If you are experiencing difficulty breathing or shortness of breath, there could be many causes. One cause could be related to a weak or paralyzed diaphragm. Difficulty breathing at rest and during exercise is the most common symptom of diaphragmatic paralysis.
Read on to understand the signs, causes and treatment for diaphragm paralysis.
What is the diaphragm?
Your diaphragm is an important muscle that helps you breathe in and out (inhale and exhale).
Located just below the lungs, the thin, domed-shaped muscle separates the chest and belly organs.
When you inhale, your diaphragm tightens, becoming smaller, causing the lungs to expand in the chest cavity and draw in air. When the muscle relaxes, it enlarges, forcing air to leave the lungs. The phrenic nerve controls the tightening and relaxing of your diaphragm.
“The phrenic nerve controls the two halves of the diaphragm,” said Stephanie Worrell, MD, a thoracic surgeon at Banner - University Medicine. “This nerve runs through your cervical spine, neck, and chest.”
What is a paralyzed diaphragm?
Diaphragm paralysis is the loss of control of one or both sides of the diaphragm.
“A paralyzed diaphragm occurs when there is phrenic nerve damage or dysfunction,” Dr. Worrell said. “The diaphragm stops moving appropriately with inspiration (breathing in) and expiration (breathing out). As a result, the diaphragm ends up being elevated therefore decreasing the space the lung has to expand.”
Paralyzed diaphragm symptoms
When the diaphragm isn’t working correctly, the phrenic nerve no longer communicates between the brain and the diaphragm. Unilateral diaphragmatic paralysis affects one side and bilateral diaphragmatic paralysis affects both sides of the diaphragm. As a result, it can cause several respiratory issues, including shortness of breath.
“This can be felt by an inability to take a large breath or getting out of breath more easily,” Dr. Worrell said.
Other symptoms may include headaches, blue lips and fingertips, tiredness (chronic fatigue) and trouble sleeping.
What causes diaphragm paralysis?
The two common causes of a paralyzed diaphragm are trauma or injury, such as a car accident or sports injury.
“It can also be injured or temporarily stunned after surgery in the chest,” Dr. Worrell said.
Other possible causes include the following:
- Diseases of the nervous system, such as ALS (amyotrophic lateral sclerosis) and multiple sclerosis
- Spinal cord disorders
- Neuropathic disease, including thyroid disorders and autoimmune diseases
In rare cases, a paralyzed diaphragm is an unknown defect that can occur in fetal development or during delivery.
While the cause can be identified in some cases, many cases are idiopathic, meaning there is no known cause.
How is diaphragm paralysis diagnosed?
Your health care provider will diagnose diaphragm paralysis using a combination of your medical and family history, physical exam and additional testing (if necessary). Testing may include medical imaging, pulmonary function tests and a Sniff test.
“Sniff is a special test that uses fluoroscopy, a type of imaging that uses continuous X-rays, to film your diaphragm as you take deep breaths,” Dr. Worrell said. “If the diaphragm is paralyzed, it will not move as expected while breathing.”
Other times, blood tests, such as arterial blood gas analysis, can be used to see if there is a lack of oxygen in the bloodstream.
Paralyzed diaphragm treatment options
Your treatment plan will depend on the severity of your condition. Sometimes, the nerve is only temporarily stunned and will heal with time.
“If you don’t improve with time, further treatment will depend on how the nerve was injured,” Dr. Worrell said. “This may include both non-surgical and surgical treatments.”
The following treatment options may be used:
- Diaphragmic pacing: If the phrenic nerve is still intact, pacing the nerve can sometimes return the function. Pacing is a minimally invasive surgical option that involves placing a pacemaker to regulate breathing by electrically stimulating the phrenic nerve.
- Diaphragm plication: If the phrenic nerve is not intact or pacing is not an option, plication can improve symptoms and quality of life. This surgical option involves flattening the diaphragm's affected side. This allows your chest to expand as it should so that you can inhale properly.
How long can you live with a paralyzed diaphragm?
You can live with a paralyzed diaphragm. Many people don’t have any symptoms and never need treatment.
Exercising with a paralyzed diaphragm can be challenging for some, but there are options to make it easier. Talk to your health care provider about therapeutic exercises you can do to help activate your diaphragm muscles.
Diaphragm paralysis is the loss of control of one or both sides of the diaphragm. This can cause shortness of breath, tiredness and other symptoms.
If you are experiencing symptoms like shortness of breath, schedule an appointment with your health care provider. They may refer you to a thoracic surgeon, a specialist who can diagnose and treat illnesses related to the diaphragm, lungs and heart.