Your diaphragm is a muscle below your heart and lungs that separates the chest organs from the belly organs and helps you breathe. When you inhale, your diaphragm pushes down and allows your lungs to expand and take in air. When you exhale, your diaphragm relaxes and moves upward. This makes your lungs smaller, which forces air out of them.

The tightening and relaxing of your diaphragm are controlled by your phrenic nerve, which is attached to the neck (cervical) area of your spine. Typically, diaphragm paralysis or weakness is caused by pressure on your phrenic nerve or damage to the nerve — rather than an injury to the diaphragm itself.

Diaphragm paralysis can happen on one side of the muscle (unilateral) or both sides (bilateral).

Causes

Phrenic nerve damage can be caused by:

• Birth defects or injuries to the phrenic nerve during delivery
• Cancer
• Cervical spine disorders, including arthritis
• Neuromuscular diseases
• Spinal cord injuries

Symptoms

People with unilateral diaphragmatic paralysis may not notice any symptoms. Some may notice breathing difficulties only during activity or when they're lying down.

Those with bilateral paralysis have more noticeable symptoms, including:

• Frequent upper-airway and lung infections, such as pneumonia 
• Severe shortness of breath
• Sleep difficulties
• Tiredness

Newborns with bilateral diaphragmatic paralysis need immediate attention and usually require a ventilator to help them breathe.

At the University of Miami Health System, you work with specialists who are experts in diagnosing and treating diaphragmatic paralysis and weakness. You get personal attention and treatment that’s customized to your needs. We develop a plan to help you feel better as soon as possible.

Tests

Arterial Blood Gas Test
This blood test measures the pH level of your blood and checks the function of your lungs by measuring the amount of oxygen they move into the blood and the amount of carbon dioxide they remove.

Electromyography (EMG)
This test examines the function of your muscles and the nerves that stimulate them.

Lung Function Tests
Lung function tests measure how much air your lungs can hold and how quickly air moves in and out of them. Tests may include spirometry, plethysmography, gas diffusion, or inhalation challenge tests.

Imaging Exams
Your doctor may use one or more imaging tests to look at your diaphragm and lung function. Potential tests include X-ray, ultrasound, CT, MRI, and fluoroscopy (a continuous X-ray that shows movement).

Treatments

CPAP and BiPAP Therapies
Continuous positive airway pressure (CPAP) therapy and bilevel positive airway pressure (BiPAP) are breathing machines that push air through your nose, or nose and mouth, to keep your airways open while you sleep.

Diaphragmatic Pacing
A diaphragmatic pacemaker stimulates your diaphragm to make it tighten and draw air into your lungs, making it easier to breathe. Your surgeon uses a minimally invasive approach to place electrodes inside your diaphragm muscle. The electrodes are connected to an external device that sends the electrical impulses.

Diaphragm Plication
This minimally invasive surgery reshapes the diaphragm so that your lungs can expand.

Why Choose UHealth?

Fast, accurate diagnosis. We offer the latest testing in our technologically advanced pulmonary function labs, including advanced diagnostic imaging. Our experienced teams and advanced equipment give us the highest quality results for a correct diagnosis.

A comprehensive, team approach to care. You benefit from the expertise of specialists in thoracic surgery, lung care, cancer, spine health, and more. They work as a team to treat the cause of diaphragmatic paralysis and give you comprehensive care. We use the least invasive approach to help you breathe easier and feel better.

Get the latest treatment breakthroughs sooner. As an academic medical center, we offer the latest, proven approaches backed by the leading-edge research of the University of Miami Miller School of Medicine. Our medical and academic researchers are continually seeking better ways to find and treat airway and lung problems with ongoing research and clinical trials in asthma, cystic fibrosis, pulmonary fibrosis, and more.

Leaders in robotic surgery treatment. We have some of the world’s most experienced robotic surgeons for minimally invasive procedures. We were the first academic medical center in the world to get the da Vinci Xi robotic surgery system. Our surgeons have completed more than 5,000 robotic surgeries — procedures that offer less pain and scarring and a faster recovery.