Neck and shoulder problems after head and neck cancer treatment

After treatment for a surgery for a head and neck cancer, it is important to contact your specialist doctor or nurse if you notice any changes in the treated area.  They can tell you if the symptoms are caused by your treatment and give you advice on how they can be managed.

Surgery to remove lymph nodes in the neck (neck dissection) can cause changes in the neck and shoulder. After surgery, the skin in the area becomes tighter and thicker as the scar heals. As the scar heals, you may feel pricking, tingling or numbness on the skin 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.

Radiotherapy, especially after surgery, can also cause tightness in the skin and tissue in the treated area.

After treatment it is important to get to know how the skin on your neck feels. This is so you can notice any changes in the area. If you notice anything new or it feels different, contact your specialist doctor or nurse or consultant.

After these treatments 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 recover completely. Some people have pain in their neck or ear that lasts a few seconds before going away. These are known as spasms. 

It is important to get any stiffness checked and treated as early as possible. This reduces the risk of developing a frozen shoulder. This is where the tissue around the shoulder becomes inflamed, stiff and painful. Stiffness in the neck and shoulder usually develop before any pain. 

Changes in your neck and shoulders can take up to 6 months to develop

During surgery to remove lymph nodes in the neck (neck dissection) 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 shoulder movement can be painful, more difficult 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 recovers 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 try to avoid damage to the nerve.

After surgery and radiotherapy, it is common to have some swelling in your face or neck. This usually goes away within a few weeks.  

Some people might develop a long-term swelling called lymphoedema (lymphedema). This can happen if the lymphatic system which normally drains fluid away, has been damaged by treatment.  

There may be more risk of developing long-term swelling if you:

• had surgery to remove lymph nodes from your neck
• had radiotherapy after surgery.

If you had any lymph nodes in your neck removed it is important to look after the skin on your head, face and neck. This may help to reduce the risk of developing lymphoedema. 

Lymphoedema can also affect tissues inside the neck, such as the throat or larynx (voicebox). This can cause problems with speaking, swallowing or breathing.  Lymphoedema may be worse in the morning and improve as the day goes on.

Always tell your cancer doctor, nurse or GP if you notice swelling in your face or neck or tightness in the muscles. They can assess you to find out the cause.  Lymphoedema is usually treated by a lymphoedema therapist.

One of the main treatments for lymphoedema is a type of massage called manual lymphatic drainage (MLD). It encourages lymph fluid to drain away from the swollen area.