Effects on the neck and shoulders after head and neck cancer treatment

Surgery to the neck may cause changes in your neck and shoulders. Some of these changes may happen straight after surgery. Others may develop months afterwards. Possible changes may include:

  • numbness, pain or pins and needles around the scar
  • pain in the neck, shoulder or ears
  • 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.

Effects on the neck and shoulders

After surgery for a head and neck cancer, it is important to get to know how the skin on your neck feels now. This is so you can notice any changes in the area. If you feel anything new, you should contact your specialist nurse or consultant to discuss it further.

Surgery to remove lymph nodes in the neck (neck dissection) can cause changes in the neck and shoulder. After your operation, the skin in the area becomes tighter and thicker as the scar heals. Radiotherapy given after surgery can also cause tightness in the skin and tissue in the area that has been treated.

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 pain in their neck or ear. The pain may last a few seconds before going away. This is known as spasms.

As the scar heals, you may have a feeling of pins and needles 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.

Removing lymph nodes in the neck can sometimes cause a build-up of fluid in the tissues. This can lead to stiffness and swelling (lymphoedema).

During surgery to lymph nodes in the neck, 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 the shoulder can be painful, more difficult to move 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 heals 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 will try to avoid damage to the nerve.

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, very stiff and painful.


Coping with 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.

The physiotherapist may suggest:

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

If you have changes in your neck and shoulders, you may find lying down for long periods of time uncomfortable. If you are having restorative dental treatment, talk to your dentist about getting into a more comfortable position in the chair. You could also suggest breaking the treatment up into shorter appointments.

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 may show you exercises to improve movement and reduce pain. Doing these 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 (an orthosis). These will 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 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. Practise doing this until it feels like your normal posture.

Massage

Once the scar tissue has healed, firmly massage the area regularly. Massage the area around a scar, using a non-perfumed oil or cream, to 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 a family member 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 caused by tightness in your neck or shoulder, physiotherapy and exercise may also help.