The diaphragm is a dome-shaped muscular structure located in the chest cavity between the lungs and the stomach. It plays a vital role in the breathing process by constantly contracting and relaxing, which creates a vacuum that allows the lungs to expand with air. When it expands, the space vacated by the diaphragm leaves space for the lungs to expand when inhaling. In some rare cases, patients might have to deal with a paralyzed diaphragm.

What happens when the diaphragm is paralyzed?
The diaphragm is one of the main muscles responsible for breathing. A paralyzed diaphragm means inefficient contraction and relaxation of this muscle. Common causes of a paralyzed diaphragm are damage to the muscle or issues with the associated nerves. The diaphragm is connected to the phrenic nerve responsible for the messages being sent and received by the diaphragm. When the diaphragm is dysfunctional, it moves up when breathing in instead of going down. This movement causes it to take up essential space, not allowing the lungs to expand properly.

Diaphragm paralysis is an uncommon condition that can result in reduced lung capacity. The patient may be diagnosed with unilateral or bilaterally diaphragm paralysis, depending on the location of the condition. The impact of the paralysis on lung capacity is more severe in bilateral patients than in unilateral patients.

Symptoms of paralyzed diaphragm
The most common symptoms of diaphragmatic paralysis or weakness are associated with breathing. Since it is an important muscle that accelerates the breathing process, the severity of the symptoms is higher in patients with bilateral paralysis of the diaphragm.

The most common and noticeable symptom of unilateral paralysis is dyspnea. It is difficult for the patient to breathe as it causes the patient to experience exertion when lying down.

In bilateral diaphragm paralysis patients, the body will experience difficulty in breathing even when the body is at rest. It can adversely impact the patient’s lifestyle since the condition can compromise their active and rest times. These patients can also experience difficulty falling or staying asleep. Other common noticeable symptoms include recurrent pneumonia and fatigue.

Causes of paralyzed diaphragm
In most cases, a weak or paralyzed diaphragm results from pressure or damage to the phrenic nerve. Apart from this factor, various other causes could act as contributing factors.

• Birth defect
  Conditions like a faulty diaphragm are hard to come by. The body is a smart mechanism that can often work around itself to make sure that the person is healthy. However, conditions like congenital central hypoventilation syndrome might act as a causative agent.
• Nerve conditions
  Some health conditions might also give rise to complications. Similarly, a paralyzed diaphragm might be seen in people with nervous system disorders. The list can include people with multiple sclerosis as well as amyotrophic lateral sclerosis. ALS, or Lou Gehrig’s condition, impacts the nerves and the muscles of the body, thereby making it difficult for patients to carry out regular day-to-day activities.
• Injury
  Injuries to the body and, in turn, to the nerves can make this rare condition a possible outcome. Especially if the injury is sustained to the back, this includes people who have sustained an injury to the upper cervical column. The phrenic nerve might also be frayed or damaged following a cardio-thoracic surgery that impacts the nerves.
• Other health concerns
  Patients who have been diagnosed with conditions such as cancer or cervical arthritis also have the chance of developing this condition. Cancer patients might have to deal with a weak or paralyzed diaphragm if the cancer has spread to various parts of the body and is impacting the phrenic nerve.

However, it is important to note that the cause of a paralyzed diaphragm might not always be diagnosed. As many as 40% of these patients are diagnosed with idiopathic paralyzed diaphragm.

Diagnosis of paralyzed diaphragm
Imaging techniques like X-rays, ultrasounds, and MRI can help diagnose this condition. The diagnosis process can also include blood tests that can check arterial blood gas levels. If the test reveals that the levels of blood oxygen are lower than required, it can be a sign that the patient needs help. PFT or pulmonary function tests may also be performed to better understand the patient’s condition.

Treatment for diaphragmatic weakness and paralysis
The treatment plan for the condition is decided by the doctor based on the severity of the injury and the symptoms. Most doctors prefer prescribing patients with non-surgical options.

• Ventilatory devices
  If the symptoms are mild, the doctor might recommend the use of supportive treatment devices to be used at night. These will help the patient breathe better and sleep well. In most cases, surgery is recommended when the diaphragmatic condition starts impacting the patient’s daily life. These ventilatory devices might include the use of BiPAP and C-PAP.

• Diaphragmatic plication
  Diaphragmatic plication is a process in which the diaphragm is pulled down taut, and the doctor tries to keep it in place with a series of sutures. This surgical intervention is most commonly used for patients with unilateral diaphragmatic paralysis. The procedure is done via minimally invasive methods and allows the lungs more space to expand when inhaling.

• Pacemakers
  This option can be used in patients with diaphragm paralysis resulting from spinal cord injury or ALS. The pacemaker is applicable for patients with a functioning phrenic nerve—the use of this device not only results in improved respiratory function but also low infection rates.
• Phrenic nerve reconstruction
  This option can be employed when the diaphragm is non-responsive because of the subdued function of the phrenic nerve. It can be employed to treat patients with paralysis of the right hemidiaphragm. Additionally, the condition can also be managed by physical therapy in combination with other treatment options.