What is Paralyzed Diaphragm & How is it Treated?
What is Paralyzed Diaphragm?
The diaphragm is a muscular sheath in the body which separates the chest and abdominal cavities. This muscle is controlled by the phrenic nerve. Diaphragm is an essential part of the breathing process. Just like any other part of the body, the diaphragm can too get paralyzed or damaged due to a variety of reasons which have been delineated below.
Since diaphragm plays an essential part in the breathing process, a Paralyzed Diaphragm may cause difficulty in breathing. Paralyzed Diaphragm does not cause the breathing to stop entirely as there are other muscles near the diaphragm which assist in breathing but the breathing in such cases is very labored since these other muscles are not as strong as the diaphragm.
Paralyzed Diaphragm may be unilateral or bilateral meaning that either one side of the diaphragm gets paralyzed or both sides of the diaphragm get paralyzed.
If Paralyzed Diaphragm is unilateral then the condition is not quite serious and the patient may still able to function, and it does not cause any alarming symptoms.
In cases where there is bilateral Paralyzed Diaphragm then the symptom onset is quite rapid and it is considered as an emergency situation requiring immediate treatment before the patient goes into respiratory distress which may in turn prove fatal for the patient. Bilateral Paralyzed Diaphragm may be further complicated by the presence of certain other underlying illnesses which may cause respiratory failure and may prove fatal for the patient.
What Causes Paralyzed Diaphragm?
Some of the causes of Paralyzed Diaphragm are:
- Lung cancer metastasis which has spread to encompass the diaphragm and compress the phrenic nerve, which controls the working of the diaphragm, can result in a Paralyzed Diaphragm
- Surgical trauma after a cervical or a cardiothoracic surgery is yet another cause for Paralyzed Diaphragm
- Birth trauma can injure the phrenic nerve causing Paralyzed Diaphragm in newborns and infants
- Disease conditions like amyotrophic lateral sclerosis, multiple sclerosis, muscular dystrophy are some of the neuromuscular disorders which can cause Paralyzed Diaphragm.
- Disorders of the spinal cord are yet another cause for Paralyzed Diaphragm.
- Any damage or injury to the phrenic nerve which controls the diaphragm can also lead to Paralyzed Diaphragm
What are the Symptoms of Paralyzed Diaphragm?
As stated above, unilateral Paralyzed Diaphragm is completely asymptomatic and is not a cause of worry to the patient. The symptom onset of bilateral Paralyzed Diaphragm is rapid in onset and includes:
- Severe shortness of breath when lying flat or with even little activity
- Sleep disordered breathing is yet another symptom of Paralyzed Diaphragm resulting in a decrease in blood oxygen levels
- In cases of newborns, even unilateral Paralyzed Diaphragm can cause symptoms to include respiratory distress due to the muscles being weaker. The child may have a weak cry and may have GI distress to include frequent bouts of vomiting.
- Children who have bilateral Paralyzed Diaphragm need emergent treatment as the condition can become potentially life threatening for them quite quickly due to the nature of the disease
How is Paralyzed Diaphragm Treated?
Before formulating a treatment plan for a patient with Paralyzed Diaphragm, the physician will first look at the overall age and health status of the patient. The physician will also see if the patient has a history of any neuromuscular disorder or has a history of any metastatic disease to the lung which may complicate the situation and require more aggressive treatments.
Some of the treatment options for Paralyzed Diaphragm are:
This is purely in cases if there is unilateral Paralyzed Diaphragm and there are not much symptoms and the patient has no other comorbid conditions to complicate the situation. The chances of the condition getting resolved spontaneously are very high in such cases
This is a surgical procedure in which the diaphragm is pulled down by way of continuous sutures which allows the lungs to have space to expand more and make breathing easier. This procedure is usually done to treat unilateral Paralyzed Diaphragm and in some cases bilateral Paralyzed Diaphragm.
These are electronic devices which are implanted to allow for improved breathing post Paralyzed Diaphragm. This is usually done in patients who have other underlying conditions like ALS or spinal cord injury. This device not only improves the breathing in the patient with Paralyzed Diaphragm but also cuts down the chances of infection.
Mechanical Ventilation with Tracheostomy
Tracheostomy is a procedure in which there is a surgical opening made in the trachea to allow for better passage of air. The patient is put on a mechanical ventilator through which air enters via the tracheostomy and makes it easier for the patient to breathe. This procedure is done only in situations where the patient has an underlying life threatening disease and is not a candidate for the above mentioned treatment options for Paralyzed Diaphragm.
What is the Prognosis of Paralyzed Diaphragm?
The overall prognosis for patients with unilateral Paralyzed Diaphragm is extremely good and in some cases the condition resolves on its own provided the patient is absolutely healthy and has no comorbid conditions complicating the condition.
The prognosis for bilateral Paralyzed Diaphragm is somewhat guarded and depends on the overall health condition of the patients. With surgery, the quality of life of some of the patients may improve and is perhaps the best option for treatment for bilateral Paralyzed Diaphragm.
How is Paralyzed Diaphragm Diagnosed?
To diagnose Paralyzed Diaphragm, the physician will begin by taking the history of the patient and conduct a physical examination. During the physical examination, the physician will observe the motion of the abdomen during inhalation. Under normal circumstances, the abdomen moves outwards during inhalation but in cases of Paralyzed Diaphragm the abdomen will move inwards. This will clearly indicate the presence of a dysfunctional diaphragm. To further confirm the diagnosis the physician may order the following tests:
- Lung function tests to see the status of the functioning of the lungs
- Chest X-ray to look at the internal structures and rule out other causes of the symptoms
- Ultrasound to look at the motion of the diaphragm which is cases of Paralyzed Diaphragm will be abnormal
- Measuring of breathing muscle strength to see how weak are the muscles that assist in breathing
- Measure of diaphragm strength to see if there is any abnormality in there which in cases of Paralyzed Diaphragm there will be
- Radiological studies to delineate the cause of Paralyzed Diaphragm like CT and MRI scans of t he abdomen and thorax
The above test will confirmatively diagnose Paralyzed Diaphragm.