Diaphragmatic Paralysis

1. Place flat portion of one hand in infraclavicular region and the other below costal margin. Note the contribution of intercostals and diaphragm in expanding the chest. Make a similar assessment of the other side.
2. Infracostal Movement:
   Apply both your palms along infracostal region and note the symmetrical downward displacement of hands with deep inspiration. There is symmetrical outward movement of epigastrium with inspiration. In diaphragmatic paralysis there will be ipsilateral inspiratory retraction of epigastrium (Paradoxical movement). This results in see-saw movement of epigastrium during respiration.
3. Tidal Percussion:
   Percuss diaphragmatic position with deep inspiration and expiration and assess the depth of mobility.
4. Orthopnea:
   Diaphragm assumes 80% function for inspiration in supine position. Hence if the diaphragm is paralyzed, significant compromise occurs and patients become very short of breath.