Diaphragmatic Paresis

Diaphragmatic Paresis

Diaphragm paresis or paralysis of the diaphragm results from paralysis of the phrenic nerve (diaphragmatic nerve). Coming from the third to fifth cervical segments of the spinal cord, it activates the diaphragm and several other organs in the thoracic cavity, such as the pericardium. Paralysis of the nerve leads to relaxation of the diaphragm on the affected side. This causes the abdominal organs to push up because the diaphragm can no longer hold them down.

What is diaphragmatic paresis?

The diaphragm is made up of muscles and tendons, is located below the costal arch and separates the chest cavity from the abdomen. 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 perform its function as a breathing muscle to a limited extent or no longer. For hypovolemia definition and meaning, please visit howsmb.com.

There is also a risk of tumors in the lungs and other chest or abdominal organs moving to the diaphragm. Then parts of the diaphragm may have to be removed and replaced. Diaphragmatic paresis can also result from nerve damage from surgery or external influences such as gunshot wounds. If it develops without comprehensible causes of the disease, it is referred to as idiopathic diaphragmatic paralysis.

Causes

Any diaphragmatic paresis has a major impact on human breathing. Diaphragmatic breathing pumps two-thirds to four-fifths of the inhaled air through the body. On inhalation, the diaphragm is supported by additional muscles, which lift the ribs and thus enlarge the rib cage. This process is also called chest breathing.

It can provide adequate ventilation to the lungs even with complete paralysis of the diaphragm, but only in a state of rest and low exertion. The diaphragm works on the principle of contraction. When you breathe in, it contracts and becomes about a third shorter. At the same time, it flattens and acquires a cone shape.

The contracting diaphragm moves the organs in the upper abdomen, but this is compensated for by the slackening of the abdominal muscles and the bulging of the abdominal wall. The organs retain the space they need and the pressure conditions in the abdominal cavity remain the same. With each exhalation, the diaphragm relaxes again. During this process, the lungs contract and the diaphragm returns to its dome shape.

When the phrenic nerve spasms, it manifests itself in so-called hiccups. The largely harmless bites in the side also have such causes. The insufficient supply of oxygen to the diaphragm plays a major role here. However, diaphragm spasms in connection with tetanus spasms can be very dangerous for life and limb.

A distinction must be made between unilateral and bilateral paralysis of the diaphragm. In the unilateral form, damage to the phrenic nerve can be due to tumors, such as bronchial carcinoma, mediastinal lymphoma, or neurofibroma. Aortic aneurysms or abscesses are also possible causes. Trauma such as a thoracic trauma or viral infections ( herpes zoster ) can also cause unilateral paralysis of the diaphragm.

Less commonly, viral or bacterial infections are responsible for a paralyzed diaphragm. However, these can affect all organs in the upper body. Since the phrenic nerve is anatomically part of the arm nerve network, its paralysis can also be related to what is known as shoulder-arm weakness. In addition, advanced wear and tear of the cervical spine is a possible cause.

The bilateral form can be favored by neuropathies such as alcohol poisoning, lead poisoning or porphyria. Possible reasons are also a spinal cord injury, syringomyelia or neuromuscular diseases such as ALS.

Symptoms, Ailments & Signs

In most cases, the diaphragmatic paresis is only visible on one side. It can be congenital, but the most common causes are canker sores. If these settle in the lungs, for example, or if a diseased lymph node develops, the phrenic nerve quickly gets under pressure and no longer works properly.

One-sided paralysis of the diaphragm is often hardly noticed by the patient. Breathing difficulties usually only occur during vigorous physical activity. However, insidious dangers lurk for the lungs if they are not properly ventilated on one side. Then it is very sensitive to inflammation caused by infections.

In the case of bilateral paralysis of the diaphragm, greater or lesser shortness of breath is to be noted in any case. Affected people can then often not sleep lying flat, because in longer phases of sleep the diaphragm is the only active respiratory muscle. With great luck, this deficiency can only be avoided by breathing with the upper body upright and the arms supported.

Diagnosis & course of disease

X- ray and ultrasound make a unilateral diaphragmatic paresis clearly visible. The paralyzed side of the organ is always slightly higher than the healthy one. In addition, parameters of the 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 help with the diagnosis. Lung function tests provide information about the degree of breathing difficulties. In addition, a thorough and long-term examination of the patient in the sleep laboratory is under discussion.

Complications

Diaphragmatic paresis is a very serious complaint that can, in the worst case, lead to the death of the person concerned. The further course of this disease depends very much on the exact cause of the diaphragmatic paralysis, with life expectancy being significantly reduced in most cases. Those affected suffer from breathing difficulties and possibly from tiredness and exhaustion.

Inflammation and infections of the respiratory tract occur very frequently and can significantly reduce the quality of life. This can also cause shortness of breath, so that in severe cases patients can also lose consciousness. Strenuous activities or sporting activities are hardly possible for the patient.

The treatment of diaphragmatic paresis depends very much on the underlying disease, which must be treated in the first place. If the disease is triggered by a tumor, it can often no longer be completely cured and the patient dies prematurely. In other cases, surgical interventions are necessary for diaphragmatic paresis in order to alleviate the symptoms. However, the treatment itself is not associated with any further complications.

When should you go to the doctor?

A doctor is needed as soon as the affected person notices a deterioration in their condition over several days or weeks. If his physical or mental performance drops, if he feels unwell or feels ill, there is a need for action. Special care should be taken if there are problems with breathing. If these are not due to temporary overexertion, they are often a warning signal from the organism. Breathing disorders should therefore be examined by a doctor immediately if they persist for several days. Of particular concern is an increase in complaints. If states of anxiety or insomnia occur, a doctor should be consulted as soon as possible.

A feeling of pressure in the chest, a feeling of tightness or the inability to take a deep breath are signs of a health problem. If physical activity causes fatigue very quickly, there is a need for action. A doctor should be consulted immediately so that the cause can be clarified and a diagnosis made. If the person concerned awakens from sleep due to a lack of oxygen, a doctor’s consultation is indicated. Impaired breathing as soon as physical positions are changed is also a cause for concern. An increased susceptibility to inflammatory diseases, a slightly elevated body temperature or internal irritation are other complaints that should be examined.

Treatment & Therapy

If the diaphragmatic paresis is still in the early stages and not very pronounced, physiotherapy is sometimes sufficient. In more serious cases, a diaphragmatic lift may be needed.

Prevention

Since diaphragmatic paresis is often the result of a previous illness and these have very different characteristics, general prevention is hardly possible. However, a healthy lifestyle with plenty of exercise and a balanced diet is recommended as a preventive measure. If you spend a lot of time sitting down at work, it is advisable to do regular back exercises to prevent wear and tear on the back muscles.

Aftercare

In most cases, those affected with diaphragmatic paresis only have a few and only very limited measures of direct aftercare available. Therefore, the person affected by this disease should consult a doctor as early as possible and also initiate treatment in order to prevent the occurrence of further complications and symptoms.

Self-healing cannot occur in this case, so that treatment by a doctor is always necessary. The sooner a doctor is consulted for diaphragmatic paresis, the better the further course of the disease. As a rule, those affected by diaphragmatic paresis are dependent on the measures of physiotherapy and physical therapy.

This can permanently limit and alleviate most complaints. Furthermore, the support of one’s own family in everyday life is often very important and can help to prevent depressive moods. Contact with other people affected by diaphragmatic paresis can also prove to be very useful and make everyday life easier for those affected.

Get plenty of exercise and a healthy lifestyle. Being overweight should also be avoided. In most cases, this disease does not reduce and does not further limit the life expectancy of the person affected.

You can do that yourself

In most cases, there are limitations in the case of diaphragmatic paresis. Depending on the severity and cause of the disease, everyday activities may not be possible or only with great effort. The quality of life of the patients is also often significantly reduced by regularly occurring respiratory infections.

Those affected usually suffer from shortness of breath even with little exertion. For this reason, people with diaphragmatic paresis should not exercise or engage in strenuous activities. Certain relaxation techniques such as meditation can be helpful, but these should only be used in consultation with the doctor treating you. However, yoga or Pilates is not recommended. Furthermore, the patients usually have an increased need for sleep. You should therefore take regular rest breaks.

Basically, those affected should avoid stress of any kind. A stable social environment and a healthy lifestyle are important. Ideally, the sick will be supported by relatives or family members. Otherwise, professional care is required in some cases. Those affected should ensure a healthy diet and avoid alcoholic beverages and coffee. Smoking must be stopped immediately if you have diaphragmatic paralysis.

Diaphragmatic Paresis