Diaphragmatic palsy, or phrenic paralysis, results from paralysis of the phrenic nerve. It originates in the third to fifth cervical segments of the spinal cord and activates the diaphragm as well as several other organs in the chest cavity, such as the pericardium. Paralysis of the nerve causes the diaphragm on the affected side to slacken. This causes the abdominal organs to push upward because the diaphragm can no longer hold them down.
What is diaphragmatic paresis?
The diaphragm is made of muscles and tendons, is located below the costal arch, and separates the chest cavity from the abdominal cavity. It is dome-shaped and reaches an average thickness of three to five millimeters. Its functioning depends directly on the phrenic nerve. If this is injured or paralyzed, the diaphragm can only fulfill its function as a respiratory muscle to a limited extent or no longer at all. In addition, there is a risk that tumors of the lung and other chest or abdominal organs may move into the diaphragm. In this case, parts of the diaphragm may have to be removed and replaced. Diaphragmatic paresis can also result from nerve damage caused by surgery or external influences such as gunshot wounds. If it develops without traceable causes of disease, it is called idiopathic diaphragmatic paralysis.
Causes
Any diaphragmatic paralysis has a major impact on a person’s breathing. Diaphragmatic breathing pumps two-thirds to four-fifths of the inhaled air through the body. During inhalation, the diaphragm is assisted by additional muscles that lift the ribs up, enlarging the chest. This process is also called thoracic breathing. It can provide adequate ventilation of the lungs even when the diaphragm is completely paralyzed, but only in a state of rest and low exertion. The diaphragm works on the principle of contraction. It contracts during inhalation, becoming about one-third shorter. At the same time, it flattens and takes on a cone shape. The contracting diaphragm displaces the organs in the upper abdomen, but this is compensated for due to the slackening of the abdominal muscles and protrusion of the abdominal wall. The organs retain their necessary space and in the abdominal cavity the pressure conditions remain the same. With each exhalation, the diaphragm relaxes again. During this process, the lungs contract and the diaphragm changes back to its dome shape. When the phrenic nerve contracts, this manifests itself in the so-called hiccups. The largely harmless side stitches also have such causes. Here, the undersupply of oxygen to the diaphragm plays a major role. However, diaphragmatic cramps in connection with tetanus can be very dangerous to life and limb. A distinction must be made between unilateral and bilateral diaphragmatic paralysis. In the unilateral form, damage to the phrenic nerve may be due to tumors, such as bronchial carcinoma, mediastinal lymphoma, or neurofibromas. Aortic aneurysm or abscesses are also possible causes. Trauma such as thoracic trauma or viral infections (herpes zoster) can also cause unilateral diaphragmatic paralysis. Less frequently, infections caused by viruses or bacteria are responsible for a paralyzed diaphragm. However, these can affect all organs in the upper body. Since the phrenic nerve anatomically belongs to the brachial plexus, its paralysis may also be related to a so-called shoulder-arm weakness. In addition, advanced wear and tear of the cervical spine is a possible cause. The bilateral form may be favored by neuropathies such as alcohol intoxication, lead poisoning or porphyria. Conceivable causes also include spinal cord injury, syringomyelia, or neuromuscular diseases such as ALS.
Symptoms, complaints, and signs
In most cases, diaphragmatic paresis manifests on only one side. It may be congenital, but the most common causes are cancerous tumors. If these settle in the lungs, for example, or if a diseased lymph node develops, the phrenic nerve quickly becomes distressed and no longer works properly. A unilateral paralysis of the diaphragm is often hardly noticed by the sufferer. In this case, breathing difficulties usually only occur during vigorous physical activity. However, treacherous dangers lurk for the lungs if they are not properly ventilated on one side.Then it is very susceptible to inflammation brought on by infection. In the case of bilateral diaphragmatic paralysis, greater or lesser shortness of breath is experienced in every case. Affected persons are then often unable to sleep lying flat, because during longer periods of sleep the diaphragm is the only active respiratory muscle. With great luck, this deficiency can be avoided only by means of breathing with the upper body erect and the arms propped up.
Diagnosis and course of the disease
X-ray and ultrasound clearly demonstrate unilateral diaphragmatic paralysis. The paralyzed side of the organ always stands a bit higher than the healthy one. In addition, parameters of respiratory function and respiratory pressure values can be measured, which allow conclusions to be drawn about the activity of the diaphragm. A blood gas analysis can also be useful for diagnosis. Pulmonary function tests provide information about the degree of respiratory symptoms. In addition, a thorough and longer-term examination of the patient in a sleep laboratory is a possibility.
Complications
Diaphragmatic paresis is a very serious complaint that, in the worst case, can lead to the death of the affected person. The further course of this condition depends very much on the exact cause of the diaphragmatic paresis, with life expectancy being significantly reduced in most cases. Those affected suffer from breathing difficulties and possibly fatigue and exhaustion. Inflammations and infections of the respiratory tract occur very frequently, which can significantly reduce the quality of life. Respiratory distress may also develop, and in severe cases patients may lose consciousness. Strenuous activities or sporting activities are thus hardly possible for the patient anymore. The treatment of diaphragmatic paresis depends very much on the underlying disease, which must be treated first and foremost. If the disease is caused by a tumor, it often cannot be completely cured and the patient dies prematurely. In other cases, diaphragmatic paresis requires surgical intervention to relieve the symptoms. However, the treatment itself is not associated with further complications.
When should you see a doctor?
A doctor is needed as soon as the affected person notices a deterioration in his condition over several days or weeks. If his physical or mental performance decreases, a feeling of malaise appears or a feeling of illness sets in, there is a need for action. Particular care should be taken with respiratory complaints. If these are not due to temporary overexertion, they are often a warning signal from the organism. Respiratory disorders should therefore be examined by a physician immediately if they persist for several days. Of particular concern is an increase in symptoms. If states of anxiety or sleep disturbances occur, a doctor should be consulted as soon as possible. A feeling of pressure in the chest, a tightness or the inability to take a deep breath are signs of a health disorder. If fatigue occurs very quickly during physical activities, action is needed. A doctor should be consulted immediately so that clarification of the cause can be made and a diagnosis made. If the affected person awakens from sleep due to lack of oxygen, consultation with a physician is indicated. If breathing is impaired as soon as physical positions are changed, this is also cause for concern. An increased susceptibility to inflammatory diseases, a slightly elevated body temperature or internal irritability are other complaints that should be investigated.
Treatment and therapy
If diaphragmatic paresis is still in its early stages and is not very pronounced, physiotherapy is sometimes sufficient. In more severe cases, diaphragmatic retraction may need to be performed.
Prevention
Since diaphragmatic paresis is often a sequela of a previous disease and these have very different manifestations, a general prevention is hardly possible. However, a healthy lifestyle with plenty of exercise and a balanced diet is advisable as a preventive measure. If you spend a lot of time sitting due to your job, it is advisable to do regular back exercises to prevent wear and damage to the back muscles.
Aftercare
In most cases, only a few and also very limited measures of direct aftercare are available to affected persons with diaphragmatic paresis. Therefore, the affected person should see a doctor as early as possible in this disease and also initiate treatment in order to prevent the occurrence of further complications and complaints. Self-healing cannot occur in this case, so treatment by a doctor is always necessary in this case. The earlier a doctor is consulted in the case of diaphragmatic paresis, the better the further course of the disease usually is.As a rule, those affected by diaphragmatic paresis are dependent on the measures of physiotherapy and physiotherapy. This can permanently limit and alleviate most of the symptoms. Furthermore, support from one’s own family in everyday life is often very important and can help to prevent depressive moods. Contact with other sufferers of diaphragmatic paresis can also prove very useful and make the sufferer’s everyday life easier. Exercise a lot and follow a healthy lifestyle. Excess weight should also be avoided. In most cases, this disease does not reduce the life expectancy of the affected person and does not continue to limit it.
This is what you can do yourself
In most cases, diaphragmatic paresis causes limitations. Depending on the severity and cause of the disease, coping with everyday activities is not possible or only possible with great effort. The patient’s quality of life is also often significantly reduced by regularly occurring respiratory infections. Those affected usually suffer from shortness of breath even during minor exertion. For this reason, people with diaphragmatic paresis should not engage in sports or strenuous activities. Certain relaxation techniques such as meditation can be helpful, but these should only be used in consultation with the attending physician. Yoga or Pilates, however, are not recommended. Furthermore, sufferers usually have an increased need for sleep. They should therefore take regular rest breaks. In principle, sufferers should avoid stress of any kind. A stable social environment and a healthy lifestyle are important. Ideally, sufferers are supported by relatives or family members. Otherwise, professional care may be required in some cases. Those affected should pay attention to a healthy diet and avoid alcoholic beverages and coffee. Smoking must be stopped immediately in cases of diaphragmatic paresis.
