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IntroductionNeck dissection surgery (NDS) is frequently used in the management of head and neck malignancies. However, it may result in injury to the spinal accessory nerve, leading to trapezius atrophy, shoulder dysfunction, chronic neck pain, and scapular dyskinesia.Material and methodsSeventy-six patients, aged between thirty and fifty, experiencing shoulder dysfunction following NDS, were randomly assigned to two equal-sized groups. Group A: 38 patients underwent the Mulligan mobilization technique (MWM) three times a week, along with a conventional physical therapy program, for six weeks; Group B: 38 individuals underwent a conventional physical therapy regimen for six weeks. Shoulder ROM (range of motion) was evaluated by a digital goniometer (flexion, abduction, and external rotation), and upper limb function by the shoulder pain and disability index (SPADI), before and after intervention.ResultsBoth groups showed a substantial improvement in shoulder ROM over the course of the intervention (p < 0.001). In Group A, the participants demonstrated an increase of 19.21% in flexion, 28.89% in abduction, and 29.68% in external rotation. In Group B, the improvements were slightly less, with increases of 7.86% in flexion, 8.07% in abduction, and 8.89% in external rotation. Both groups exhibited a substantial decline in SPADI scores post-intervention compared with pre-intervention (p < 0.001). A 58.65% decrease in SPADI score was noted in Group A, and a 22.30% decrease in group B.ConclusionsMWM is effective in improving shoulder ROM and upper limb function in patients with shoulder dysfunction post-NDS.

Shoulder Injury Related to Vaccine Administration (SIRVA) is a rare disorder characterized by persistent shoulder pain and limited range of motion presenting within 48 h after vaccine administration. With the widespread distribution of the COVID-19 vaccine, the incidence of SIRVA is expected to rise. This sudden rise in vaccine administration presents an ideal opportunity to estimate the prevalence of SIRVA and to better characterize SIRVA. This study aims to investigate the prevalence of SIRVA following COVID-19 vaccine administration among hospital workers in the Netherlands. A questionnaire was sent to all hospital workers from a single non-academic hospital in the Netherlands. Respondents who had active SIRVA complaints were invited for an outpatient orthopaedic clinic assessment. Data was collected on participant characteristics and physical examination including assessment of active and passive range of motion (ROM). An ultrasound was performed to identify potential abnormalities. 32 out of 981 (3.3%) respondents reported shoulder pain with limited ROM occurring within 48 h after vaccine administration lasting for at least 7 days. Of these 32 respondents with SIRVA, 18 (56.2%) still reported active symptoms at the time of the survey. Clinical examination of 13 (72.2%) respondents with active SIRVA complaints showed limited glenohumeral ROM, limitations in activities of daily living and injection site pain. Twelve out of thirteen (92.3%) respondents with active SIRVA complaints showed abnormalities of the soft-tissue of the shoulder on ultrasound. Physiotherapy was the most common treatment modality for persistent SIRVA complaints (38.9%). The prevalence of SIRVA is estimated at 3% in the adult working population. Signs and symptoms of SIRVA are variable in severity, localization and timing. Soft-tissue abnormalities is the most common clinical sign. This study contributes to clinician’s knowledge on SIRVA, aiding in early recognition and treatment, which are imperative for prevention of persistent and severe shoulder pathology.

IntroductionHead and neck cancer (HNC) affects the mouth, throat, salivary glands, voice box, nose or sinuses. Every year, over 12 000 people in the UK are diagnosed with HNC. Neck dissection is a key, surgical component of patient care. However, many people experience postoperative restriction in shoulder and neck movements, pain, fatigue and low mood, with only half ever returning to work.Methods and analysisGetting Recovery Right After Neck Dissection (GRRAND) is a two-arm, multicentre, pragmatic randomised controlled trial. The trial aims to compare clinical and cost-effectiveness of a personalised physiotherapy programme (GRRAND programme) versus usual practice, National Health Service (NHS), postdischarge care.The planned sample size is 390 participants. Participants will be recruited from across UK sites and followed up for 12 months. The primary outcome is the shoulder pain and disability index at 12 months. Economic evaluation will be conducted from a healthcare system and personal social services perspective. Secondary outcome data, including pain, function, health-related quality of life, mental well-being, health resource use and adverse events, will be collected at 6 weeks, 3, 6 and 12 months, with exercise adherence at 6 weeks. A process evaluation will determine how GRRAND is implemented, delivered and received across clinical settings, exploring what works, for whom and under what conditions. Analysis will be on an intention-to-treat basis and reported inline with the Consolidated Standards of Reporting Trials statement.Ethics and disseminationThe trial was approved by the London-Brent Research Ethics Committee (ref: 24/LO/0722) on 15 October 2024. Trial results will be disseminated via peer-reviewed publications, presentations at national and international conferences, in lay summaries and social media. This protocol adheres to the recommended Standard Protocol Items: Recommendations for Interventional Trials checklist.Trial registration numberISRCTN13855775.

Background Modified radical mastectomy (MRM) is associated with persistent psychological and physical sequelae in geriatric breast cancer survivors. This study examines the 60-month longitudinal associations between pain catastrophizing, depression, pain interference, shoulder dysfunction, and lymphedema. Methods In this retrospective cohort study, 89 geriatric women (median age = 72, IQR = 69–76, range = 65–88) who underwent MRM were assessed at baseline (pre-surgery), 1, 3, and 2 months after completion of radiotherapy (median 5 months post-surgery, IQR 4.5–5.5), and 12, 24, 36, 48, and 60 months post-surgery. Pain Catastrophizing Scale (PCS), Geriatric Depression Scale (GDS), Brief Pain Inventory (BPI) interference, shoulder range of motion (ROM) differences (flexion and abduction), and lymphedema severity (Frustum formula, ISL staging) were measured. Lymphedema was defined using a primary threshold of ≥ 5% inter-limb volume difference and a sensitivity analysis threshold of ≥ 10% or ≥ 200 mL. Patients were stratified by baseline PCS median (high: ≥25; low: <25). Spearman correlations, Wilcoxon signed-rank tests, Mann-Whitney U tests, and Fisher’s exact tests were used. All statistical tests were two-tailed, and p-values were adjusted for multiple comparisons using the false discovery rate (FDR) method. Results Strong correlations were observed between PCS, GDS, and BPI across all time points (ρ = 0.911–0.994, q < 0.001). Shoulder ROM differences correlated significantly with PCS, GDS, and BPI from 1 month onward (ρ = 0.864–0.939, q < 0.001), peaking at 24 months. Lymphedema (≥ 5% threshold ) showed moderate correlations at 3 months (ρ = 0.443–0.516, q < 0.001), strengthening by 24–36 months (ρ = 0.687–0.803, q < 0.001). High PCS patients had significantly worse GDS, BPI, ROM differences, and lymphedema incidence (see Table 3). Conclusions Pain catastrophizing is strongly and persistently associated with shoulder dysfunction and lymphedema in geriatric breast cancer survivors. Early PCS-based risk stratification is recommended to guide targeted interventions.

Background Impingement syndrome, a common cause of shoulder pain, often leads to functional limitations. Manual thoracic therapy is frequently employed as a non-surgical intervention, but its efficacy remains debated. This review assesses the impact of manual thoracic therapy on pain reduction and functional improvement in impingement syndrome. Methods A systematic review of randomized clinical trials was conducted, focusing on studies that applied manual thoracic therapy to patients with impingement syndrome. The primary outcomes were pain reduction and functional improvement. Studies were evaluated for methodological quality using the PEDro scale, with scores ≥ 6 indicating high quality. Results Nine studies met the inclusion criteria. All studies demonstrated high methodological quality (PEDro score ≥ 6). Pain reduction was consistent across studies, with an NPRS score reduction of 0.6 to 1.5 points immediately after treatment and up to 3.2 points at follow-up. Functionality improvements were statistically significant in some studies. However, the results showed limited homogeneity, and the majority of studies did not report substantial differences between intervention and placebo groups. Conclusion This review suggests that manual thoracic therapy may lead to pain reduction in impingement syndrome, with some evidence of functional improvement. However, the variability in manual therapy techniques and the limitations in research methodologies indicate a need for further controlled studies. These findings underscore the potential of manual therapy as a supplementary treatment but also highlight the necessity for more robust clinical trials to fully ascertain its effectiveness in clinical practice. Graphic abstract

Background and Objectives: Shoulder dysfunction is a frequent complication after cervical lymph node dissection in patients with head and neck cancer (HNC), leading to pain, reduced mobility, and impaired quality of life. Physiotherapy programs that include strength exercises have shown benefits in managing these sequelae, but the potential added value of neurodynamic mobilization techniques (NDMTs) remains unclear. This pilot randomized controlled trial was designed to examine whether a NDMTs program improves pain and shoulder-related function in HNC survivors with shoulder dysfunction, assessing trajectories during treatment and at short-term follow-up. Materials and Methods: A pilot, assessor-blinded, randomized, parallel-group clinical trial was conducted with 20 participants who had undergone HNC surgery and exhibited shoulder dysfunction. Participants were randomized to either a control group (strength exercises alone) or an experimental group (strength exercises plus NDMTs). Outcomes were assessed at baseline, mid-term (1 week), post-treatment, and 3 months post-treatment. The primary outcome was quality of life measured by the QLQ-H&N35 questionnaire. Secondary outcomes included pain intensity (VAS), disability (DASH), and handgrip strength. Results: Significant improvements were observed in the experimental group for all primary and secondary outcomes. The experimental group demonstrated improved quality of life (p = 0.009), lower pain intensity (p < 0.001), reduced disability (p < 0.001), and increased handgrip strength. Interaction effects for time and group were significant across multiple measures, favoring the NDMTs group. Conclusions: NDMTs are a promising addition to strength programs for improving shoulder dysfunction outcomes in HNC patients, with implications for both clinical practice and future research. Registered in ClinicalTrials: NCT05604235 prior to recruitment.

Purpose The primary endpoint of the study was to quantitatively evaluate the presence of IIB neck level metastases in patients with laryngeal carcinoma, to provide valuable evidence to aid surgeons in the decision-making process for neck dissections. As a secondary aim this study analyzed the presence of factors that may be associated with a higher prevalence of metastasis. Methods Two independent authors (EE, MVV) searched for articles on PubMed, Cochrane, Embase, and Scopus databases. Review of the articles was carried out following 2020 PRISMA guidelines, all articles were assessed for quality according to NICE guidelines. Afterwards the statistical analysis was performed with STATA 18SE software. Studies were also assessed for heterogeneity and risk of publication bias. Results A total of 19 studies were included, from which data on 1205 subjects was extracted. Out of 997 patients with a cN0 LC, 21 patients developed metastasis. This meta-analysis found the cumulative rate of metastasis to be 1% (95% CI 0–2%). Also, there is a 51% higher probability (OR: 1.51, 95% CI 0.06, 2.92) of occult IIB metastasis in higher stages (T3/T4) compared to lower stages (T1/T2). Conclusions Dissection of level IIB may be safely spared in patients with cN0 laryngeal cancer, possibly leading to improved QoL and shoulder function as well as reducing OR times and costs.

There is an increasing need for evidence-based postoperative rehabilitation strategies to optimize patient outcome. Knowledge of potential prognostic factors could steer the development of rehabilitation protocols and could result in better treatment outcomes and higher patient satisfaction. This study aimed to investigate which potential prognostic factors predict baseline shoulder pain and function and its evolution in the first 2 years following surgery, in patients with total shoulder arthroplasty. The secondary objective is to investigate which potential prognostic factors predict baseline quality of life and its evolution in the first two years following surgery. To reach the aims of this project, a prospective longitudinal study, running from January 2020 to March 2025, will be carried out with a follow-up of 48 months. Patients will be randomized based on sling wear. We will study factors such as shoulder function, patient expectations, psychosocial factors, lifestyle factors, sling wear, soft tissue integrity, and physiotherapy treatment. Test moments will take place preoperatively, at 6 weeks, 12 weeks, 6 months, 12 months, and 24 months. Descriptive statistics will be used to describe the patient population characteristics. Based on literature review, expert opinion, and univariate analyses, potential prognostic factors will be chosen as covariates. A mixed regression model for repeated measures will be used to assess both the evolution of the Shoulder Pain and Disability Index within persons from baseline over time and the differences in evolution between participants. Correlation analyses will be used to investigate associations between the other outcome measures such as the Constant and Murley Score, shoulder range of motion, shoulder muscle strength, and proprioception, and the primary outcome measure, the Shoulder Pain and Disability Index score. Potential prognostic factors not included in the model will be presented in a descriptive manner. Data collection started in January 2020. In April 2023 the sample size was reached. Data collection will end in April 2025. Analyses will follow when data collection is completed. Knowledge of potential prognostic factors will have implications toward better rehabilitation strategies of patients after total shoulder arthroplasty. ClinicalTrials.gov NCT04258267; https://clinicaltrials.gov/study/NCT04258267. DERR1-10.2196/56522.

Background Scapulothoracic motion during arm elevation involves scapular posterior tilt (PT), upward rotation (UR), and external rotation (ER). Abnormal scapular kinematics are common in people with chronic shoulder pain, potentially exacerbating symptoms and impairing function. Push-ups, a common exercise for shoulder rehabilitation, may influence scapular motion but have not been extensively studied in this context. Thus, this study aimed to investigate the effect of hand position on scapular kinematics during a push-up exercise in athletes with and without chronic shoulder pain (CSP). Methods Twenty-four male overhead athletes were allocated into two groups: CSP ( n  = 12) and Control (CON; n  = 12). Scapular kinematics in three planes (PT, UR, and ER) were measured using a Vicon motion capture system during push-ups in three hand positions (internal rotation, IR; neutral rotation, NR; and external rotation, ER). Measurements were taken in the concentric phase of the push-up. Statistical analyses using repeated-measures ANOVA assessed the effects of hand position and elbow extension on scapular kinematics between the two groups. Results For PT of the scapula, in the IR hand position, participants from both the CON and CSP groups showed similar decreases (CON group = from 25.74° to -16.10°; P  < 0.001). In the NR hand condition, the CON group decreased PT from 16.12° to -15.98° ( P  < 0.001), but there was no significant change in the CSP group. In the ER hand condition, for the CON group, PT decreased from 18.63° to -9.38° ( P  < 0.026), with no significant change observed in the CSP group. For UR of the scapula, the CON group showed significant decreases in the IR hand condition (from 15.37° to -2.28°; P  < 0.019), while the CSP showed minimal changes. In the IR hand condition, the ER of the scapula increased from 20.44° to 25.13° ( P  < 0.003) in the CON group. At the same time, the CSP showed smaller changes. In the NR hand condition, ER of the scapula in the CON group decreased from 24.79° to 9.38° ( P  < 0.001), with no significant change observed in the CSP group. Conclusion Scapular kinematics (UR, PT, and ER) differed significantly across hand rotation conditions and groups. The CON group exhibited more pronounced changes in these kinematic measures, while the CSP group showed limited variation. This may indicate an association between chronic pain and movement restriction. These findings emphasize the need for targeted rehabilitation strategies that consider these kinematic differences.

Shoulder dysfunction characterized by scapular internal rotation is associated with muscle weakness, pectoralis minor shortening, and altered postural alignment. Although breathing-integrated scapular stabilization or thoracic–scapular stabilization exercises may improve these impairments, no prior study has directly compared their effects in this population. Methods: Thirty-two adults with shoulder dysfunction characterized by scapular internal rotation were randomly assigned to an experimental group (n = 16), which performed breathing-integrated scapular stabilization exercises, or a control group (n = 16), which performed thoracic–scapular stabilization exercises. Both groups participated in a 4-week intervention program conducted three times per week, with each session lasting 40 min. Muscle strength, pectoralis minor length (PML), and shoulder sagittal angle (SSA) were assessed at baseline and after the intervention. Data were analyzed using two-way repeated-measures ANOVA to examine group × time interactions, followed by Bonferroni-adjusted post hoc tests (α = 0.025). Results: No significant group × time interaction effects were observed for any outcome (p > 0.025), indicating that neither intervention demonstrated clear superiority over the other during the study period; however, both groups showed significant improvements over time in muscle strength, PML, and SSA following intervention (p < 0.025), except for upper trapezius strength, which did not change significantly. Conclusions: Both breathing-integrated scapular stabilization and thoracic–scapular stabilization exercises were associated with improvements in muscle strength, pectoralis minor length, and shoulder sagittal angle over time in individuals with shoulder dysfunction characterized by scapular internal rotation. However, no clear superiority of one intervention over the other was demonstrated during the 4-week study period.