What Are The Different Types of Phrenic Nerve Injury and Diaphragm Paralysis?

The phrenic nerve controls the muscles of your diaphragm and is crucial to respiratory health. A damaged phrenic nerve can lead to a range of symptoms, from shortness of breath with exertion to the need for mechanically-assisted respiration. Long considered to be incurable, there have been recent advances, many pioneered at The Institute for Advanced Reconstruction, that have greatly increased recovery and quality of life.

According to Dr. Matthew Kaufman, a leader in state-of-the-art treatment for phrenic nerve injury, there are two main types of diaphragm paralysis:

• Unilateral diaphragmatic paralysis affects either the left or right side and is typically less severe and more treatable.
• Bilateral diaphragmatic paralysis affects both sides, which greatly impacts normal respiration and usually requires surgical intervention.

Understanding Diaphragmatic Dysfunction

Diaphragmatic dysfunction can cover everything from snoring and frequent hiccups to difficulty breathing and respiratory distress. According to the National Institutes of Health, it can be problematic for clinicians to identify and, as such, is oftentimes underdiagnosed. 

“As one of our Distinguished Centers at The Institute for Advanced Reconstruction, we are on a mission to change that,” shares Dr. Kaufman. “By using advanced diagnostic tools and pioneering techniques, we are finding life-changing solutions for this condition that is so often misdiagnosed.”

Causes of Phrenic Nerve Damage

The causes of phrenic nerve damage and diaphragmatic dysfunction are varied, including but not limited to:

• Birth defects or trauma
• A surgical injury, especially from surgeries near the heart, lungs, and neck
• Cancer in the lungs or lymph nodes
• Complications from interscalene nerve blocks, epidural injections, or other anesthetic injury
• Spinal cord disorders
• Trauma, such as a fall, car accident, or sports-related injury
• Chiropractic manipulation of the neck

Testing for Phrenic Nerve Damage

There are a variety of tests to determine if there is phrenic nerve damage and its severity, including a CT scan, fluoroscopy (or “sniff test”), and MRI.

When determining which test is needed to diagnose phrenic nerve damage, an individual’s journey typically begins with a thorough physical examination and evaluation of overall patient history. 

Based on these findings, Dr. Kaufman advises that the team may proceed with a fluoroscopy as the first line of testing. Then, if more detailed imaging is needed, an MRI or CT scan may be ordered. 

“In some cases, we also use specialized diagnostic testing, such as nerve conduction studies or electromyography, to assess the extent of nerve function,” elaborates Dr. Kaufman. “The choice of test often depends on the individual's symptoms, medical history, and the suspected cause of the phrenic nerve injury."

Unilateral Diaphragmatic Paralysis

After diagnostic testing confirms phrenic nerve damage, it is essential to understand the specific type of dysfunction impacting the diaphragm. “One common condition is unilateral diaphragmatic paralysis, which significantly impairs the ability to inhale and exhale on one side of the body.” explains Dr. Kaufman.

Symptoms 

Symptoms can be slight and are often overlooked, including but not limited to:

• Difficulty breathing, especially when lying flat or during strenuous activity
• Reduced ability to exercise
• Fatigue
• Difficulty sleeping

Treatment 

Our team offers several surgical treatment options for unilateral diaphragmatic paralysis. These procedures aim to restore normal breathing function or improve the patient’s quality of life by addressing the underlying cause of diaphragm dysfunction. Key surgical treatments include:

• Phrenic nerve reconstruction
• Diaphragm plication
• Diaphragm pacemaker implantation

Bilateral Diaphragmatic Paralysis

“Unlike unilateral paralysis, where one side of the diaphragm can sometimes compensate for the other, bilateral paralysis severely limits the body's ability to breathe independently,” explains Dr. Kaufman. “Due to its impact on basic life functions, this condition almost always requires medical intervention to prevent further complications."  

Symptoms

Some symptoms of bilateral paralysis are similar to unilateral but will present more severely, oftentimes presenting as: 

• Increased difficulty breathing
• Recurrent pneumonia
• Fatigue
• Persistent sleep disturbances

Treatment 

Treatment for bilateral diaphragm paralysis is similar to treatment for unilateral diaphragm paralysis but typically more aggressive. Additional treatments can include:

• Phrenic nerve reconstruction surgery
• Diaphragm pacemaker 
• Assisted respiration options

If you or a loved one are seeking surgery to treat phrenic nerve paralysis, contact Dr.  Kaufman or the team at The Institute for Advanced Reconstruction at 855-980-6981.

Schedule an online consultation with our team here.