Diaphragmatic Paralysis & Associated Neck Stiffness

[Stanislavyeung]

Since November 2011, I have been feeling left dyspnea that I think is caused by what I think is the diaphragmatic
paralysis on left.

My neck is affected as well but my MRI shows no problem with my cervical spine but I ascertain that this neck
stiffness (when I tilt to either left side or right side with slight movement) has something to do with the diaphragm
problem.

Mr MRI shows that
There are no significant visceral mass or other lesions seen in brain, head and NECK,
thorax, abdomen and pelvis.
No evidence of left PHRENIC NERVE PALSY.

What should I do and what tests should I look for? I am so surprised that even MRI cannot show problems
with my neck.

p.s. I am 19. I am from Hong Kong.

[Stanislavyeung]

Thank you for your comment. It's been 18 months now. I am still convinced that I have pinched my phrenic nerve at my lower left rib.  I have been having left breathing weakness (but not in the most extremities like I don't have to use a ventilator but that nerve right down there does affect my left lower breathing a lot).

I also am experiencing quite a bit of bone swellings at my neck. I haveswollen bones bilaterally that are between my mastoid process and my clavicle bone (both my mastoid process and clavicle are fine) under the left sternocleidomastoid muscles? The bones at the back of my neck, and the bilateral bones near my Adam's apple . Also when I try to maneuver my hyoid bone with my fingers, I can feel the friction and the sound near the sides of the hyoid bone.

It all happens after my phrenic nerve was pinched. I have to say I got the problems with my hyoid and those near Adam's apple recently so they did not arise in the beginning. So all of these are kind of bad I know, and after some digging on Internet, it may have something to do with the cartilages? The one near my Adam's apple should be thyroid cartilages? Though I cannot find a specific name for the swollen parts between my mastoid and clavicle.

i definitely may consult a doctor that specializes in phrenic nerve surgery in new Jersey quite soon, but regarding my neck, which are obviously full of problems, and with no avail to conservative treatments, do you think I am looking at problems with the cartilages? Will I get relief with surgery?

[Paderla Anitha, DNB]

Hello and hope you are doing well.

The symptoms mentioned could be caused by cervical spondylosis. You may be having a nerve compression at the cervical (neck) level. The nerve compression could be due to an osteophyte, growth or a disc. This could be causing the odd sensations. A neurological examination by your primary care physician may confirm this. He may then ask for blood test, an x ray and if needed an MRI to find out what is causing the compression. This is usually treated conservatively (without surgery) with physiotherapy, traction and cervical collars. Please discuss this with your doctor am sure he will provide further assistance.

Hope this helped and do keep us posted.

[Stanislavyeung]

Thank you very much for your reply.

As things happened a bit of time ago, there were many things/some
symptoms I might not feel necessary to mention that might not have
been taken into account for this even though it still is not a
diagnosis but merely you being extremely helpful and giving me an
explanation for my situation as best as you could. I appreciate it
a lot!

I do remember before I felt this nerve dysfunction and this
breathing problem that exist below my left rib cavity, I had a
sharp pain an inch above my belly button towards the middle of my
abdomen below the left ribcage and then the next thing I know, I had a weird sensation a small degree of numbness near the left temporal area.

So later, as this pain subsides, the nerve dysfunction and
the breathing problem began to gradually appear and I at first
didn‘t notice my neck was affected until I could feel the stiffness (and the sensation of numbness was gone after my GP prescribed my with
xanax but at times I would still feel a bit of weakness in my left
temple because the left side of my neck felt stiffer)

After a bit of searching online, I am suspicious the spinous processes
of my upper neck are the culprit. My hands can also feel them being a little abnormal, I can rub the affected areas as if they grow to be little nodules ( i mean the left/right spinous processes)
<(I'm not sure the exact terminologies.)

To me there is a possibility (to me) the origin is neurological
and stems from a pinched/compressed nerve below my left rib cavity
(towards the side) and it works its way towards the middle and to
the back of my neck which I think is the case. Maybe what I experienced is a flaring of the phrenic nerve?

I should have a neck x-ray?

[Paderla Anitha, DNB]

Hello and hope you are doing well.

If there is no evidence of diaphragmatic paralysis on the MRI, its unlikely to be there. Inadequate oxygenation can produce symptoms of breathlessness, as the body tries in an effort to compensate for the decreased oxygen supply. The breathlessness could be due to cardiac or lung disorders. You can have an EKG or a treadmill test to rule out a cardiac cause for your symptoms. Lung function tests could further help in evaluation. Please discuss this with your doctor am sure he will provide further assistance.

Hope this helped and do keep us posted.