Patients with diaphragmatic paralysis may experience shortness of breath, headaches, blue lips and fingers, fatigue, insomnia and overall breathing difficulty. Also:
- Unilateral diaphragmatic paralysis may go undiagnosed. Often patients compensate for the discomfort of reduced lung capacity by sleeping in a semi-upright position or reducing physical activity when there is shortness of breath.
- Bilateral diaphragmatic paralysis presents more severe symptoms, which leads patients to seek medical attention. The shortness of breath is more severe, even with mild exertion.
Newborns and children with unilateral diaphragmatic paralysis may experience more severe respiratory distress than an adult, due to weaker muscles and a more compliant chest wall. The newborn may have a weak cry or show signs of gastrointestinal distress, with frequent vomiting. Children with bilateral diaphragmatic paralysis require immediate medical attention and ventilator intervention because the condition can be life threatening
The tools used to diagnose diaphragmatic paralysis include:
- 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.
- Chest X-rays or an upright, inspiratory chest radiograph.
- A blood test to measure the amount of oxygen in the blood.
- Measuring transdiaphragmatic pressure and thickness.
- Phrenic nerve stimulation testing.
- Electromyography, a test that evaluates and records electrical activity produced by skeletal muscles.
- Computed tomography (CT) scanning of the thorax and/or abdomen.
- Magnetic resonance imaging (MRI) to determine if there is an underlying condition involving the spinal column or nerve roots.
- Ultrasound to see the activity of the diaphragm and to identify any unusual movement or lack of movement.
Causes and Risk Factors
The causes and risk factors that compromise diaphragmatic function include:
- Cancer in the lung or in the lymph nodes may grow into or compress the nerve which leads to nerve compression.
- Surgical trauma, such as unintentional injury after a cardiothoracic or cervical procedure.
- In newborns and infants, birth trauma can injure the phrenic nerve.
- ALS, multiple sclerosis, muscular dystrophy or other neuromuscular disorders
- Spinal cord disorders and quadriplegia.
- Injury to the phrenic nerve, the nerve that controls the function of the diaphragm.
- Neuropathic disease including thyroid and autoimmune disease, Guillain-Barre syndrome, etc.