Phrenic Nerve Injury Tests & Procedures

Your phrenic nerve controls your diaphragm and is essential for breathing. When the phrenic nerve is damaged, it can lead to a condition known as diaphragm paralysis, resulting in chronic shortness of breath. At The Institute for Advanced Reconstruction, we’re proud to offer world-class treatments for diaphragm paralysis, including phrenic nerve breathing pacemaker surgery, diaphragm muscle replacement surgery, and our revolutionary nerve reconstruction surgery.

Patients who visit us should already have a confirmed diagnosis of diaphragm paralysis, which is caused by phrenic nerve injury. There are many tests available to diagnose diaphragm weakness and paralysis. Diagnosis generally starts with a physical exam to look for paradoxical motion, which is when the abdominal wall moves inward during inhalation, instead of outward as it should. Additional tests may include:

• Imaging tests such as X-rays, ultrasound, or CT scans to assess diaphragm motion and muscle thickness
• MRI to determine if there is an underlying condition involving the spinal column or nerve roots
• Lung function tests, both when sitting and lying down
• Sniff test, or chest fluoroscopy, to show paradoxical motion
• Phrenic nerve stimulation in the neck by electric or magnetic stimulation
• Electromyography, which evaluates and records the electrical activity of skeletal muscles
• Arterial blood gas test, which can reveal a lack of necessary oxygen in the bloodstream

Advances in nerve decompression and transplants, pioneered by our very own Dr. Matthew Kaufman, make it possible to reverse diaphragm paralysis. The techniques he utilizes are derived from the procedures commonly used to treat arm or leg paralysis, which allow surgeons to restore function to previously paralyzed muscle groups.

The right phrenic nerve damage treatment for your diaphragm paralysis will depend on many factors, including the underlying cause and any prior treatments.

Phrenic nerve reconstruction

Phrenic nerve reconstruction uses microscopic surgical techniques to repair damaged nerves and restore functioning to the diaphragm muscle. Developed by Dr. Kaufman, the procedure offers renewed hope to patients who may have once thought they had to live with diaphragm paralysis. Dr. Kaufman is the only known surgeon in the world to perform this type of specialized phrenic nerve surgery.

What to Expect

During surgery, we may use X-ray to determine how much lung capacity is compromised. The surgeons will locate the damaged areas of the phrenic nerve and remove any scar tissue that may be compressing the nerve via nerve decompression surgery, giving the nerve adequate space. Depending on the injury, your surgery may also involve various types of nerve repair, including nerve transfer, which reroutes a donor nerve to connect to a damaged nerve, or a nerve graft, which uses a nerve transplanted from another part of the body to replace the damaged area. In bypassing the injured nerve, the brain is able to effectively relay messages to the diaphragm, restoring function.

After Surgery

Following the procedure, as much as 85 percent of our patients experience improvement in their symptoms, including regaining the ability to exercise. In addition, many patients report a reversal of sleeping difficulties related to the diaphragm paralysis.

Breathing Pacemakers for Diaphragm Paralysis

This procedure involves surgically implanting a breathing pacemaker to control activity in the diaphragm muscle. Electrodes implanted around the nerves to the diaphragm (or placed directly into the muscle) cause an inhalation event to occur.

In conjunction, an external transmitter sends a signal through the implanted electrodes, causing the diaphragm to contract. The contraction mimics the activity that occurs with normal breathing, and exhalation occurs passively in response to the inhaled air.

What to Expect

The Institute for Advanced Reconstruction is one of the only places worldwide that performs diaphragm pacemaker implantation. During the procedure, we implement a variety of minimally-invasive surgical approaches, usually through a small neck incision or laparoscopically through the abdomen. The surgeon implants electrodes, or small leads that connect to wires. An additional electrode is placed just below the skin near the other electrodes.

For certain patients, the pacemaker procedure can even be performed on an outpatient basis. For others, breathing pacemakers can be used in conjunction with intercostal or spinal accessory nerve grafting to restore diaphragm function and allow pacing in patients who otherwise would not be candidates.

After Surgery

Most patients will be able to breathe without the support of a ventilation machine. It can take weeks to months to strengthen the diaphragm through tailored diaphragmatic breathing exercises. Patients should be able to close their tracheostomy, and many regain the ability to speak.

Diaphragm Muscle Replacement Surgery

Over their years of experience in the field of nerve reconstructive surgery, Dr. Kaufman and his colleagues have developed a state-of-the-art procedure known as diaphragm muscle replacement surgery. Diaphragm muscle replacement surgery transfers healthy muscle from the patient’s body into the chest cavity, effectively replacing the irreversibly damaged diaphragm and restoring functional breathing activity.

Initially, the procedure was performed solely for children with congenital diaphragm problems. Now, Dr. Kaufman and his team are able to offer it to both children and adults who have diaphragm paralysis.