Patients with diaphragm paralysis are often led to believe that their only treatment options are nonsurgical therapy or diaphragm plication, neither of which attempt to restore normal function to the paralyzed diaphragm. However, advances in nerve surgery have made it possible to surgically reverse diaphragm paralysis. During this lecture, case managers will gain knowledge on diaphragm paralysis and the surgical treatment options available to patients. Diaphragm paralysis may result in chronic shortness of breath, sleep disturbances, and lower energy levels. This condition can significantly impact an individual’s quality of life and ability to return to work. The phrenic nerve controls function of the diaphragm muscle, the primary muscle involved in breathing. Injury to the phrenic nerve can lead to diaphragm paralysis or dysfunction. During this lecture, we will review the common causes of workplace injury-related diaphragm paralysis. Injuries to the phrenic nerve may occur due to a surgical injury, an anesthetic injury, a manipulation injury or a traumatic accident. In the workplace, phrenic nerve injuries are likely to result from a direct injury caused by a traumatic accident (such as a fall). Phrenic nerve injury may also result from surgical treatment of an unrelated workplace injury. For example, shoulder injuries are a common injury in the workplace that may require surgical treatment. An interscalene nerve block is typically performed to provide anesthesia during shoulder surgeries and carries the risk of potential phrenic nerve injury. We will also discuss surgical options to reverse ventilator dependency in spinal cord injured patients with chronic respiratory insufficiency. This lecture will cover the surgical treatments available for diaphragm paralysis, including phrenic nerve reconstruction, diaphragm pacemakers and diaphragm muscle replacement. We will discuss the benefits of these procedures, current supporting evidence, and how case managers can play a crucial role in helping patients restore respiratory function and return to work.

OBJECTIVES:

• Describe how workplace injuries may lead to diaphragm paralysis.
• Identify the signs and symptoms of diaphragm paralysis and recommend appropriate physician referrals.
• Discuss the surgical treatments available for diaphragm paralysis and potential benefits to patients.

PRESENTER:
Matthew Kaufman, MD