How to manage unilateral paralysis of the diaphragm?

Hi,

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Unilateral diaphragmatic paralysis ismost commonly seen on the left side. The diaphragm is the most important muscle of ventilation. Unilateral diaphragmatic paralysis is usually well tolerated if there is no underlying lung or rib cage pathology. But, if severe, then it may cause dyspnea and hypoxemia and require treatment.

The most common cause is nerve compression either trauma or some cancer or it may go unidentified called as idiopathic. Patients usually develop severe restrictive ventilatory impairment on spirometry. The vital capacity and total lung capacity frequently are below 50% of predicted for that patient.

Lung capacity is reduced when the patient assumes the lying down position. The main treatment is directed at the treatment of the underlying etiologic cause andchest physiotherapy. But, in your case as you said, plication is already failed. The only way to increase its strength is by the inspiratory muscle strength and endurance training through physiotherapy. In some cases there is spontaneous recovery if the impairment is mild or if the etiology is removed. But, ultimately it is the endurance training that will help in the long run.

Also, every attempt should be made to prevent any lung infection, which will become very difficult to treat in the future. The probable cause include traumatic or some cancer, causing nerve compression. Investigation to be done is magnetic resonance imaging (MRI) Scan and spirometry. the probable diagnosis may be unilateral diaphragmatic paralysis.

I hope this addresses your concerns.

Please feel free to follow up if you need any additional clarification.

Thank you.