The diaphragm, a dome-shaped skeletal muscle which separates the abdomen from the thoracic cavity, assists with breathing, aids in defecation, and in giving birth. Rupture of a structure is defined as an organ or tissue that breaks apart. In this case, the tissue involved is the diaphragm. Herniation occurs when there is a bulge of an organ or a part of an organ through the wall of the cavity that normally contains it.

Muscle injury and failure of movement of the diaphragm include: trauma, surgery, gunshot wounds, or blasts.

Signs and symptoms that may manifest from rupture of the diaphragm may include: difficulty in breathing, especially during the inspiratory phase; and difficulty in moving the bowels and expulsion of the child during childbirth. Other expulsive efforts include: sneezing, coughing, vomiting etc. In addition, if herniation of the diaphragm occurs, respiratory distress or strangulation and gangrene of the fundus of the stomach may occur.

A physical examination is usually done, but it may be difficult to carry out due to pain. Muscle strength is tested and graded on a scale of 0 (none) to 5 (normal). Evaluations of motor strength and muscle deterioration are done. In addition, to determine the movements of the diaphragm, a diaphragmatic excursion measurement may be done, and arterial blood gases (ABG), with or without pulse oximetry, are usually done to evaluate adequacy of oxygenation. X-rays may be done to evaluate the hernia.

Herniation repair is usually done via surgery. Once the herniation is repaired and the patient has recovered, physical therapy is one of the major treatments to restore and maintain muscle function. In addition, transcutaneous electrical nerve stimulation (TENS), and ultrasound may be helpful. Anti-inflammatory drugs and muscle relaxants may also be used in cases that involve muscle spasm secondary to inflammation. In addition, patients may also require supplemental oxygen or artificial ventilation to maintain oxygen levels until the condition improves.

Physical capabilities require certain functioning muscles to perform activities of daily living (ADL). The extent of muscle injury and recovery will determine the outcome for independent living. Muscle injury that is caused by trauma, gunshot wounds, or blasts may result in scars (see Diagnostic Code: 7804 Scars, superficial, painful on examination). In addition, injury to the diaphragmatic area may result in inadequate oxygenation and acid-base imbalance, as well as malnutrition. This could lead to extended treatment due to residuals experienced.

• Rate under diagnostic code 7346.

Notes

• None.