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trapezius muscle. This may lead to mechanical overload. Functional overload may arise from stretch of muscle and ligaments, pressure on the clavicular joints due to changes in position of the shoulder girdle (medial rotation and protraction) and overload of compensating muscles. In addition, a severance of the sensory nerves (great auricular nerve, transverse cervical nerve and supraclavicular nerves) results in (neuropathic) pain in the neck/shoulder region (Terrell, Welsh et al. 2000). Risk factors for the occurrence of shoulder complaints are reconstructions and sacrificing the accessory nerve (Dijkstra, van Wilgen et al. 2001). At hospital discharge, several clinical observations were found to be predictive of the level of disability scores four months on: active range of motion (AROM) of abduction and forward flexion (with lower AROM predicting higher disability), the presence of shoulder pain, pain during external rotation of the shoulder, shoulder droop and non-selective neck dissection (Stuiver, van Wilgen et al. 2008). Recovery of accessory nerve function seems to occur six months on at the earliest (Laverick, Lowe et al. 2004). A cohort study showed that patients who had received head and neck cancer treatment including neck dissection in the first months after the procedure reported worse scores for physical functioning, role limitations due to physical problems, social functioning and pain (Stuiver, van Wilgen et al. 2008). An earlier cohort study, too, showed deteriorating scores for range of motion, activities of daily living and leisure, whereby the severity of the shoulder impairment was associated with the extensiveness and level of the neck dissection (Taylor, Terrell et al. 2004). After neck dissection, 34 to 50% of patients were unable to return to work (Shone and Yardley 1991, Terrell, Nanavati et al. 1999, Taylor, Terrell et al. 2004).\u000D5.5.1.1 Detection and assessment of shoulder disabilities resulting from neck dissection\u000DScreening and referral occur on the basis of known risk factors: active range of motion (AROM) of abduction and forward flexion, presence of shoulder pain, pain during external rotation of the shoulder, shoulder droop and non-selective neck dissection (Stuiver, van Wilgen et al. 2008). Patients at a high risk and with a treatment preference are referred to physical therapy treatment, as part of the rehabilitation programme if warranted, or in primary care. Patients may develop shoulder complaints at a later stage. This is usually detected during follow-up by the main treating physician, and is followed by referral to and intake by a physical therapist.\u000DTo determine the severity of the complaint and for further evaluation, patients fill out the Shoulder Pain And Disability Index (SPADI) and/or the Neck Dissection Impairment Index (NDII) during intake. Both scales are reliable and valid for use in this particular population (Stuiver, ten Tusscher et al. 2016). Furthermore, range of motion is measured to assess the arthrogenic function, muscle function, and functional movement in view of the patient\u2019s care needs. The Patient-Specific Complaints (PSC) questionnaire (Beurskens, Koke et al. 1999, Stevens, Beurskens et al. 2013) is used to identify goals in terms of shoulder function in activities of daily living (including work), so that a tailored exercise programme may be drawn up. The Patient-Specific Complaints list (PSC) is a screening tool that maps out the most important problems experienced by the patient that they would also like to see changed, and indicates their relative weight (Beurskens, Koke et al. 1999). The patient may indicate in a list of predefined options which problem areas are relevant for them. An empty box is also offered, in which patients may include any problem not taken up in the list. From the problems indicated by the patient the four most prominent problems are selected. The severity of these problems is scored with the use of a visual analogue scale (VAS). The PSC has not been validated specifically for use in an oncological setting. Using a VAS score to evaluate changes in a problem area has, however, is generally considered a valid, reliable and responsive method (Carlsson 1983).\u000D121\u000D