Effectiveness of Oncological Physiotherapy on Shoulder Dysfunction After Cervical Lymph Node Dissection in Head and Neck Cancer: A Pilot Randomized Controlled Trial

Abstract

Background and Objectives: Shoulder dysfunction is a frequent complication after cervical lymph node dissection in patients with head and neck cancer (HNC), leading to pain, reduced mobility, and impaired quality of life. Physiotherapy programs that include strength exercises have shown benefits in managing these sequelae, but the potential added value of neurodynamic mobilization techniques (NDMTs) remains unclear. This pilot randomized controlled trial was designed to examine whether a NDMTs program improves pain and shoulder-related function in HNC survivors with shoulder dysfunction, assessing trajectories during treatment and at short-term follow-up. Materials and Methods: A pilot, assessor-blinded, randomized, parallel-group clinical trial was conducted with 20 participants who had undergone HNC surgery and exhibited shoulder dysfunction. Participants were randomized to either a control group (strength exercises alone) or an experimental group (strength exercises plus NDMTs). Outcomes were assessed at baseline, mid-term (1 week), post-treatment, and 3 months post-treatment. The primary outcome was quality of life measured by the QLQ-H&N35 questionnaire. Secondary outcomes included pain intensity (VAS), disability (DASH), and handgrip strength. Results: Significant improvements were observed in the experimental group for all primary and secondary outcomes. The experimental group demonstrated improved quality of life (p = 0.009), lower pain intensity (p < 0.001), reduced disability (p < 0.001), and increased handgrip strength. Interaction effects for time and group were significant across multiple measures, favoring the NDMTs group. Conclusions: NDMTs are a promising addition to strength programs for improving shoulder dysfunction outcomes in HNC patients, with implications for both clinical practice and future research. Registered in ClinicalTrials: NCT05604235 prior to recruitment.