Fortunately, treatments exist to remedy the condition. The phrenic nerve is actually a twin nerve, with one on the left side and one on the right of the diaphragm. The nerves serve to send signals between the brain and the diaphragm. Breathing is an interesting bodily process because although you usually do not have to think about doing it, you do have the ability to hold your breath or to take a deep breath.
The phrenic nerve is responsible for handling these decisions. When the nerve is damaged, this control is lost. The phrenic nerve begins in the brain and then continues down to the first few vertebrae of the spine, where it then splits. The two nerves then continue through each side of the body, with the right side coming in contact with the windpipe and heart, while passing the lungs. The left side also comes in close contact with the heart, with both sides eventually ending up in the diaphragm.
Because of its location and proximity to both the lungs and the heart, the nerve can be impacted if there are specific conditions in either of these organs. If either of the nerves is damaged and signals between the brain and diaphragm are interrupted, normal breathing may be prevented. If the phrenic nerve is damaged, it ceases to function normally. There are few diseases that specifically damage the phrenic nerve, though it is more common for there to be systemic problem with nerves that also impacts the phrenic nerve, than a specific disease that impacts it.
If the nerve is damaged, difficulty in breathing is a common symptom, as well as a shortness of breath when lying flat. Some of the common causes of phrenic nerve damage include:. The symptoms are varied, depending on whether the left or right nerve is damaged. If only one is damaged, the patient will continue to breathe, though it will be labored. If both nerves are damaged, it becomes medically urgent, as you can no longer breathe on your own.
Other symptoms include:. Fortunately, treatment exists for damage, though treatments vary depending on the severity and presentation. As breathing regulation is the main symptom of phrenic nerve damage, it is crucial that the solution reinstates a normal breathing pattern and enables the subconscious process of breathing.
When the heart beats irregularly, patients get a pacemaker to normalize the beat. A similar concept is used for patients who have phrenic nerve damage. Though each patient has an individual set of conditions and treatment plan, those who are eligible may utilize the Avery Diaphragm Pacing System System, the only diaphragm pacing system with full pre-market approval from the USFDA and CE marking privileges under the European Active Implantable Medical Device Directive for both adult and pediatric use.
It is available for patients with an intact phrenic nerve. The pacemaker may be used for patients with phrenic nerve damage from the above causes, as well as those suffering from CCHS, ALS, and diaphragm paralysis. The pacemaker works by stimulating the phrenic nerve. Patients work with physical therapists on strengthening their diaphragm and using their rib intercostal muscles and neck scalene muscles to help with breathing. Patients who continue to have difficulty breathing or who continue to be dependent on a mechanical ventilator are advised to undergo surgical treatment.
Surgery is recommended when it is believed that the chances of achieving further recovery are better with nerve reconstruction than waiting for the nerve to heal on its own. By months, the nerve permanently loses its connection to the muscle. Taking that into account, and the fact that a repaired nerve heals at 1 mm a day, surgery is offered by 6 to 9 months. Surgical treatment focuses on healing the injured nerve s. Call Today! Phrenic nerve surgery is performed under general anesthesia and can last a few hours.
After surgery, patients are typically wrapped in a shoulder sling to protect the nerve reconstruction against the motion. For most nerve procedures, patients may only need an overnight hospital stay and are discharged home the following morning. If rib intercostal nerves are used as nerve transfers, patients may be admitted overnight in the Intensive Care Unit as a precaution to monitor their breathing and then stay for days before being discharged to home.
During the hospital stay, pain specialists place the patient on medications that specifically treat nerve pain. Three weeks after surgery, patients may take off their shoulder sling. At this point, full stretching is permitted except in patients with rib intercostal nerve transfers. Patients with rib intercostal nerve transfers must wait a total of 8 weeks before stretching the shoulder to avoid pulling the nerve connections apart.
Patients will be followed closely by physical therapists, who will use electrical stimulation to gently help the nerves turn back on. This condition is not painful in the acute sense of the term.
It causes problems with breathing, which is thoroughly uncomfortable on its own. These problems lead to fatigue, insomnia, headaches, blue lips and fingers, and overall difficulty breathing.
Unless the phrenic nerve is injured on both sides, making the patient unable to breathe on his or her own, this is often an elective treatment situation.
If nerve damage is left for over a year, there is a good chance the nerve will permanently lose its connection to the diaphragm. Otherwise, the first step is physical therapy to strengthen the diaphragm, rib, and neck muscles. Untreated phrenic nerve paralysis will likely end with the patient being required to use a mechanical ventilator to breathe, and no one likes the thought of that.
Phrenic nerve paralysis leads to a poor quality of life, as the person is plagued by chronic fatigue and shortness of breath. Activities the person formerly enjoyed are basically out of the question due to inherent difficulty with simple breathing. With any surgery there are risks, but the alternative of not having your nerve damage addressed has far more downsides. Seruya is a peripheral nerve surgery specialist. He is certified by the American Board of Plastic Surgery and has exceptional expertise and experience with nerve transfers and bypass grafting.
His entire focus is peripheral nerve surgery. So, while there are risks of further nerve damage, along with all of the risks inherent in any surgery, such as excessive bleeding, reaction to anesthesia, and the like, in these surgeries the rewards far outweigh the potential risks.
For additional information on Phrenic Nerve Paralysis and Paralyzed Diaphragm treatment in Los Angeles, CA, call our office at to schedule a consultation today! Phone: What is Phrenic Nerve Paralysis? Symptoms of a Paralyzed Diaphragm.
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