The diaphragm is a muscle that separates the chest and abdominal cavities; it is controlled by the phrenic nerves.

Diaphragmatic paralysis is uncommon. In patients where one side of the diaphragm is paralyzed, people usually have no symptoms unless they have another reason for shortness of breath (asthma, emphysema, etc.). Because a paralyzed diaphragm is higher than usual, it compresses the lung and prevents the patient from taking a normal breath. Also, when a patient breaths, the diaphragm usually moves down to pull air in to the lung. Paradoxically, a paralyzed diaphragm moves up and further compresses the lung


Symptoms of Diaphragmatic Paralysis

  • Shortness of breath
  • Orthopnea (shortness of breath worse lying down and better sitting up)
  • Fatigue
  • Insomnia
Risk Factors

Causes and Risk Factors for Diaphragm Paralysis

Diaphragm paralysis sometimes occurs because of damage to your phrenic nerve. There are many situations where the phrenic nerve does not work because it was invaded, compressed, cut, including:

  • Cancer
  • Surgical trauma, such as unintentional injury after a heart or neck procedure
  • In newborns and infants, birth trauma
  • Neurological diseases, such as ALS, multiple sclerosis, muscular dystrophy, Guillain-Barre syndrome
  • Spinal cord disorders and quadriplegia
  • Chest Surgery where the phrenic nerve is cut or removed to remove a tumor
  • Chronic pneumonia, bronchitis or cardiac arrhythmias
  • Thyroid and autoimmune disease

Diagnosis of Diaphragmatic Paralysis

  • Pulmonary function testing while lying down and again while upright.
    • Lung capacity is often reduced about 10 percent when a person is lying down
    • Patients with bilateral diaphragmatic paralysis may experience a 70 to 80 percent reduction in lung capacity while patients with unilateral diaphragmatic paralysis may experience a 50 percent reduction
    • FEV 1 = 60-70% of normal
    • Total Lung Capacity: 60-70% of normal
  • Chest X-rays (see figure): the diaphragm is higher than usual and compresses the lung or an upright, inspiratory chest radiograph
  • Sniff Test: With fluoroscopy, the radiologist watches he diaphragm as the patient sniffs. A normal lung moves down and the lung expands. A paralyzed lung moves up to compress the lung.
  • Phrenic nerve stimulation testing shows the nerve does not work
  • Computed tomography (CT) scanning of the thorax shows the diaphragm is high and is done to make sure there is no tumor on the phrenic nerve
  • Magnetic resonance imaging (MRI) to determine if there is an underlying condition involving the spinal column or nerve roots

Treating Diaphragmatic Paralysis

Treatment begins with an evaluation of the overall health of the patient, how much the shortness of breath impacts the patient’s life, and any underlying cause for the paralysis. This is an elective operation so the symptoms need to be bad enough to justify the operation.

Prognosis for Diaphragmatic Paralysis

The prognosis for unilateral paralysis is quite good, providing there is no underlying pulmonary disease. Sometimes, patients recover without any medical intervention.
The prognosis for bilateral paralysis also depends on the overall health of the patient but surgery may be the best option for patients who continue to have a poor quality of life.

Doctors Who Treat Paralyzed Diaphragm

Paralyzed Diaphragm FAQs

What happens if the diaphragm is paralyzed?

The diaphragm is a crucial muscle that plays a pivotal role in breathing. It’s located below the lungs and heart and separates the chest cavity from the abdomen. When you inhale, the diaphragm contracts and flattens, creating a vacuum that pulls air into the lungs. When you exhale, it relaxes and moves upward, helping to expel air from the lungs.

When there is diaphragm paralysis, the muscle ceases to function effectively. This paralysis can result from several causes such as nerve damage, surgical complications, or diseases affecting the nerves or muscles. The paralysis of the diaphragm can lead to its weakness or even complete inability to contract.

This weakness or paralysis impairs your lung function. Since the diaphragm cannot move down normally, the volume of air that can be inhaled decreases, leading to reduced lung capacity. This can make it difficult to breathe deeply, and you may find yourself becoming easily short of breath, especially during physical activity. Additionally, because the diaphragm also aids in coughing and clearing the lungs, its paralysis can increase the risk of respiratory infections due to ineffective clearing of secretions.

Management of diaphragm paralysis depends on its cause and severity but may include respiratory therapies, mechanical aids like ventilators in severe cases, or surgical interventions such as diaphragm pacing or repair, depending on the specific circumstances and overall health condition.

Can a paralyzed diaphragm be reversed?

The reversibility of diaphragm paralysis depends on the cause. If the paralysis is due to reversible nerve damage, such as bruising or compression of the phrenic nerve, there’s potential for recovery as the nerve heals. However, severe damage like nerve severance may require surgical interventions like diaphragm plication, which tightens the diaphragm, or diaphragm pacing, which uses electrical impulses to stimulate the nerve. Recovery is less likely if paralysis results from chronic diseases like ALS, where treatment focuses on symptom management and maintaining respiratory function. Regular medical follow-up is crucial for managing this condition effectively.