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Overview

The phrenic nerve is part of the autonomic nervous system which automatically controls the functions of organs in the human body. This specific nerve controls the diaphragm, which is the muscle that divides the chest cavity and abdomen, and its function is to control the breathing process.

The phrenic nerve is a twin nerve with one being present on either side of the diaphragm. The nerve originates from the brain and passes the first few vertebral bones of the spine where it splits and continues through either side of the body.

If the phrenic nerve becomes damaged or is injured, it stops functioning normally. The affected individual will struggle to breathe and this can be a life-threatening situation.

Causes

Some of the common causes of phrenic nerve injury or damage include the following:

  • Injury to the spinal cord, especially at an area above the third spinal vertebra in the neck.
  • Neck injury due to physical trauma such as a blunt force or a motor vehicle accident.
  • As a surgical complication following procedures performed around the neck but also those performed on the chest or abdomen.
  • Conditions that affect the organs where the phrenic nerve runs through. These may include strokes, brain tumours, dilated cardiomyopathy, and any chest masses.

Signs and Symptoms

The signs and symptoms of phrenic nerve damage will depend on whether the left or right nerves are affected.

If only one of the nerves is damaged, the affected individual will still be able to breathe although it will be more challenging to do so. If both nerves are affected it will be difficult for the individual to breath on their own and this will be regarded as a medical emergency.

Others clinical features of phrenic nerve damage include:

  • Abnormal contraction of the diaphragm which causes small intakes of air and this results in having persistent hiccups.
  • Paralysis of the diaphragm which is the most problematic issue of an injury to the phrenic nerve as this prevents the individual from being able to control their own breathing.

Treatment

Treating a phrenic nerve injury entails incorporating protocols that reinstate a normal breathing pattern in the affected person.

The treatment of choice then is to use an implantable pacemaker which works by stimulating the phrenic nerve. The device is implanted surgically with an electrode being positioned alongside the phrenic nerve.

Affected individual can have one or two pacemakers placed depending on whether one or both phrenic nerve branches are affected. A receiver device is then implanted under the skin which converts radio waves into electrical impulses that are sent down the electrodes to stimulate the phrenic nerve.

The procedure takes a few hours to be completed and patients can even be discharged home the very same day.

Prognosis

The prognosis for a phrenic nerve injury is good for those individuals who only have damage to one nerve as they do not require aggressive treatments. Those patients who have both phrenic nerves involved, though, will require ventilatory support to normalize their breathing until a breathing pacemaker is inserted.  

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