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Phrenic nerve damage

  My husband had his phrenic nerve damaged during a rough hickman catheter
  removal two and a half months ago. I know it is unusual. His diaphragm is
  elevated and his lung collapses. The worst part is that he has not had much
  relief from pain. I want to make sure that we are doing everything there is
  to do. He has been referred to a pain clinic, but we are more interested in
  getting rid of the pain than dulling it. What are the chances of the nerve
  healing. There is a definite swelling at the base of the neck. Should we
  go to see a doctor elsewhere that knows what to do? So far no one has ever
  seen this and all they say is that it may be permanent.
Thanks for your question.  There are at least two separate issues in your
husband's case, the pain symptoms, and the motor function of the phrenic
nerve.  There are Nerve Conduction Exam techniques to evaluate quantitatively
the motor function of the phrenic nerve, but the results are often difficult
to interpret, primarily because of the location of this nerve, and the
diaphragm muscle in the chest cavity.  In many ways, the clearest indicator
of the function of the nerve (or lack of function) in your husband's case
is the elevated hemi-diaphragm in the chest X-ray.  If the latest X-ray
which showed the deficit in diaphragmatic motility is recent, it is very
likely that the nerve was indeed completely transected.  In that case, the
chances of regeneration/recovery of the nerve would unfortunately be very
small.  One imaging study that you might want to discuss with your physicians
is a so-called "SNIFF" test.  It basically consists in the observation of
diaphragmatic movement under direct fluoroscopy (X-ray).
Regarding your husband's pain symptoms, it is worrisome that there is an
external alteration in local anatomy - the "swelling" at the base of his
neck.  It would be very helpful to obtain an imaging study (preferably
an MRI scan) of the base of his neck.  There are a large number of very
important blood vessels and peripheral nerves in that region besides the
phrenic nerve, and the pain could be an indicator of organ damage.
I hope this information is helpful.  Best of luck.
This information is provided for general medical education purposes only.
Please consult your doctor regarding diagnostic and treatment options.

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