Early vs. Late Referral for Scapular Exercises in Shoulder Function After Neck Dissection

Inclusion Criteria

1. Age between 20 and 65 years.

2. Newly diagnosed with head and neck cancer and experiencing clinical symptoms of accessory nerve dysfunction after unilateral neck dissection, such as shoulder drooping, restricted active range of motion in shoulder abduction, or insufficient muscle strength against gravity in shoulder abduction.

3. Scapular dyskinesia, such as asymmetrical scapular movement in multiple planes.

4. Scapular asymmetry, defined as a bilateral difference of more than 1.5 cm between the inferior angle of the scapula and the spinous process of the seventh thoracic vertebra when performing 90° shoulder abduction in the scapular plane under a 1 kg load.

Exclusion Criteria：

1. Presence of distant metastasis or cancer recurrence.

2. Inability to communicate or comprehend the questionnaire.

3. History of shoulder pain within one year before neck dissection.

4. Any condition that may affect motor performance.

5. History of neuromuscular disorders or tendon pathology in the affected shoulder, other than accessory nerve dysfunction.