CASE REPORT/CASE SERIES
Bilateral Diaphragmatic Paralysis Due to Cervical Chiropractic Manipulation Seby John, MD and Jinny Tavee, MD
Abstract: Neck pain from cervical spinal disease is a common problem with significant disability, and chiropractic manipulation has emerged as one of the leading forms of alternative treatment for such spinal symptoms. However, more experience with these forms of treatment has revealed associated complications that are far from benign. Complications range from mild symptoms, such as local neck tenderness or stiffness, to more severe injuries involving the spinal cord, peripheral nerve roots, and arteries within the neck. Phrenic nerve injury causing diaphragmatic palsy is a rare complication of cervical chiropractic manipulation. We report a case of bilateral diaphragmatic paralysis in a healthy gentleman who underwent cervical manipulation. Physicians must be aware of this complication and should be cautious when recommending spinal manipulation for the treatment of neck pain, especially in the presence of preexisting degenerative disease of the cervical spine. Key Words: cervical chiropractic manipulation, orthopnea, diaphragmatic paralysis, electromyography
(The Neurologist 2015;19:65–67)
C
hiropractic manipulation has emerged as one of the leading forms of alternative treatment for chronic neck pain.1 Complications range from mild symptoms, such as local neck tenderness or stiffness, to more severe injuries involving the spinal cord, peripheral nerve roots, and arteries within the neck. Phrenic nerve injury causing diaphragmatic palsy is a rare complication of cervical chiropractic manipulation.2–7 We report a case of bilateral diaphragmatic paralysis in a patient following cervical manipulation.
On examination, the patient was in no apparent distress while sitting, but would immediately become dyspneic on lying down. General physical examination was normal except for decreased bibasilar breath sounds. Neurological examination was also normal without any focal deficits. Specifically, there were no sensory changes, weakness, or deep tendon reflex abnormalities in the upper extremities. Sniff test revealed absent excursions of both hemidiaphragms during shallow breathing and paradoxical movement during forced inspiration. Pulmonary function tests (PFTs) showed severe restrictive pulmonary impairment with a corresponding severe impairment in the inspiratory muscle strength. Forced vital capacity was decreased and further reduced with supine posture (Table 1). The diffusion capacity was normal. An electromyogram (EMG) was not performed on the first visit because the injury was
Bilateral Diaphragmatic Paralysis Due to Cervical Chiropractic Manipulation Seby John, MD and Jinny Tavee, MD
Abstract: Neck pain from cervical spinal disease is a common problem with significant disability, and chiropractic manipulation has emerged as one of the leading forms of alternative treatment for such spinal symptoms. However, more experience with these forms of treatment has revealed associated complications that are far from benign. Complications range from mild symptoms, such as local neck tenderness or stiffness, to more severe injuries involving the spinal cord, peripheral nerve roots, and arteries within the neck. Phrenic nerve injury causing diaphragmatic palsy is a rare complication of cervical chiropractic manipulation. We report a case of bilateral diaphragmatic paralysis in a healthy gentleman who underwent cervical manipulation. Physicians must be aware of this complication and should be cautious when recommending spinal manipulation for the treatment of neck pain, especially in the presence of preexisting degenerative disease of the cervical spine. Key Words: cervical chiropractic manipulation, orthopnea, diaphragmatic paralysis, electromyography
(The Neurologist 2015;19:65–67)
C
hiropractic manipulation has emerged as one of the leading forms of alternative treatment for chronic neck pain.1 Complications range from mild symptoms, such as local neck tenderness or stiffness, to more severe injuries involving the spinal cord, peripheral nerve roots, and arteries within the neck. Phrenic nerve injury causing diaphragmatic palsy is a rare complication of cervical chiropractic manipulation.2–7 We report a case of bilateral diaphragmatic paralysis in a patient following cervical manipulation.
On examination, the patient was in no apparent distress while sitting, but would immediately become dyspneic on lying down. General physical examination was normal except for decreased bibasilar breath sounds. Neurological examination was also normal without any focal deficits. Specifically, there were no sensory changes, weakness, or deep tendon reflex abnormalities in the upper extremities. Sniff test revealed absent excursions of both hemidiaphragms during shallow breathing and paradoxical movement during forced inspiration. Pulmonary function tests (PFTs) showed severe restrictive pulmonary impairment with a corresponding severe impairment in the inspiratory muscle strength. Forced vital capacity was decreased and further reduced with supine posture (Table 1). The diffusion capacity was normal. An electromyogram (EMG) was not performed on the first visit because the injury was
![[Bilateral diaphragmatic paralysis due to Parsonage-Turner syndrome].](/assets/img/hold.png)
