BACKGROUND: It is the purpose of this study to determine the incidence of shoulder pain and restricted range of motion of the shoulder after neck dissection, and to identify risk factors for the development of shoulder pain and restricted range of motion. METHODS: Clinical patients who underwent a neck dissection completed a questionnaire assessing shoulder pain. The intensity of pain was assessed using a visual analog scale (100 mm). Range of motion of the shoulder was measured. Information about reconstructive surgery and side and type of neck dissection was retrieved from the medical records. RESULTS: Of the patients (n = 177, mean age 60.3 years [SD, 11.9]) 70% experienced pain in the shoulder. Forward flexion and abduction of the operated side was severely reduced compared to the non-operated side, 21 degrees and 47 degrees, respectively. Non-selective neck dissection was a risk factor for the development of shoulder pain (9.6 mm) and a restricted shoulder abduction (55 degrees ). Reconstruction was risk factor for a restricted forward flexion of the shoulder (24.5 degrees ). CONCLUSIONS: Shoulder pain after neck dissection is clinically present in 70% of the patients. Non-selective neck dissection is a risk factor for shoulder pain and a restricted abduction. Reconstruction is a risk factor for a restricted forward flexion of the shoulder.