Left phrenic nerve paralyzed after cortsone injection in lower neck area

[tealcondor]

Hi! I am a very healthy 48 yr.old woman with no diseases.I do have a dowager's forward neck posture. I have been a swim instructor for over 20 years.January 2005 I woke up with a neck spasm after sleeping crookedly on my couch. After a few days, spasm did not go away so I got a trigger point injection Kenalog w/ Marcaine at the base of my neck at urgent care . Neck felt better but within a week I was not breathing well at all.Since then I have had every test possible, no tumors, no findings whatsoever.Pulmonologist attributes this to cortisone shot or says it could be idiopathic.Said I need to go home and "mourn" the loss of my diaphragm and move on. Have you ever heard of a cortisone injection wiping out a phrenic nerve like that? I am concerned that this will happen to the other side if they say it is "idiopathic".This all occured on the left side. Is Kenalog the normal injection for that area around the neck/shoulder?
Thank you so much for reading this.Sincerely,
Tealcondor

[The Big Cat]

Is it theoretically possible that cervical stenosis and/or osteophyte growth across the C2-3 juncture could compress the phrenic nerve(s) causing: 1) sensations that an arrested breathing crisis is imminent; and/or  2) actual momentary arrest (a type of apnea?) during sleep with an unfavorable neck position?  If not, why not?  If so, do you know of any actual case studies of such a diagnosis to which I could refer?  
          ---Thanks, The Big Cat

[CCF-Neuro-M.D.-PW]

The phrenic nerve runs from the higher cervical nerve roots in the neck down deep in conjuntion with the major neck vessels into the thorax to supply the diaphragm. It would be unusual for a superfical injection to damage the nerve, unless it went very deep. A direct trauma would have caused symptoms without a delay.

A delay like the above suggests neuralgic amytrophy (see previous question to this). This less commonly affects the phrenic nerve (it commonly affects pure motor nerves preferentially, like the anterior interosseous nerve in the arm and the dorsal scapular nerve in the shoulder, and rarely the phrenic nerve. The cause is not known but some cases run in families. It can be triggered by even trivial trauma or surgery. It may recur in a minority of cases, or affect other nerves. In 90% of people there is improvement or reolution by 1 year, depending on the severity of nerve damage.

Other even rarer causes of idiopathic phrenic nerve palsy might include sarcoid, metastatic involvement by a tumor (evident on a structural scan by a CT), infarction from diabetes/vasculitis, chest disease (also evident on CT) and high cervical spine lesions (also apparent on imaging, and unlikely without other symptoms.

Good luck