The canine phrenic-to-intercostal reflex
- Balkowiec A, Kukula K, Szulczyk P. Functional classification of afferent phrenic nerve fibres and diaphragmatic receptors in cats. The Journal of Physiology. 1995;483:759–768.[PMC free article] [PubMed] [Google Scholar]
- Brichant JF, De Troyer A. On the intercostal muscle compensation for diaphragmatic paralysis in the dog. The Journal of Physiology. 1997;500:245–253.[PMC free article] [PubMed] [Google Scholar]
- Cardin A. Distribuzione radicolare dei nervi frenici nel diaframma. Bolletino della Societa Italiana di Biologia Sperimentale. 1936;11:102–106.[Google Scholar]
- Corda M, von Euler C, Lennerstrand G. Proprioceptive innervation of the diaphragm. The Journal of Physiology. 1965;178:161–177.[PMC free article] [PubMed] [Google Scholar]
- De Troyer A. The electro-mechanical response of canine inspiratory intercostal muscles to increased resistance: the cranial rib-cage. The Journal of Physiology. 1992;451:445–461.[PMC free article] [PubMed] [Google Scholar]
- De Troyer A. Rib motion modulates inspiratory intercostal activity in dogs. The Journal of Physiology. 1996;492:265–275.[PMC free article] [PubMed] [Google Scholar]
- De Troyer A. Role of joint receptors in modulation of inspiratory intercostal activity by rib motion in dogs. The Journal of Physiology. 1997;503:445–453.[PMC free article] [PubMed] [Google Scholar]
- De Troyer A, Farkas GA. Inspiratory function of the levator costae and external intercostal muscles in the dog. Journal of Applied Physiology. 1989;67:2614–2621. [PubMed] [Google Scholar]
- De Troyer A, Kelly S. Chest wall mechanics in dogs with acute diaphragm paralysis. Journal of Applied Physiology. 1982;53:373–379. [PubMed] [Google Scholar]
- De Troyer A, Sampson M, Sigrist S, Macklem PT. Action of costal and crural parts of the diaphragm on the rib cage in dog. Journal of Applied Physiology. 1982;53:30–39. [PubMed] [Google Scholar]
- Duron B, Jung-Caillol MC, Marlot D. Réflexe inhibiteur phrénico-phrénique. In: Duron B, editor. Respiratory Centres and Afferent Systems. Vol. 59. Paris: INSERM; 1976. pp. 193–197. [Google Scholar]
- Duron B, Jung-Caillol MC, Marlot D. Myelinated nerve fiber supply and muscle spindles in the respiratory muscles of cat: quantitative study. Anatomy and Embryology. 1978;152:171–192. [PubMed] [Google Scholar]
- Gill PK, Kuno M. Excitatory and inhibitory actions on phrenic motoneurones. The Journal of Physiology. 1963;168:274–289.[PMC free article] [PubMed] [Google Scholar]
- Hilaire GG, Nicholls JG, Sears TA. Central and proprioceptive influences on the activity of levator costae motoneurones in the cat. The Journal of Physiology. 1983;342:527–548.[PMC free article] [PubMed] [Google Scholar]
- Hinsey JC, Hare K, Phillips RA. Sensory components of the phrenic nerve of the cat. Proceedings of the Society for Experimental Biology and Medicine. 1939;41:411–414.[Google Scholar]
- Hussain SNA, Magder S, Chatillon A, Roussos C. Chemical activation of thin-fiber phrenic afferents: respiratory responses. Journal of Applied Physiology. 1990;69:1002–1011. [PubMed] [Google Scholar]
- Jami L. Golgi tendon organs in mammalian skeletal muscle: functional properties and central actions. Physiological Reviews. 1992;72:623–666. [PubMed] [Google Scholar]
- Jammes Y, Buchler B, Delpierre S, Rasidakis A, Grimaud C, Roussos C. Phrenic afferents and their role in inspiratory control. Journal of Applied Physiology. 1986;60:854–860. [PubMed] [Google Scholar]
- Jammes Y, Speck DF. Respiratory control by diaphragmatic and respiratory muscle afferents. In: Dempsey JA, Pack AI, editors. Regulation of Breathing. 2. New York, USA: Marcel Dekker; 1995. pp. 543–582. [Google Scholar]
- Katagiri M, Young RN, Platt RS, Kieser TM, Easton PA. Respiratory muscle compensation for unilateral or bilateral hemidiaphragm paralysis in awake canines. Journal of Applied Physiology. 1994;77:1972–1982. [PubMed] [Google Scholar]
- Kaufman M. Afferents from limb skeletal muscles. In: Dempsey JA, Pack AI, editors. Regulation of Breathing. 2. New York, USA: Marcel Dekker; 1995. pp. 583–616. [Google Scholar]
- Kaufman M, Rybicki KJ. Discharge properties of group III and IV muscle afferents: their response to mechanical and metabolic stimuli. Circulation Research. 1987;61:160–165. [PubMed] [Google Scholar]
- Landau BR, Akert K, Roberts TS. Studies on the innervation of the diaphragm. Journal of Comparative Neurology. 1962;119:1–10.[Google Scholar]
- Langford LA, Schmidt RF. An electron microscopic analysis of the left phrenic nerve in the rat. Anatomical Records. 1983;205:207–213. [PubMed] [Google Scholar]
- Ninane V, Farkas GA, Baer R, De Troyer A. Mechanism of rib cage inspiratory muscle recruitment in diaphragmatic paralysis. American Review of Respiratory Disease. 1989;139:146–149. [PubMed] [Google Scholar]
- Nochomovitz L, Goldman M, Mitra J, Cherniack NS. Respiratory responses in reversible diaphragm paralysis. Journal of Applied Physiology. 1981;51:1150–1156. [PubMed] [Google Scholar]
- Rijlant P. Contribution à l'étude du contrôle réflexe de la respiration. Bulletin de l'Académie de Médecine de Belgique. 1942;7:58–107.[Google Scholar]
- Speck DF. Supraspinal involvement in the phrenic-to-phrenic inhibitory reflex. Brain Research. 1987;414:169–172. [PubMed] [Google Scholar]
- Speck DF, Revelette WR. Attenuation of phrenic motor discharge by phrenic nerve afferents. Journal of Applied Physiology. 1987a;62:941–945. [PubMed] [Google Scholar]
- Speck DF, Revelette WR. Excitation of dorsal and ventral respiratory group neurons by phrenic nerve afferents. Journal of Applied Physiology. 1987b;62:946–951. [PubMed] [Google Scholar]
- Stradling JR, Kozar LF, Dark J, Kirby T, Andrey SM, Phillipson EA. Effect of acute diaphragm paralysis on ventilation in awake and sleeping dogs. American Review of Respiratory Disease. 1987;136:633–637. [PubMed] [Google Scholar]
- Strohl KP. Respiratory activation of the facial nerve and alar muscles in anaesthetized dogs. The Journal of Physiology. 1985;363:351–362.[PMC free article] [PubMed] [Google Scholar]
"Phrenectomy" redirects here. It is not to be confused with frenectomy, removal of a frenulum.
The phrenic nerve is a mixed motor/sensory nerve which originates from the C3-C5 spinal nerves in the neck. The nerve is important for breathing because it provides exclusive motor control of the diaphragm, the primary muscle of respiration. In humans, the right and left phrenic nerves are primarily supplied by the C4 spinal nerve, but there is also contribution from the C3 and C5 spinal nerves. From its origin in the neck, the nerve travels downward into the chest to pass between the heart and lungs towards the diaphragm.
In addition to motor fibers, the phrenic nerve contains sensory fibers, which receive input from the central tendon of the diaphragm and the mediastinal pleura, as well as some sympathetic nerve fibers. Although the nerve receives contributions from nerves roots of the cervical plexus and the brachial plexus, it is usually considered separate from either plexus.
The nerve is named from the Ancient Greekphren, meaning diaphragm.
The phrenic nerve originates in the phrenic motor nucleus in the ventral horn of the cervical spinal cord. It descends obliquely with the internal jugular vein across the anterior scalene, deep to the prevertebral layer of deep cervical fascia and the transverse cervical and suprascapular arteries. On the left, the phrenic nerve crosses anterior to the first part of the subclavian artery. On the right, it lies on the anterior scalene muscle and crosses anterior to the 2nd part of the subclavian artery. On both sides, the phrenic nerve usually runs posterior to the subclavian vein as it enters the thorax where it runs anterior to the root of the lung and between the fibrous pericardium and mediastinal parietal pleura.
The pericardiacophrenic arteries and veins travel with their respective phrenic nerves.
The phrenic nerve can be marked by a line connecting these two points:
- 1st point can be labelled 3.5 cm at the level of the thyroid cartilage from the midsagittal plane.
- 2nd point is at the medial end of the clavicle.
As with most nerves in the neck, multiple anatomic variants have been described. Notably, there may be variability in the course of the phrenic nerve in the retroclavicular region such that the nerve courses anterior to the subclavian vein, rather than its typical position posterior to the vein (between the subclavian vein and artery). This variant may predispose the phrenic nerve to injury during subclavian vascular cannulation.
In addition, an accessory phrenic nerve is commonly identified, present in up to 75% of a cadaveric study.
In canines the phrenic nerve arises from C5-C7 with occasional small contributions from C4. In the cat, horse, ox, and small ruminant the phrenic nerve arises variably from C4-C7.
Both of these nerves supply motor fibers to the diaphragm and sensory fibers to the fibrous pericardium, mediastinal pleura, and diaphragmatic peritoneum.
Some sources describe the right phrenic nerve as innervating the gallbladder, other sources make no such mention. The right phrenic nerve may also supply the capsule of the liver.
Pain arising from structures supplied by the phrenic nerve is often "referred" to other somatic regions served by spinal nerves C3-C5. For example, a subphrenic abscess beneath the right diaphragm might cause a patient to feel pain in the right shoulder.
Irritation of the phrenic nerve (or the tissues it supplies) leads to the hiccup reflex. A hiccup is a spasmodic contraction of the diaphragm, which pulls air against the closed folds of the larynx.
The phrenic nerve must be identified during thoracic surgery and preserved. To confirm the identity of the phrenic nerve, a doctor may gently manipulate it to elicit a dartle (diaphragmatic startle) response. The right phrenic nerve may be crushed by the vena cava clamp during liver transplantation. Severing the phrenic nerve, or a phrenectomy, will paralyse that half of the diaphragm. Bilateral diaphragmatic paralysis or BDP can also be caused by spinal cord injury, motor neuron disease, infection, pneumonia, sarcoidosis, multiple sclerosis, polyneuropathy, myopathy and amyotrophy, cardiac surgery, lung transplantation, or mediastinal tumors. Diaphragm paralysis is best demonstrated by sonography. Breathing will be made more difficult but will continue provided the other nerve is intact.
The phrenic nerve arises from the neck (C3-C5) and innervates the diaphragm, which is much lower. Hence, patients suffering spinal cord injuries below the neck are still able to breathe effectively, despite any paralysis of the lower limbs.
Brachial plexus injuries can cause paralysis to various regions in the arm, forearm, and hand depending on the severed nerves. The resulting palsy has been clinically treated using the phrenic nerve as a donor for neurotization of the musculocutaneous nerve and the median nerve. This treatment has a high success rate (84.6%) in partial to full restoration of the innervation to the damaged nerve. Furthermore, this procedure has resulted in restored function to nerves in the brachial plexus with minimal impact to respiratory function of the phrenic nerve. The instances where pulmonary vital capacity is reduced have typically been a result of use of the right phrenic as the donor for the neurotization whereas use of left phrenic nerve has not been significantly linked to reduced pulmonary vital capacity.
This article uses anatomical terminology.
- ^O'Rahilly, Ronan (2008). Basic Human Anatomy. Hanover, New Hampshire: Geisel School of Medicine. Retrieved 3 April 2019.
- ^Moore, Keith L. (1999). Clinically oriented anatomy. Philadelphia: Lippincott Williams & Wilkins. ISBN .[page needed]
- ^ abPrakash; Prabhu, L. V.; Madhyastha, S; Singh, G (2007). "A variation of the phrenic nerve: Case report and review"(PDF). Singapore Medical Journal. 48 (12): 1156–7. PMID 18043847.
- ^Evans, Howard (1979). Miller's Anatomy of the Dog. Philadelphia, PA: W. B. Saunders Company. p. 978. ISBN .
- ^Alexander, William (1940). "The innervation of the biliary system". Journal of Comparative Neurology. 72 (2): 357–370. doi:10.1002/cne.900720205.
- ^Lautt, W. Wayne (2009). "Hepatic Nerves". Morgan & Claypool Life Sciences.
- ^Dalman, Ronald; Thompson, Robert (2015). "7. Neurogenic Thoracic Outlet Syndrome Exposure and Decompression: Supraclavicular". Operative Techniques in Vascular Surgery. Philadelphia, PA: Wolters Kluwer Health. p. 50. ISBN .
- ^ abMcAlister, Vivian C.; Grant, David R.; Roy, Andre; Brown, William F.; Hutton, Linda C.; Leasa, David J.; Ghent, Cameron N.; Veitch, James E.; Wall, William J. (1993). "Right phrenic nerve injury in orthotopic liver transplantation". Transplantation. 55 (4): 826–30. doi:10.1097/00007890-199304000-00027. PMID 8475559.
- ^Hine, Maynard Kiplinger (1975). Review of dentistry: questions and answers (6th ed.). Mosby. p. 421. ISBN .
- ^Mizubuti, Glenio, MD, MSc, Wang, Louie, et al. Perioperative Management for Abdominal Surgery in Bilateral Diaphragmatic Paralysis: A Case Report and Literature Review. A&A Case Reports. 2017;9(10):280-282. doi:10.1213/XAA.0000000000000592.
- ^Chen HY, Chen HC, Lin MC, Liaw MYBilateral diaphragmatic paralysis in a patient with critical illness polyneuropathy: a case report. Medicine (Baltimore). 2015;94:e1288.
- ^ abYu-Dong, G., Min-Ming, W., Yi-Lu, Z., Jia-Ao, Z., Gao-Meng, Z., De-Song, C., Ji-Geng, Y. and Xiao-Ming, C. (1989), Phrenic nerve transfer for brachial plexus motor neurotization. Microsurgery, 10: 287–289. doi: 10.1002/micr.1920100407
- ^Luedemann, Wolf, Michael Hamm, Ulrike Blömer, Madjid Samii, and Marcos Tatagiba. "Brachial Plexus Neurotization with Donor Phrenic Nerves and Its Effect on Pulmonary Function." Journal of Neurosurgery 96.3 (2002): 523-26. Web.
Suspected bilateral phrenic nerve damage following a mediastinal mass removal in a 17-week-old pug
1. Kitchell RL, Evans HE. The spinal nerves. In: Evans HE, editor. Miller’s Anatomy of the Dog. 3rd ed. Philadelphia, Pennsylvania: Saunders; 1993. pp. 829–893. [Google Scholar]
2. Robinson NE. Overview of respiratory function: Ventilation of the lung. In: Cunningham JG, Klein BG, editors. Textbook of Veterinary Physiology. 3rd ed. Philadelphia, Pennsylvania: Saunders; 2002. pp. 468–478. [Google Scholar]
3. Warner WP. Phrenicotomy in traumatic injury to the chest. Can Med Assoc J. 1926;16:427–428.[PMC free article] [PubMed] [Google Scholar]
4. Ostrowska M, de Carvalho M. Prognosis of phrenic nerve injury following thoracic interventions: Four new cases and a review. Clin Neurol Neurosurg. 2012;114:199–204. [PubMed] [Google Scholar]
5. Aguirre VJ, Sinha P, Zimmet A, Lee GA, Kwa L, Rosenfeldt F. Phrenic nerve injury during cardiac surgery: Mechanisms, management and prevention. Heart Lung Circ. 2013;22:895–902. [PubMed] [Google Scholar]
6. Merino-Ramírez MA, Juan G, Ramón M, Cortijo J, Morcillo EJ. Diaphragmatic paralysis following minor cervical trauma. Muscle Nerve. 2007;36:267–270. [PubMed] [Google Scholar]
7. Ross Russell RI, Helms PJ, Elliott MJ. A prospective study of phrenic nerve damage after cardiac surgery in children. Intensive Care Med. 2008;34:728–734. [PubMed] [Google Scholar]
8. Tripp HF, Bolton JW. Phrenic nerve injury following cardiac surgery: A review. J Card Surg. 1998;13:218–223. [PubMed] [Google Scholar]
9. Zhang YB, Wang X, Li SJ, Yang KM, Sheng XD, Yan J. Postoperative diaphragmatic paralysis after cardiac surgery in children: Incidence, diagnosis and surgical management. Chin Med J. 2013;126:4083–4087. [PubMed] [Google Scholar]
10. Jiang S, Xu WD, Shen YD, Xu JG, Gu YD. An anatomical study of the full-length phrenic nerve and its blood supply: Clinical implications for endoscopic dissection. Anat Sci Int. 2011;86:225–231. [PubMed] [Google Scholar]
11. Joho-Arreola A, Bauersfeld U, Stauffer U, Baenziger O, Bernet V. Incidence and treatment of diaphragmatic paralysis after cardiac surgery in children. Eur J Cardiothorac Surg. 2005;27:53–57. [PubMed] [Google Scholar]
12. Chandler KW, Rozas CJ, Kory RC, Goldman AL. Bilateral diaphragmatic paralysis complicating local cardiac hypothermia during open heart surgery. Am J Med. 1984;77:243–249. [PubMed] [Google Scholar]
13. Lemmer J, Stiller B, Heise G, et al. Postoperative phrenic nerve palsy: Early clinical implications and management. Intensive Care Med. 2006;32:1227–1233. [PubMed] [Google Scholar]
14. Katagiri M, Young RN, Platt RS, Kieser TM, Easton PA. Respiratory muscle compensation for unilateral or bilateral hemidiaphragm paralysis in awake canines. J Appl Physiol. 1994;77:1972–1982. [PubMed] [Google Scholar]
15. Stradling JR, Kozar LF, Dark J, Kirby T, Andrey SM, Phillipson EA. Effect of acute diaphragm paralysis on ventilation in awake and sleeping dogs. Am Rev Respir Dis. 1987;136:633–637. [PubMed] [Google Scholar]
16. de Troyer A, Leduc D, Cappello M. Bilateral impact on the lung of hemidiaphragmatic paralysis in the dog. Respir Physiol Neurobiol. 2009;166:68–72. [PubMed] [Google Scholar]
17. Pettifer GR, Grubb TL. Neonatal and geriatric patients. In: Tranquili WJ, Thurmon JC, Grimm KA, editors. Lumb and Jones’ Veterinary Anesthesia and Analgesia. 4th ed. Ames, Iowa: Blackwell Publishing; 2007. pp. 985–991. [Google Scholar]
18. Senn D, Sigrist N, Forterre F, Howard J, Spreng D. Retrospective evaluation of postoperative nasotracheal tubes for oxygen supplementation in dogs following surgery for brachycephalic syndrome: 36 cases (2003–2007) J Vet Emerg Crit Care. 2011;21:261–267. [PubMed] [Google Scholar]
19. de Leeuw M, Williams JM, Freedom RM, Williams WG, Shemie SD, McCrindle BW. Impact of diaphragmatic paralysis after cardiothoracic surgery in children. J Thorac Cardiovasc Surg. 1999;118:510–517. [PubMed] [Google Scholar]
20. Iverson LI, Mittal A, Dugan DJ, Sampson PC. Injuries to the phrenic nerve resulting in diaphragmatic paralysis with special reference to stretch trauma. Am J Surg. 1976;132:263–269. [PubMed] [Google Scholar]
21. Hopper K, Haskins SC, Kass PH, Rezende ML, Aldrich J. Indications, management, and outcome of long-term positive-pressure ventilation in dogs and cats: 148 cases (1990–2001) J Am Vet Med Assoc. 2007;230:64–75. [PubMed] [Google Scholar]
22. King LG, Hendricks JC. Use of positive-pressure ventilation in dogs and cats: 41 cases (1990–1992) J Am Vet Med Assoc. 1994;204:1045–1052. [PubMed] [Google Scholar]
23. Lee JA, Drobatz KJ, Koch MW, King LG. Indications for and outcome of positive-pressure ventilation in cats: 53 cases (1993–2002) J Am Vet Med Assoc. 2005;226:924–931. [PubMed] [Google Scholar]
24. Beal MW, Paglia DT, Griffin GM, Hughes D, King LG. Ventilatory failure, ventilator management, and outcome in dogs with cervical spinal disorders: 14 cases (1991–1999) J Am Vet Med Assoc. 2001;218:1598–1602. [PubMed] [Google Scholar]
25. Bruchim Y, Aroch I, Sisso A, et al. A retrospective study of positive pressure ventilation in 58 dogs: Indications, prognostic factors and outcome. J Small Anim Pract. 2014;55:314–319. [PubMed] [Google Scholar]
26. Campbell VL, King LG. Pulmonary function, ventilator management, and outcome of dogs with thoracic trauma and pulmonary contusions: 10 cases (1994–1998) J Am Vet Med Assoc. 2000;217:1505–1509. [PubMed] [Google Scholar]
27. Hoareau GL, Mellema MS, Silverstein DC. Indication, management, and outcome of brachycephalic dogs requiring mechanical ventilation. J Vet Emerg Crit Care. 2011;21:226–235. [PubMed] [Google Scholar]
The Phrenic Nerve
The phrenic nerve is a bilateral, mixed nerve that originates from the cervical nerves in the neck and descends through the thorax to innervate the diaphragm.
It is the only source of motor innervation to the diaphragm and therefore plays a crucial role in breathing.
In this article, we shall look at the anatomy of the phrenic nerve – its anatomical course, motor and sensory functions.
- Nerve roots - anterior rami of C3, C4 and C5.
- Motor functions - innervates the diaphragm.
- Sensory functions - innervates the central part of the diaphragm, the pericardium and the mediastinal part of the parietal pleura.
The phrenic nerve originates from cervical spinal roots C3, C4 and C5 . This can be remembered using the limerick “C3, 4 and 5 keep the diaphragm alive”. Spinal root C4 provides the main contribution, with lesser contributions from C3 and C5 and some communicating fibres from the cervical plexus.
The nerve arises at the lateral border of the anterior scalene muscle. It then passes inferiorly over the anterior surface of anterior scalene, deep to the prevertebral layer of cervical fascia. On both sides, the nerve runs posterior to the subclavian vein. From here, the course of the phrenic nerve differs between the left and right:
Right Phrenic Nerve
- Passes anteriorly over the lateral part of the right subclavian artery.
- Enters the thorax via the superior thoracic aperture.
- Descends anteriorly along the right lung root.
- Courses along the pericardium of the right atrium of the heart.
- Pierces the diaphragm at the inferior vena cava opening.
- Innervates the inferior surface of the diaphragm.
Left Phrenic Nerve
- Passes anteriorly over the medial part of the left subclavian artery.
- Enters the thorax via the superior thoracic aperture.
- Descends anterior to the left lung root.
- Crosses the aortic arch and bypasses the vagus nerve.
- Courses along the pericardium of the left ventricle.
- Pierces and innervates the inferior surface of the diaphragm.
The phrenic nerve provides motor innervation to the diaphragm; the main muscle of respiration.
As the phrenic nerve is a bilateral structure, each nerve supplies the ipsilateral side of the diaphragm (the hemi-diaphragm on the same side as itself).
Sensory fibres from the phrenic nerve supply the central part of the diaphragm, including the surrounding pleura and peritoneum. The nerve also supplies sensation to the mediastinal pleura and the pericardium.
Clinical Relevance: Diaphragmatic Paralysis
The phrenic nerve provides motor innervation to the diaphragm. If the nerve becomes damaged, paralysis of the diaphragm can result. Causes of phrenic nerve palsy include:
- Mechanical trauma – ligation or damage to the nerve during surgery.
- Compression – due to a tumour within the chest cavity.
- Neuropathies – such diabetic neuropathy.
Paralysis of the diaphragm produces a paradoxical movement. The affected side of the diaphragm moves upwards during inspiration, and downwards during expiration. A unilateral diaphragmatic paralysis is usually asymptomatic and is most often an incidental finding on x-ray. If both sides are paralysed, the patient may experience poor exercise tolerance, orthopnoea and fatigue. Lung function tests will show a restrictive deficit.
Management of diaphragmatic paralysis is two-fold. Firstly, the underlying cause must be identified and treated (if possible). The second part of treatment deals with symptomatic relief. This is usually via non-invasive ventilation, such as a CPAP (continuous positive airway pressure).
Nerve dog phrenic
.Cervical Plexus - Anatomy Tutorial
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