Safety Study of Musculoskeletal Ultrasonographic to Assess Disabilities Arm of Head and Neck Cancer Patient
Condition: Head and Neck Cancer
MeSH terms: Head and Neck Neoplasms
Study type: Observational

Summary: 
      The investigators suppose: 1. SND may cause damage to the soft tissue around shoulder girdle.
      2. The soft tissue injury may be related with the order of severity of wing scapula and
      duration after SND. The aims of this study are: 1. To assess the functional disabilities of
      shoulder and upper extremity in different time period after SND. 2. To evaluate the soft
      tissue lesion of shoulder with soft tissue ultrasonography to prove our hypothesis. This
      study is a two years, prospective, cross-section study. The investigators will enroll 80 HNC
      post SND within 3months, >3- 6months,> 6months -1 year, more than 1 year as four different
      groups, 20 patient in each group.
    

Detailed description: 
      Lymph node metastasis is one the most important prognostic-factors in head and neck
      cancer(HNC). Radical neck dissection (RND) has been the standard surgical method for HNC with
      neck lymph nodes metastasis in past decades. This operation includes removal of the
      sternocleidomastoid muscle (SCM), internal jugular vein (IJV) all cervical lymph nodes on one
      side and spinal accessory nerve (SAN), leading to significant ipsilateral shoulder syndrome
      caused by SAN dysfunction and impact quality of life. Despite most clinics prefer to use the
      nerve-sparing selective neck dissection (SND) for patient with N0 or N1 nodal disease today,
      shoulder disability and pain were still reported from 31% to 40% after this procedure.
      However, most previous studies evaluated the shoulder disability only by functional
      evaluation, range of motion, and questionnaire. The short and long term adverse effect to
      soft tissue around shoulder girdle after SND has not been reported. The investigators
      suppose: 1. SND may cause damage to the soft tissue around shoulder girdle. 2. The soft
      tissue injury may be related with the order of severity of wing scapula and duration after
      SND. The aims of this study are: 1. To assess the functional disabilities of shoulder and
      upper extremity in different time period after SND. 2. To evaluate the soft tissue lesion of
      shoulder with soft tissue ultrasonography to prove our hypothesis. This study is a two years,
      prospective, cross-section study. The investigators will enroll 80 HNC post SND within
      3months, >3- 6months,> 6months -1 year, more than 1 year as four different groups, 20 patient
      in each group. Evaluate the soft tissue of shoulder girdle with musculoskeletal
      ultrasonography and elastography, compare the finding in each group and the range of motion
      of their shoulder, the severity of wing scapula, visual pain analog scale and the score of
      The Disability of Arm, Shoulder and Hand (DASH) questionnaire. Statistical analysis will
      perform by SPSS software (SPSS V 20. International Business Machines. USA).
    

Intervention name(s): ultrasonography and elastography
Intervention type(s): Other
Intervention description(s): Evaluate the soft tissue of shoulder girdle with musculoskeletal ultrasonography and elastography, compare the finding in each group and the range of motion of their shoulder, the severity of wing scapula, visual pain analog scale and the score of The Disability of Arm, Shoulder and Hand
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        head and neck cancer by Never-Sparing Selective Neck dissection, SND, the skin condition is
        stable, there is no wound, infection or inflammation metastasis. Exclusion criteria: (1) in
        head and neck cancer before surgery and there had been other nerves, bones, muscles,
        tendons, resulting in lesions of the shoulder pain disorders or a history of activity. (2)
        severe cognitive function can not meet the examiner. (3) age less than 20 years of age or
        over 65 years of age.
      
Keywords: neck dissection surgery; shoulder disability; musculoskeletal ultrasonography