# Scars, stiffness and contracture: shoulders, necks and jaws

Source: https://onco.cc/technologies/rejuv-rehab-scar-contracture/  
OnCo record `rejuv-rehab-scar-contracture` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Scar tissue shortens as it matures, and across a joint that means lost movement: a shoulder that will not reach a shelf, a neck that will not turn, a mouth that will not open. Silicone gel flattens and softens the scar itself in randomised trials, and stretching is what holds the joint.

## Summary

Three things stiffen after cancer treatment and they are often confused with each other. The surgical scar itself is a band of immature collagen that contracts as it remodels over months. Radiotherapy fibrosis is a slower, progressive stiffening of everything inside the treated volume, and it continues for years. Joint contracture is the loss of range that results when either of those crosses a joint and the joint is not moved through its range.

The scar. Topical silicone is the intervention with randomised evidence. A meta-analysis of six randomised trials and 375 patients found topical silicone gel significantly reduced the pigmentation, height and pliability components of the Vancouver Scar Scale against placebo or no treatment: pigmentation standardised mean difference minus 0.55 (minus 0.83 to minus 0.26), height minus 0.73 (minus 1.02 to minus 0.44) and pliability minus 0.49 (minus 0.95 to minus 0.03). Gel and sheet were comparably effective, and silicone was no better than other non-silicone topical treatments. A larger 2026 meta-analysis of 45 randomised trials and 3,806 participants found silicone gel combined with laser better than either alone on the scar scale at six months, and noted that 44 of the 45 studies were at high risk of bias.

The shoulder after breast and axillary surgery. Shoulder stiffness, weakness and pain are among the commonest impairments measured in the prospective surveillance literature, and upper-body symptoms are reported by between 10 and 64 per cent of women between six months and three years after breast cancer, with about 20 per cent developing lymphoedema. The treatment is graded range-of-movement and strengthening work from a physiotherapist, and the prospective surveillance record here is about finding it early enough for that to work.

The neck after dissection and radiotherapy. Accessory nerve traction during neck dissection weakens trapezius, and radiotherapy fibroses the soft tissue of the neck. The combination gives a dropped shoulder, limited abduction and pain. The treatment is strengthening of the scapular stabilisers and range work, and the trial evidence specific to cancer is sparse.

The jaw. Trismus, the inability to open the mouth, follows radiotherapy or surgery involving the muscles of mastication, and it matters because it determines whether a person can eat, be examined and have dental treatment. The preventive evidence is mixed and the best trial is negative. Eighty-nine patients with newly diagnosed head and neck cancer were randomised to daily jaw-opening exercises or control: there was no difference in mouth opening capacity in the first year, and trismus prevalence was 7 per cent against 19 per cent at six months and 7 against 3 per cent at twelve, neither difference significant. The authors noted a surprisingly low prevalence of trismus in both groups and suggested modern radiotherapy regimens have reduced it. Against that, a meta-analysis of 17 randomised trials and 1,569 participants in nasopharyngeal carcinoma, where the muscles of mastication sit inside the treated volume, found exercise reduced the incidence of trismus (risk ratio 0.54, 0.44 to 0.68) and its severity (0.47, 0.31 to 0.70), both at moderate certainty. The reconciliation is probably dose and site: where the pterygoid and masseter muscles receive a high dose, exercise helps; where modern planning spares them, there is less to prevent.

What comes back, and when: a surgical scar remodels over twelve to eighteen months and softens on its own; silicone accelerates the cosmetic part. Range of movement lost to a contracture returns with stretching if it is treated while the tissue is still remodelling, and becomes much harder to regain once the tissue is mature. Radiation fibrosis does not reverse, which is why the treatment is maintaining range rather than restoring it.

## Fields

- Kind: Technology
- Status: established
- Last checked: 2026-10-02
- Tags: rejuvenation; survivorship; rehabilitation; evidence:moderate
- Principle: Collagen laid down during healing aligns along the lines of tension it experiences. Tissue held short heals short. Regular movement through the full range during the remodelling phase orientates the fibres along the direction of movement; silicone acts on the scar surface by occlusion and hydration, which reduces height and improves pliability without affecting joint range.
- Strengths: Randomised evidence that silicone improves scar height, pigmentation and pliability; Exercise reduces trismus incidence and severity where the chewing muscles are in the high-dose volume; Early stretching is cheap and can be taught once
- Limitations: The best preventive jaw exercise trial found no benefit; Almost all the scar trials are at high risk of bias; Radiation fibrosis progresses for years and does not reverse

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Contracture
- Efficacy of topical silicone gel in scar management: systematic review and meta-analysis of randomised controlled trials (Int Wound J 2020): https://doi.org/10.1111/iwj.13337
- Efficacy and safety of silicone gel plus laser therapy for scar: systematic review and meta-analysis (Plast Reconstr Surg Glob Open 2026): https://doi.org/10.1097/GOX.0000000000008021
- Preventive exercise intervention for trismus in head and neck cancer: a randomized study (Clin Oral Investig 2026): https://doi.org/10.1007/s00784-026-06838-3
- Effects of exercise interventions on radiation-induced trismus and dysphagia in nasopharyngeal carcinoma (Cancer Nurs 2026): https://doi.org/10.1097/NCC.0000000000001588
- Upper-body morbidity after breast cancer within a prospective surveillance model of care (Cancer 2012): https://doi.org/10.1002/cncr.27467

## Connected records

- cancers: [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Melanoma](https://onco.cc/cancers/melanoma/), [Nasopharyngeal carcinoma](https://onco.cc/cancers/nasopharyngeal/), [Sarcomas (soft tissue, bone, GIST)](https://onco.cc/cancers/sarcoma/)
- fronts: [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Breast reconstruction: implant and autologous, immediate and delayed, and what women report afterwards](https://onco.cc/technologies/rejuv-recon-breast/), [Cancer rehabilitation: the discipline that puts function back](https://onco.cc/technologies/rejuv-rehab-cancer-rehabilitation/), [Compression, decongestive therapy and exercise for lymphoedema](https://onco.cc/technologies/lymphoedema-decongestive-therapy/), [Head and neck reconstruction: the free flap, and what it gives back](https://onco.cc/technologies/rejuv-recon-head-neck/), [Hyperbaric oxygen for late radiation injury](https://onco.cc/technologies/hyperbaric-oxygen-radiation-injury/), [Limb salvage, amputation, and the rehabilitation that follows either](https://onco.cc/technologies/rejuv-recon-limb/), [Prospective surveillance: looking for the problem before it becomes a disability](https://onco.cc/technologies/rejuv-rehab-prospective-surveillance/), [Skin during and after radiotherapy: dressings, steroids and what lasts](https://onco.cc/technologies/radiation-skin-recovery/), [Swallowing therapy around head and neck radiotherapy](https://onco.cc/technologies/rejuv-rehab-swallowing/)
- terms: [Late effects and survivorship toxicity](https://onco.cc/terms/late-effects/), [Quality of life](https://onco.cc/terms/quality-of-life/), [Radiation necrosis (brain)](https://onco.cc/terms/radiation-necrosis/)
- bottlenecks: [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)

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