Nicked Phrenic Nerve Causes Respiratory Issues

This case involved a 45-year-old male patient with a significant past medical history of shoulder pain secondary to a sports related rotator cuff injury. The patient underwent a brachial plexus interscalene block procedure for pain management therapy. As a consequence of treatment, the patient suffered severe damage to the phrenic nerve and resultant paralysis of the diaphragm.

Question(s) For Expert Witness

1. How common is a phrenic nerve injury and what are its causes?

Expert Witness Response

Peripheral phrenic nerve injuries result from damage to the nerve along its path in the cervical area or the thorax. A number of clinical entities can affect the phrenic nerve directly, including trauma, open heart surgery or thoracic surgery, chiropractic cervical spine manipulation, radiation therapy, or demyelinating diseases. This condition is relatively uncommon after surgery since its pathway should be noted by major anatomical landmarks and great care should be taken to avoid such a major nerve and all of its branches.