A pilot study of a randomized controlled trial to evaluate the effects of progressive resistance exercise training on shoulder dysfunction caused by spinal accessory neurapraxia/neurectomy in head and neck cancer survivors

BACKGROUND: Shoulder dysfunction remains a frequent complication after neck dissection procedures for head and neck cancer. METHODS: We conducted a pilot study to evaluate the effects of progressive resistance exercise training (PRET) on shoulder dysfunction caused by spinal accessory neurapraxia/neurectomy in patients with head and neck cancer. Twenty patients (mean age, 61 +/- 7.7 years) were randomly assigned to PRET or standard care intervention. Subjects assigned to the PRET group exercised three times per week for 12 weeks. The goal of the exercise program was to enhance scapular stability and strength of the upper extremity. The resistance-training program was progressive in terms of number of sets and repetitions performed, as well as the amount of weight lifted, depending on performance status. RESULTS: The completion rate for the trial was 85% (17 of 20). The exercise group completed 93% of scheduled exercise sessions. Significant improvements were found in favor of the PRET group in active shoulder external rotation (p =.001), shoulder pain (p =.038), and overall score for shoulder pain and disability (p =.045). CONCLUSIONS: The study results demonstrate a high rate of completion and adherence with our PRET program among patients with head and neck cancer. The preliminary findings, although limited, also suggest a potential therapeutic role for resistance exercise as an adjunct to standard physical therapy treatment.     

Shoulder function after accessory nerve-sparing neck dissections

BACKGROUND: This study was designed to observe the effect of preserving the spinal accessory nerve (SAN) during neck dissection (ND) and adjuvant radiotherapy (ART) after ND on shoulder function. METHODS: Fifty-seven patients with head and neck cancer who had undergone primary tumor resection and various types of NDs were enrolled in this prospective study. Postoperative shoulder joint range of motion was evaluated by goniometry, and muscle strength was measured manually. SAN function was evaluated with electromyography (EMG) with respect to percentage of denervation and presence of neurogenic involvement. Patients were grouped by treatment as follows: radical ND (RND) versus modified radical ND (MRND)/selective ND (SND) and ART versus no ART. RESULTS: Shoulder joint range of motion and shoulder muscle strength were significantly better in the MRND/SND group than in the RND group. However, EMG findings were similar in the RND and MRND/SND groups. When all patients who underwent ND, RND, or MRND/SND were compared with the control group, statistically significant changes in shoulder joint range of motion and shoulder muscle strength were found. Also, denervation and neurogenic involvement of the SAN were significantly higher after all NDs than in the control group. ART did not affect range of motion of the shoulder joint, shoulder muscle strength, or the degree of denervation and neurogenic involvement in any of the ND groups. CONCLUSIONS: ART does not have a negative effect on shoulder function after ND. SAN is always functionally impaired even if we preserve it macroscopically during ND.     

Functional assessment using Constant's Shoulder Scale after modified radical and selective neck dissection

BACKGROUND: Constant's Shoulder Scale is a validated and widely applied instrument for assessment of shoulder function. We used this instrument to assess which treatment and demographic variables contribute to shoulder dysfunction after neck dissection in head and neck cancer patients. METHODS: A convenience sample of 54 patients with 64 neck dissections and minimum follow-up of 11 months were evaluated. Thirty-two accessory nerve-sparing modified radical (MRND) and 32 selective neck (SND) dissections were performed. Multivariable regression analysis was used to determine the variables that were predictive for shoulder dysfunction. Clinical variables included age, time from surgery, handedness, weight, radiation therapy, neck dissection type, tumor stage, and site. RESULTS: Patients receiving MRND had significantly worse shoulder function than patients with SND (p =.0007). Radiation therapy contributed negatively, whereas weight contributed positively (p =.0001). CONCLUSIONS: The critical factors contributing to shoulder dysfunction after neck dissection were weight, radiation therapy, and neck dissection type.     

喉癌颈淋巴清扫患者术后预防性肩功能康复锻炼的效果观察

目的验证喉癌颈淋巴清扫术后患者预防性康复锻炼对于改善肩功能的效果。方法非同期对照类实验设计,将76例喉癌手术同期行颈淋巴清扫患者按时间先后分为对照组和观察组,每组38例。对照组接受头颈外科常规护理(无肩功能康复锻炼),观察组接受早期预防性肩功能康复锻炼,术后3个月、6个月时采用Constant-Murley肩功能评分测评两组肩功能状况。结果术后3个月时两组患者肩功能评分均较术前下降,至术后6个月时,两组肩功能评分均呈现上升趋势。两组肩功能主观评分及客观评分的时间效应存在统计学差异(均P0.01),组间效应、时间与组间的交互效应无统计学差异(均P0.05)。结论喉癌颈淋巴清扫术后早期预防性肩颈康复锻炼的效果有限,肩功能呈现自我恢复趋势,在更充分证据产生之前,不建议临床常规开展预防性康复锻炼。     

Chronic pelvic pain in women: still a challenge

Chronic pelvic pain (CPP), a common condition particularly in reproductive-aged women, causes disability and distress, and significantly compromises quality of life and affects healthcare costs. The pathogenesis of CPP is still poorly understood and consequently poorly managed. Furthermore, the lack of a consensus on the definition of CPP greatly hinders epidemiological studies. Patients present with various associated problems, including bladder or bowel dysfunction, gynaecological pathologies or sexual dysfunction, and other systemic or constitutional symptoms. Other conditions, e.g. depression, anxiety and drug addiction, can also coexist. Effective management presupposes an integrated knowledge of all pelvic organs and other systems, including musculoskeletal, neurological and psychiatric systems. The key to treating CPP is to treat it as the complex disease it is. Treatment options range from conservative medical therapy to surgical intervention, and are primarily directed towards symptom relief. Unsatisfactory results of treatment render this condition a frustrating problem for both patients and physicians.