The Possibilities of Diagnosing Diaphragm Dysfunction in the Practice of a Therapist

Aim. To show the diagnostic possibilities of detecting diaphragm dysfunction (DD) in the practice of a therapist using a complex of non-invasive studies, including clinical, radiological, spirometric, ultrasound and neurophysiological techniques. Design. An open cohort study. Materials and methods. 28 patients with DD were examined: 6 with complete DD (DDc) and 22 with partial DD (DDp). The complex of non-invasive studies for suspected DD included clinical, radiological (chest X-ray while standing and lying down, with calm and forced breathing; video recording of the diaphragm during breathing; spiral computed tomography of the chest), spirometric (sitting and lying down), ultrasound and neurophysiological studies. Results. Clinical features of dyspnea (associated with physical exertion, occurrence during lying down, swimming, in combination with comorbid diseases), the presence of a thoracoabdominal paradox, characteristic radiological (high standing of the dome of the diaphragm with decreased mobility, paradoxical movement and a positive Sniff test), spirometric (initial dose was 72 to 48% with a decrease of 20.83 ± 18.49% during the transition to the supine position), ultrasound disorders (decreased excursion of patients with the affected half of the diaphragm and the fraction of thickening of the diaphragm on deep inspiration and Sniff test). DDp was diagnosed in 22 patients, and the results of X-ray examination (with an emphasis on video recording of the respiratory cycle) were crucial. In 12 patients, the diagnosis was confirmed by the results of spirometric and ultrasound examinations. Conclusion. Nonspecific clinical manifestations of DD in combination with comorbid diseases with insufficient knowledge and lack of alertness on the part of the doctor determine its underdiagnosis in real practice. Suspicion of the development of DD should arise in the presence of certain features of dyspnea, a combination of DD with previous procedures (surgical interventions) near the diaphragmatic nerve, and the inability to explain the origin of dyspnea by the most common pathology. The use of a full range of noninvasive studies in the therapist's practice made it possible to identify DDc (in the form of complete hemidiaphragmal paresis) in 6 patients (with evidence at each stage of the examination). DDp was proven in 22 patients based on the results of X-ray (with an emphasis on video recording of the respiratory cycle) and ultrasound examinations in 12 patients. Keywords: dysfunction of the diaphragm, shortness of breath, X-ray and ultrasound examination of the diaphragm, spirometry.