Abstract Details

Title Bilateral Diaphragmatic Paralysis As A Complication Of Chiropractic Cervical Manipulation

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 12-028

Objective Chiropractic manipulation is a common treatment in the U.S. Rarely, serious neurological complications such as arterial dissections with stroke, radiculopathies, myelopathies, and neuropathies can occur. We report a patient with bilateral diaphragmatic paralysis following chiropractic cervical manipulation.

Background A previously healthy 54 year old man presented with a 6 month history of sudden onset severe pain in his neck, orthopnea that forced him to sleep sitting up, and dyspnea on exertion that all began immediately after chiropractic cervical manipulation. After several days the pain subsided but his dyspnea and orthopnea persisted.

Design/Methods NA

Results Examination and testing revealed winging of the right scapula, but was otherwise normal, forced vital capacity of 2.09 liters (44% of predicted), with minimal diaphragm movement visible on fluoroscopy bilaterally. Routine electrodiagnostic studies were normal, but phrenic nerve conduction responses were absent bilaterally.

Conclusions The combination of scapular winging and impaired diaphragmatic movement suggests a C3-C5 radiculopathy and possible phrenic neuropathy. Diaphragmatic paralysis usually presents with symptoms of dyspnea, a restrictive process on pulmonary testing, or radiographic elevation of one or both hemidiaphragms. Dyspnea in bilateral diaphragmatic paralysis universally worsens in the supine position due to a marked reduction in vital capacity from increased abdominal pressure and cranial displacement of the diaphragm. Diaphragmatic paralysis is more common than clinically recognized. Most cases are iatrogenic but the etiology remains unidentified in more than two thirds of cases. Bilateral diaphragmatic paralysis causes severe morbidity in adults and the prognosis depends on the underlying process. When phrenic nerve injury is not due to a progressive or generalized disease, recovery may take months to years. Phrenic nerve injury is a rare but serious complication of cervical manipulation and the degree of recovery can be variable. In all cases of idiopathic phrenic nerve paralysis, we recommend taking a careful history about previous cervical manipulation.

Authors/Disclosures
James Noto, DO PRESENTER	No disclosure on file
William K. Jens, DO, FAAN (UPMC)	Dr. Jens has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Abvie.
Zachary Simmons, MD, FAAN (Penn State Hershey Med Center)	Dr. Simmons has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amylyx. Dr. Simmons has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Clene. Dr. Simmons has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Insmed. Dr. Simmons has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Simmons has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Corcept. The institution of Dr. Simmons has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wiley. The institution of Dr. Simmons has received research support from MGH. The institution of Dr. Simmons has received research support from Clene. The institution of Dr. Simmons has received research support from NIH via MGH. The institution of Dr. Simmons has received research support from Aburo. The institution of Dr. Simmons has received research support from NIH subaward via Univ of Pennsylvania.

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