Rehabilitation of Spinal Accessory Nerve Injury and Shoulder Dysfunction Following Neck Dissection for Head and Neck Cancer: A Narrative Review

Spinal accessory nerve (SAN) injury is one of the most common causes of shoulder impairment after neck dissection for head and neck cancer. Dysfunction of trapezius muscle function is related to scapular biomechanics, and it results in pain, along with a reduction in range of motion, muscle weakness, and limitations in activities of daily living. Recently, exercise-based rehabilitation has been recognized as an important component of care. Evidence regarding the most effective rehabilitation strategies remains limited. The aim of this narrative review is to provide a comprehensive overview of SAN-related shoulder dysfunction following neck dissection for head and neck cancer, with particular emphasis on three main aspects: surgical strategies for preventing SAN injury, postoperative rehabilitation interventions for patients with established or suspected SAN-related dysfunction, and clinical and patient-reported outcome measures used to assess shoulder function and disability. A narrative review was conducted. Papers evaluating rehabilitation interventions for spinal accessory nerve injury after head and neck cancer surgery were included, and studies on rehabilitation interventions (manual therapy, strengthening, and supervised exercise) that are related to a reduction in pain and improvements in shoulder mobility, disability, and function were analyzed. Manual therapy enhanced cervical mobility and quality of life, strengthening improved short-term shoulder abduction, and supervised programs were more effective than home-based rehabilitation for pain and disability reduction. Targeted rehabilitation, including structured exercises and supervised physiotherapy, may improve shoulder mobility, reduce pain, and enhance functional recovery following spinal accessory nerve injury. Hospital-based supervised programs appear to offer greater short-term benefits. However, the limited evidence, small sample sizes, and heterogeneity in interventions prevent definitive recommendations. Further high-quality randomized trials with standardized protocols and long-term follow-up are needed.