Scientific paper
Injuries to the phrenic nerve resulting in diaphragmatic paralysis with special reference to stretch trauma

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Abstract

Traumatic interruption of the phrenic nerve causing diaphragmatic paralysis occurs much more commonly than realized. Patients present with symptoms referable to the respiratory, gastrointestinal, or cardiovascular systems as a result of anatomic displacement of the respective organ (eventration). Symptoms often occur shortly after the injury but may be delayed for many years; consequently, prolonged follow-up of these patients is essential. If patients are symptomatic after trauma, judicious observation is dictated, since many will experience gradual return of normal diaphragmatic function over the succeeding six to twelve months. In those who remain significantly symptomatic, thoracotomy and imbrication of the eventration is a simple and effective surgical procedure.

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    This is often asymptomatic in people who are otherwise in good health; however, it may present with pain, cough, dyspnea, orthopnea, or even respiratory failure.12-15 Respiratory complications include pneumonia.14 Diagnosis is usually confirmed using chest radiograph, which shows a raised hemidiaphragm on the side of the damaged nerve.

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    The phrenic nerves originate from the third to fifth cervical roots and then follow a downward course in the neck in front of the scalenus anterior before entering the thorax; their anatomic position, therefore, explains why they can be injured after a cervical trauma. The most recognized mechanism of phrenic damage is that produced by penetrating and blunt injuries of the neck which accounts for the majority of the cases; to the contrary, stretching of the nerves is very uncommon and has been seldom reported [2,4–6]. The latter has been observed after traffic accidents where extreme displacement of the cervical spine with or without joint dislocation or fracture, causes the injury.

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Presented at the Forty-Seventh Annual Meeting of the Pacific Coast Surgical Association, Monterey, California, February 15–18, 1976.

1

From the Division of Thoracic and Cardiac Surgery, Samuel Merritt Hospital, and the Department of Thoracic Surgery, Highland General Hospital, Oakland, California.

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