Outpatient Rehabilitation for a Post-Operative Thyroid Cancer Patient with Pectoralis Major Flap Reconstruction and Head and Neck Lymphedema: A Case Report

Background: Individuals diagnosed with head and neck cancers are often presented with a range of treatment options which may include surgery, chemotherapy, and radiation. For some with advanced cancers, this may include a form of neck dissection surgery followed by a pectoralis major pedicled flap reconstruction (PMPF). Past research has shown that such surgeries may make the individual more likely to experience cervical spine and glenohumeral pain and dysfunction along with head and neck lymphedema. Each of these surgical side effects may be managed with physical therapy rehabilitation, though there is limited research to guide decision-making with these patients. Case Description: A thyroid cancer patient presented to physical therapy for cervical spine and glenohumeral pain and limitations as well as head and neck lymphedema after undergoing a radical neck dissection and PMPF. He also underwent chemotherapy and radiation treatments for his cancer prior to and throughout physical therapy. Intervention: Progressions from passive, active assisted, active, and active with resistance range of motion (ROM) and strengthening for this patient’s cervical spine and glenohumeral joint were implemented. Complete Decongestive Therapy (CDT) was also initiated and maintained in his treatment for lymphedema. Outcome Measures: The greatest increases in the patient’s active range of motion (AROM) were in glenohumeral flexion, abduction and internal rotation (IR), as well as cervical spine extension and side bending to the surgical side. The patient subjectively described improvement in lymphedema symptoms with CDT. Discussion: While neck dissection and PMPF surgeries have been common for head and neck cancer patients, there are known resultant limitations on the cervical spine and glenohumeral joint on the surgical side. However, there is a lack of information or research on best physical therapy interventions for these patients. This case report describes a progression of physical therapy interventions targeting cervical and shoulder pain and dysfunction secondary to radical neck dissection, one of the first of its kind.