This protocol was last updated before 2005

Purpose

To identify patients at risk for shoulder dysfunction after neck dissection and provide interventions to decrease discomfort and improve range of motion and strength in postoperative neck dissection patients.

Procedure

1. A registered nurse will assess the patient on the first postoperative clinic visit using the attached assessment tool. The assessment will include:
   • Ability to perform ADLs
   • ROM in the affected arm(s)
   • Level of pain at rest and with movement using a numeric or descriptive scale
2. Consult with physician regarding assessment and implementation of shoulder exercise program. Initiation may be dependent on patient condition.
3. The type of intervention to improve ROM (Phase I) will be based on patient's pain assessment:
   • Nursing will provide patient with an exercise program for pain rated as "0 to 7" or "mild to moderate."
   • A physical therapy referral will be completed for patients with pain rated as "greater than 7" or "severe."
4. Patients will be reassessed for compliance and progress with an exercise program on subsequent clinic visits.
5. Pending patient's progress, Phase II may be implemented to improve strength.