The diaphragm is the most important breathing muscle in our chest. Although diaphragmatic paresis (also known as diaphragmatic paralysis) is rare, it is crucial for our quality of life. Symptoms of diaphragmatic paralysis include breathlessness and shortness of breath.
In the following text, you can find out what causes it and what you can do about the symptoms. You can also find specialists for the treatment of diaphragmatic paresis here.
Between the chest cavity and the abdominal cavity lies the most important breathing muscle we have: the diaphragm. Doctors also call it the diaphragm (Greek for dividing wall). The term diaphragm describes a function of the diaphragm: it separates the lungs in the chest and the thorax from the organs further down.
The diaphragm is essential for breathing. It tenses when you inhale and sinks downwards. This creates negative pressure in the chest cavity and the lungs fill with air.
When a person breathes out, the diaphragm moves upwards again and pushes used air out of the lungs.
On the right side, the respiratory muscle is slightly higher, with the liver below it. On the left side, the spleen is located under the diaphragm.
The diaphragm (diaphragm) is a dome-shaped, thin muscle-tendon plate @ magicmine /AdobeStock
Doctors differentiate between unilateral and the rarer bilateral diaphragmatic paralysis.
On both sides, the phrenic nerve runs from the spinal cord through the thorax to the diaphragm. This nerve has a long route from the spinal cord past the lymph nodes, aorta, pericardium and lungs to its destination.
If the phrenic nerve is damaged along this route, this can result in diaphragmatic paralysis.
The paralysis in turn leads to a raised diaphragm: the diaphragm moves further upwards than normal when exhaling.
In addition to paralysis of the diaphragm, other causes can also be responsible for a high diaphragm:
If the diaphragm is too high, its function is restricted. This also constricts the lungs and leads to breathing difficulties. In more severe cases, this becomes noticeable as shortness of breath.
If the diaphragm is too high up, it can no longer or only partially fulfill its function. In addition, the lungs have less space, which leads to breathing difficulties. Shortness of breath and shortness of breath are the consequences that patients experience.
When standing, the paralysis is less severe than when lying down. This is because gravity pulls the abdominal organs downwards and the diaphragm also moves downwards.
In this case, the lungs have more room to expand. However, shortness of breath increases when bending over or lying down. Even when swimming, the paralyzed diaphragm moves upwards and takes away the necessary space for the lungs.
Physical exertion intensifies the symptoms.
This is particularly noticeable in patients who already have pre-existing respiratory conditions:
Diaphragmatic paralysis increases the likelihood of developing pneumonia.
Typically, shortness of breath occurs when bending over, lying down or swimming @ RFBSIP /AdobeStock
The phrenic nerve runs along various organs on its long journey. It comes close to the spine, lymph nodes and main arteries. The thymus gland, which is important for the immune system, the pericardium and the lungs are also on its path.
There are many causes that can lead to damage to the phrenic nerve along this route:
Often, however, the cause of the paralysis remains unknown; the doctor then speaks of an idiopathic cause.
The rare bilateral diaphragmatic paralysis can be the result of spinal cord injuries or neuromuscular diseases such as ALS. Idiopathic paresis, i.e. paralysis with an unknown cause, is also possible here.
To diagnose diaphragmatic paralysis, the doctor will perform a chest x-ray: the elevated diaphragm, which is caused by the paralysis of the muscle, can be seen on the x-ray.
If patients complain of shortness of breath after heart surgery, an X-ray examination is useful.
A breathing measurement at rest, known as spirometry, shows the extent of the damage to the diaphragm. This tells the doctor how much air volume enters the lungs when breathing in. In the case of unilateral diaphragmatic paralysis, this shows a reduced capacity when sitting. When lying down, even less air enters the lungs.
The blood gas analysis from the laboratory provides information via a blood count.
The doctor uses ultrasound to examine the diaphragm in order to assess the movement of the muscle. He also recognizes whether or not the muscle moves with the necessary muscle thickening when inhaling, which is necessary to prove or disprove diaphragmatic paralysis.
If the cause is still unclear, computer tomography (CT) or magnetic resonance imaging (MRI) can provide information and rule out other diseases.
In rare cases, neurological examinations such as neurography or electromyography are used to find out more about the nerve damage present.
Paralysis only requires treatment if patients suffer from shortness of breath. Doctors then perform a diaphragmatic retraction. If the damaged phrenic nerve only causes mild discomfort, this is not necessary.
During a diaphragmatic lift, surgeons insert sutures to hold the diaphragm in place. This prevents it from bulging upwards into the chest. This improves the efficiency with which the rest of the respiratory muscles can work: More air flows into the lungs when breathing in.
If other conditions such as obesity or COPD are the cause, the patient should reduce their weight and/or take medication.
If diaphragmatic paralysis occurs after an operation, it can be helpful to wait up to two years: In some cases, the diaphragm recovers and the symptoms subside. Respiratory or exercise therapy can also help.
Doctors have already used diaphragmatic pacemakers to stimulate the phrenic nerve in people with a special form of ALS.
Diaphragmatic paralysis is usually the result of damage to the phrenic nerve. It can occur after operations, injuries and illnesses and leads to breathlessness and shortness of breath. In severe cases, diaphragmatic tightening surgery can help. The treatment of causative diseases is also necessary.
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