Effectiveness Of Cervical Rehabilitation Program After Thyroidectomy
Condition: Post-Thyroidectomy Hypoparathyroidism
MeSH terms: Hypoparathyroidism
Study type: Interventional

Summary: 
      The aim of this research is to determine the Effects of cervical rehabilitation program on
      neck pain, ROM and disability after thyroidectomy. Randomized controlled trials will be done
      at Pakistan ordinance factory (POF) Hospital. The sample size will be 52. The subjects were
      divided in two groups, with 26 subjects in Group A and 26 in Group B. Study duration was of 6
      months. Sampling technique applied was Non probability Convenience Sampling technique. Both
      males and females of aged 30-50 years with thyroidectomy were included. Tools used in the
      study are Numeric Pain Rating Score (NPRS), goniometer and neck disability index (NDI).
    

Detailed description: 
      Thyroidectomy, or surgical removal of the gland, is highly recommended treatment for thyroid
      disorders. The most prevalent of these conditions are symptomatic benign large goiter and
      tumorous condition of the thyroid gland. Both younger females and postmenopausal older women
      are prevalent towards these disorders (nodular goiter, cancer, and hypothyroidism).

      Due to hyperextended position of neck during surgery patient usually complaint about the
      posterior neck pain, movement difficulties of shoulder and neck, occipital headaches,
      shoulder stiffness, motion's cervical range of limitations and some of them experiences the
      discomfort symptoms such as stretching, pressing, or choking feelings in the neck, headache,
      shoulder stiffness, and difficulty in moving the neck or shoulders. These symptoms may
      persist for an extended period following surgery and may even have a negative effect on the
      patient's quality of life. It has been reported that hyperextension can cause bilateral
      hypoglossal palsy, tetraplegia and cervical artery dissection Recently, a variety of
      treatment modalities have been used to overcome these disturbing symptoms, such as
      intraoperative transcutaneous electrical nerve stimulation (TENS), preoperative bilateral
      greater occipital nerve (GON) block, bilateral superficial cervical plexus block combined
      with bilateral GON block, and postoperative neck stretching exercise. Due to surgical
      position of thyroidectomy patient often develops posture syndrome of thyroid surgery (PSTS),
      symptoms include postoperative nausea, vomiting, dizziness, headache and some discomfort
      associated with neck an occipital radiating pain.

      Nepa Patel et al reported that both positional release technique and MET are effective for
      treatment of upper trapezius tightness or trigger points as the trapezius muscle works to
      move the neck in several directions, its degree of tightness or looseness affects neck
      flexibility. Om C. Wadhokar et al conducted a study on patients having neck pain with TMJ
      dysfunction, causes tightness of occipital muscles, difficulty in mouth opening and forward
      head posture. In this study suboccipital release technique was found to be more effective
      than conventional treatment.

      In an RCT, stretching of pectoralis along with cervical mobilizations and rotation exercises
      were used for treatment of mechanical neck pain. And it has evaluated that it improves the
      active range of motion in all directions, perceived pain and disability levels. In 2019,
      Samah et al conducted a study to compare the effects the active neck stretching exercises and
      kinesio taping on patients after thyroidectomy; a significant improvement was observed in
      active stretching group. Another study investigated the effects of neck stretching exercises
      on post thyroidectomy patients with complaint of neck discomfort, and it concluded that neck
      stretching exercises are improving the patient disability level.
    

Intervention name(s): Cervical Rehabilitation program (Intervention Group) Group A; control group group B
Intervention type(s): Other; Other
Intervention description(s): (Positional release technique on trapezius muscle): the therapist locate and apply pressure along the tender points in the upper fibers of the trapezius. Lateral flexion of subject's head toward the side of a tender point held for 90 seconds.
(Suboccipital muscle release): The therapist places both his palms under the sub occipital region of the subject with his curled-up fingers and places an upward pressure causing a stretch and distraction for 30 seconds,This technique was performed 3 times in one session.
Stretching of pectoralis muscle:
Pectoralis muscle stretch were performed once daily, completing three repetitions on each side with a 30-second hold. Stretching with repetition of five, three times a day for 1week neck and soulder ROMs; Relax shoulders and neck sufficiently
look down
turn face to the right
turn face to the left
incline head to the right
incline head to the left
turn shoulders round and round
slowly raise hands fully then lower them. patients were asked to perform five repetitions of each stretching exercise, three times per day (morning, afternoon, and evening).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: range of motion; disability; post-thyroidectomy