Diaphragm paralysis or paresis

Diaphragm paralysis or paresis

Diaphragm paralysis or paresis is a condition in which the diaphragm, the primary muscle responsible for respiration, loses its muscular power due to weakness of the muscle itself or damage to its nerve supply. Depending on the severity of the paralysis and whether it is unilateral or bilateral, patients can have varied clinical manifestations. 

Causes of Diaphragm Paralysis or Paresis

• Trauma or injury

The most common cause of diaphragm paralysis or paresis is direct trauma or trauma resulting from a surgical procedure.

• Neurological disorders

Neurological disorders such as amyotrophic lateral sclerosis (ALS), multiple sclerosis, and Guillain-Barré syndrome can cause diaphragm paralysis or paresis.

• Autoimmune and inflammatory diseases

Autoimmune and inflammatory diseases such as Parsonage-Turner syndrome can cause diaphragm paralysis or paresis.

• Birth defects

Birth defects or trauma to an infant during labor and delivery can cause diaphragm paralysis or paresis.

• Complications from surgeries

Complications from neck or chest surgeries, such as coronary artery bypass surgery, can cause diaphragm paralysis or paresis.

• Spinal cord injuries

Spinal cord injuries, including from trauma, can cause diaphragm paralysis or paresis.

• Tumors

Spine tumors, lung cancer, and metastatic cancers can cause diaphragm paralysis or paresis.

Symptoms of Diaphragm Paralysis or Paresis

• Shortness of breath

Difficulty breathing or shortness of breath is a common symptom of diaphragm paralysis or paresis.

• Dry cough

A dry cough that does not produce phlegm is another common symptom of diaphragm paralysis or paresis.

• Fatigue

Feeling tired or weak is a common symptom of diaphragm paralysis or paresis.

• Chest pain

Pain in the chest, especially while breathing or coughing, can be a symptom of diaphragm paralysis or paresis.

• Clubbing of fingers

Clubbing of fingers, which is the enlargement of the fingertips, can occur in some cases of diaphragm paralysis or paresis.

Diagnosis of Diaphragm Paralysis or Paresis

• Physical examination

A thorough examination of the lungs and chest is performed to assess the presence of diaphragm paralysis or paresis.

• Imaging tests

Imaging tests such as chest X-ray, CT scan, or MRI may be used to visualize the lungs and determine the extent of the paralysis or paresis.

• Pulmonary function tests

Pulmonary function tests measure how well the lungs are functioning and can help diagnose diaphragm paralysis or paresis.

• Electromyography (EMG)

EMG is a diagnostic test that measures the electrical activity of muscles and nerves and can help diagnose diaphragm paralysis or paresis.

• Phrenic nerve stimulation test

This test involves stimulating the phrenic nerve to assess its function and can help diagnose diaphragm paralysis or paresis.

Or rate primary disorder.

Note (1): A 100-percent rating shall be assigned for pleurisy with empyema, with or without pleurocutaneous fistula, until resolved.

Note (2): Following episodes of total spontaneous pneumothorax, a rating of 100 percent shall be assigned as of the date of hospital admission and shall continue for three months from the first day of the month after hospital discharge.

Note (3): Gunshot wounds of the pleural cavity with bullet or missile retained in lung, pain or discomfort on exertion, or with scattered rales or some limitation of excursion of diaphragm or of lower chest expansion shall be rated at least 20-percent disabling. Disabling injuries of shoulder girdle muscles (Groups I to IV) shall be separately rated and combined with ratings for respiratory involvement. Involvement of Muscle Group XXI (DC 5321), however, will not be separately rated.