When Phrenic Nerve Damage Causes Diaphragm Muscle Paralysis: How to Spot It

Imagine a scenario where everyday activities, like climbing the stairs or walking the dog, become Herculean tasks. They leave you short of breath and exhausted. What's going on with your body? Why are these everyday activities suddenly so strenuous?

Damage to a particular nerve called the phrenic nerve can cause your breathing muscles to stop working correctly. This can make you tired and make everyday tasks much harder.

What is Phrenic Nerve Damage?

The phrenic nerve is like a tiny but crucial cable coursing through your neck and lower chest. Its main job is to ensure your breathing muscles (diaphragm) work smoothly. If something goes wrong with this nerve - due to an accident, surgery or certain health issues - it disrupts the function of your breathing muscles. 

Your phrenic nerve can get damaged by:

• Injections in the neck before shoulder surgery or after surgery to relieve pain
• Neck chiropractic adjustments
• Vascular, neck, or chest surgery
• Scar tissue that forms in the neck and compresses the nerve
• An accident that damages the phrenic nerve
• An unknown source of injury or compression

Think of phrenic nerve damage like you’re trying to play your favorite song on a guitar with a broken string - it doesn't work right. Similarly, when damaged, the phrenic nerve can't send the right signals to your breathing muscles. This means your diaphragm doesn’t move the way it should, making it harder for you to take in air and breathe comfortably.

Signs and Symptoms: How to Spot Phrenic Nerve Damage

How do you know if you have phrenic nerve damage or something else? The most common signs and symptoms include:

• Breathing difficulties, especially during physical activity
• Persistent shortness of breath
• Chronic fatigue
• Difficulty sleeping
• Weakened or paralyzed diaphragm muscles
• Impact on overall respiratory function if left untreated

Many of these symptoms can disrupt your everyday life, making you less active and more sedentary. Over time, a sedentary lifestyle can lead to further health problems such as obesity, diabetes, high blood pressure, heart disease, and more. If you have any combination of these symptoms, schedule an appointment with your primary care provider. 

Diagnosing a Problem With the Phrenic Nerve

Damage to the phrenic nerve causing diaphragm paralysis is challenging to diagnose because the symptoms are similar to those suffering from pneumonia and asthma. Doctors often identify phrenic nerve damage by:

• Performing a physical exam
• Discussing past medical procedures that may have impacted the neck or chest
• Determining whether you are unable to perform ordinary day-to-day tasks
• Taking images of the chest with X-rays or CT scans to look at the spine and the path of the nerve
• Performing electrodiagnostic tests, electromyography, and nerve conduction studies that look at the diaphragm muscle and phrenic nerve function

Treating an Injury to the Phrenic Nerve

After diagnosing phrenic nerve injury, the initial treatment plan usually involves observation and non-interventional therapy. Most people take a wait-and-see approach for six to eight months. Patients complete recommended exercises and physical therapy to help retrain and condition the diaphragm during that time.

For those who don’t recover or whose phrenic nerve was somehow severed, surgery is an option. The surgical procedures used to treat phrenic nerve damage aim to restore function to the affected nerve or compensate for its impairment. The three main surgical approaches are:

• Diaphragmatic pacing, which involvesimplanting a device that electrically stimulates the diaphragm while bypassing the injured phrenic nerve. To do this, electrodes are placed directly on the diaphragm or within the phrenic nerve to induce contractions.
• Phrenic nerve reconstruction surgery, which aims to repair or recreate the injured phrenic nerve. Surgeons sometimes use nerve grafts in which a healthy nerve is removed from another region of the body and implanted to treat the injured piece of the phrenic nerve.
• Plication of the diaphragm, which includes lowering the position of the paralyzed diaphragm with sutures in order to provide more space for the lung to expand.

“Many people are told they must live with phrenic nerve damage, but often there’s something that can be done,” says plastic surgeon Matthew Kaufman, M.D. “For many patients, we can restore diaphragm function.”

Protecting the Phrenic Nerve

Few people realize the role of the phrenic nerve in allowing them to breathe properly. But when it gets damaged, it prevents the diaphragm from getting the message to breathe. That makes everyday life extremely difficult.

“Phrenic nerve damage, while relatively rare, can significantly impact a person's quality of life,” says Dr. Kaufman. “There are physical and psychological consequences.”

To keep your phrenic nerve in good condition, Dr. Kaufman advises that you maintain flexibility in the neck and shoulders, practice good posture, control your weight, and manage conditions like diabetes.

Next Steps & Resources

• Meet our source: Matthew Kaufman, M.D.
• To make an appointment with Dr. Kaufman or another physician near you, call 800-822-8905 or visit our website.
• Hackensack Meridian Health pioneered phrenic nerve reconstruction and is nationally and internationally recognized for the procedure. Having successfully treated over 700 patients, Hackensack Meridian Health is the world’s destination for phrenic nerve damage reconstruction. Patients come to Jersey Shore University Medical Center for surgery from around the world, including countries such as Japan, South Africa, Bolivia, Israel and Australia. Learn more about phrenic nerve reconstruction.