Effect of Mulligan technique on shoulder dysfunction post neck dissection surgery

Introduction
Dissection of the neck is frequently used in the management of head and neck malignancies. However, it may result in spinal accessory nerve injuries, leading to trapezius atrophy, shoulder dysfunction, chronic neck pain, and scapular dyskinesia.

Material and methods
Seventy-six patients, aged between thirty and fifty, experiencing shoulder dysfunction following neck dissection surgeries, were arbitrarily split into 2 equal groups. Group A: 38 patients underwent the mulligan mobilization technique three times a week, along with a conventional physical therapy program, for six weeks; and Group B: 38 individuals underwent a conventional physical therapy regimen for six weeks. Shoulder ROM was evaluated by a digital goniometer (flexion, abduction, and external rotation), as well as upper limb function was evaluated by shoulder pain and disability index before and after intervention.

Results
Both groups showed a substantial improvement in shoulder ROM after intervention in contrast with before intervention (p < 0.001). In group A, there was an increase of 19.21% in flexion, 28.89% in abduction, and 29.68% in external rotation. In group B, the improvements were slightly lower, with increases of 7.86% in flexion, 8.07% in abduction, and 8.89% in external rotation. The study found a substantial decline in SPADI scores after intervention in contrast with before intervention in groups A as well as B (p < 0.001). It was found a 58.65% decrease in SPADI score in group A as well as a 22.30% decrease in group B.

Conclusions
MWM is effective in improving shoulder ROM and upper limb function in patients with shoulder dysfunction post-NDS.