What is diaphragm paralysis in NA?
Neuralgic amyotrophy (NA) is an acute inflammation, often very painful, of a number of nerves in the shoulder, arm and/or hand. As a result, a number of muscles become paralyzed to some extent. Patients usually recover during 1 to 2 years, but it is possible that you will continue to have trouble from the affected arm(s) in your daily life and while working. In about 1 of every 15 people with NA, the phrenic nerve that innervates the diaphragm also becomes paralyzed. Sometimes this nerve can also become paralyzed without nerves in the arm being affected.
Functions of the diaphragm
The diaphragm is a dome-shaped structure of muscle and fibrous tissue that separates the thoracic cavity from the abdomen. It has an important function during respiration: it is the most important muscle involved in our breathing. The diaphragm muscle contracts at the beginning of the breath, resulting in the central tendon being pulled downwards toward the abdomen. This results in negative pressure in the chest, causing air to flow into the lungs.
Diaphragm paralysis leads to various problems:
Shortness of breath
If the diaphragm muscle no longer functions properly, the central tendon is no longer pulled sufficiently downwards. This results in difficulty in breathing and shortness of breath, especially when lying flat or bending over. The lung capacity during inhalation is limited, leading to problems when exercising and sleeping.
With a paralyzed diaphragm, it is difficult to lie flat. In this position, your abdomen presses against your diaphragm, making it difficult to breathe. In addition, when you are dreaming (during the REM phase of sleep) all your muscles become paralyzed, except the diaphragm. But if your diaphragm is also paralyzed, your auxiliary respiratory muscles do not work. As a result, you can wake up whenever you enter the REM phase. While sleeping, you may breathe more noisily or very shallowly at times.
When you eat or drink, breathing can become more difficult due to the counterpressure on the diaphragm from the abdomen. Counterpressure can also occur when you jump into a swimming pool or the sea. Due to your reduced physical fitness and poor sleep, you are often very tired. This also has consequences for your concentration and mood.
Treatment What can we do?
If you have obvious problems with lying down and sleeping, we strongly advise you to be referred to a center specializing in home respirators (Centrum voor Thuisbeademing – CTB). Following an interview and examination, the specialized center can provide you with good advice about the improvement that can be expected when using home respirators at night. If the treatment does not lead to sufficient recovery within 3 to 4 years, we can consider treating diaphragm paralysis by means of surgical plication. By folding the central tendon double and fastening it, the diaphragm can exert more force.
Treatments and examinations
Treatment of diaphragmatic paralysis in NA can be done by self-administered measures, overnight ventilation, or (if there is no recovery after 3-4 years) reefing the diaphragm.
to the treatment
The Radboudumc has several consultation hours for patients with (possible) neuralgic amyotrophy or other injuries of the nerves in the shoulder and arm.
to the treatment