Diaphragm paralysis (paradoxical breathing - injury to phrenic nerve)

Hello everyone, In this video we are going to discuss about Diaphragm paralysis (paradoxical breathing - injury to phrenic nerve).
Diaphragm paralysis or diaphramatic paralysi is the loss of control of one or both sides of the diaphragm. One sided diaphragm paralysis is known as unilateral diaphragm paralysis or hemi diaphragm paralysis. When both domes of diaphragm are paralysed then it is known as bilateral diaphragm paralysis.
Phrenic nerve (nerve) provides the motor supply of diaphragm. One of the most common cause of phrenic nerve palsy is injury phrenic nerve. One sided phrenic nerve paralysis leads to unilateral paralysis of diaphragm. Both sided phrenic nerve injury leads to bilateral diaphragmatic paralysis.
**Patient will present with shortness of breath, bluish discoloration of lips, tip of tongue, fingers, agitated, anxious, restless, fatigue & will complain about other diaphragmatic paralysis symptoms.
**On examination you will find cyanosis & paradoxical breathing or abdominal paradox. paradoxical respiration is abnormal chest movements & abnormal abdominal wall movement during inspiration.
**Several investigations are provided. Among them diaphragm paralysis radiology is important which is also known as diaphragm paralysis sniff test or diaphragm paralysis fluoroscopy. In fluroscopic chest x-ray or cxr you will find:
In case of unilateral diaphragmatic paralysis: elevated hemi diaphragm
In case of bilateral diaphragmatic paralysis: both domes will be raised higher.
We have tried to show you the basic of diaphragmatic paralysis radiology in this video.
Diaphragm paralysis ultrasound is also performed.
**Pulmonary function test also plays an important role. You will find 10-30% reduction of vital capacity in unilateral diaphragm paralysis & 30-50% reduction in case of bilateral paralysis of diaphragm.
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