm and hold your shoulder in the right position. This can reduce any pain and help you to use your arm.


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 helps with 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. Sit up or stand up straight with your shoulders back but relaxed. When you sit, make sure your lower back is supported. This puts your joints and soft tissues in a good position. Practice doing this until it feels like your normal posture.


Once the scar tissue has healed, firmly massage the area regularly. Massaging the area around a scar using a non-perfumed oil or cream, can help relieve tightness in the skin.

Always check with your physiotherapist, doctor or nurse before massaging the affected area. Your nurse or physiotherapist can show you, or someone you are close to, how to do the massage.

Pain relief

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

About our information

  • References

    Below is a sample of the sources used in our late effects of head and neck cancer treatment information. If you would like more information about the sources we use, please contact us at

    Nilsen M L, Belsky MA et al. Late and long term treatment-related effects and survivorship for head and neck cancer patients. Current treatment options in oncology. 2020. Volume 21. Issue 12.

    Machiels J.-P, Leemans C. R. et al. Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx. EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2020. Volume 31, Issue 11, Pages 1462-1475.

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Chris Alcock, Consultant Clinical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

Date reviewed

Reviewed: 01 April 2022
Next review: 01 April 2025
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

Our cancer information meets the PIF TICK quality mark.

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