Where is diaphragm in body

Here, learn about its anatomy, functions, and the kinds of health problems that can occur. Health Conditions Discover Plan Connect. Diaphragm Overview. Diaphragm anatomy and function. These openings include the: Esophageal opening. The esophagus and vagus nerve , which controls much of the digestive system, pass through this opening. Aortic opening. The thoracic duct , a main vessel of the lymphatic system, also passes through this opening. Caval opening.

The inferior vena cava , a large vein that transports blood to the heart, passes through this opening. Diaphragm diagram. Explore the interactive 3-D diagram below to learn more about the diaphragm. Diaphragm conditions. A range of health conditions can affect or involve the diaphragm. Hiatal hernia A hiatal hernia happens when the upper part of the stomach bulges through the esophageal opening of the diaphragm.

But a larger hiatal hernia may cause some symptoms, including: heartburn acid reflux trouble swallowing chest pain that sometimes radiates to the back Larger hiatal hernias sometimes require surgical repair, but other cases are usually manageable with over-the-counter antacid medication.

Diaphragmatic hernia A diaphragmatic hernia happens when at least one abdominal organ bulges into the chest through an opening in the diaphragm. They may include: difficulty breathing rapid breathing rapid heart rate blueish-colored skin bowel sounds in the chest Both an ADH and CDH require immediate surgery to remove the abdominal organs from the chest cavity and repair the diaphragm.

Cramps and spasms A diaphragmatic cramp or spasm can cause chest pain and shortness of breath that can be mistaken for a heart attack. Diaphragm spasms usually go away on their own within a few hours or days.

It can also cause: shortness of breath chest tightness chest pain abdominal pain Phrenic nerve damage Several things can damage the phrenic nerve, including traumatic injuries surgery cancer in the lungs or nearby lymph nodes spinal cord conditions autoimmune disease neuromuscular disorders, such as multiple sclerosis certain viral illnesses This damage can cause dysfunction or paralysis of the diaphragm. When it does, possible symptoms include: shortness of breath when lying flat or exercising morning headaches trouble sleeping chest pain.

Symptoms of a diaphragm condition. Symptoms of a diaphragm condition may include: difficulty breathing when lying down shortness of breath chest, shoulder, back, or abdominal pain pain in your lower ribs a fluttering or pulsing sensation in the abdomen bluish-colored skin heartburn trouble swallowing regurgitation of food upper abdominal pain after eating hiccups side pain. Tips for a healthy diaphragm. Protect your diagram by: limiting foods that trigger heartburn or acid reflux eating smaller portions of food at a time stretching and warming up before exercise exercising within your limits Like any muscle, you can also strengthen your diaphragm with special exercises.

Read this next. Thumb Medically reviewed by the Healthline Medical Network. Epiglottis Medically reviewed by the Healthline Medical Network. Medically reviewed by William Morrison, M. The ligamenta flava has a close relationship with the dural tissue at the cervical level and throughout the vertebral tract, through the posterior epidural ligaments PELs [ 29 ].

The suboccipital muscles merge with the occipitofrontalis or epicranius muscle; this muscle covers the occipital-parietal-frontal area, through a muscular area occipital and frontal and an aponeurosis below the galea capitis or aponeurotic galea [ 7 ]. From an embryological point of view, the musculature of the tongue derives from the occipital area and in adults we find these occipital-cervical relationships in the suprahyoid area, including the perivertebral spaces [ 19 ].

The interpterygoid fascia starts from the base of the skull with a medial vector, covering the oval foramen and the sphenoid spine, involving the tympanosquamous suture and the sphenopetrosal fissure [ 32 ]. The interpterygoid fascia covers the anterior surface of the styloid process, merging with the styloglossus muscle part of the extrinsic musculature of the tongue and with other muscles such as the styloid and stylopharyngeal muscle, the latter two fundamentals for the functioning of the tongue [ 32 - 33 ].

The tensor-vascular styloid fascia from the lower limit of the tensor veli palatine muscle to the styloid process laterally covers the styloid prominence and merges, finally, into the fascial network of the internal carotid artery [ 32 ]. The stylopharyngeal fascia merges into the fascia of the internal carotid artery along with the fascia of the capitis lateralis muscle and the fascia of the digastric muscle [ 32 ].

The interpterygoid fascia involves the fascial system of the internal carotid anterolaterally, where different fascial structures converge [ 32 ]. The palatoglossus muscle is in continuum with the fibers of the superior pharyngeal constrictor muscle and the pharingobasilar fascia; the latter starts from the pharyngeal tubercle of the occipital bone and merges with the buccopharyngeal or visceralis fascia [ 34 - 35 ].

The visceralis fascia covers the pharyngeal muscles and other visceral structures of the neck pharynx, esophagus, larynx, thyroid [ 35 ]. The intercarotic fascia or alar fascia involves the visceralis fascia in its path [ 35 ]. The retropharyngeal bands visceral, alar and prevertebral fascia are in communion with the posterolateral muscles of the neck longus capitis and longus colli, scalene, levator scapulae through the prevertebral fascia; the prevertebral fascia can merge with the anterior longitudinal ligament ALL [ 35 ].

The alaris fascia not to be confused with the alar fascia extends from the base of the skull to the last cervical vertebrae in a caudal direction and is found between the carotid fascia and the prevertebral fascia [ 35 ]. The connective tissue layer that covers the NL or superficial fascia of the neck envelops the neck and inserts on the hyoid bone, up to the lower surface of the mandibular bone; in its path, it wraps the stylohyoid and digastric muscles, the trapezius and sternocleidomastoid muscles SCM , the mylohyoid muscle or buccal floor and the mastoid processes of the occipital bone [ 36 ].

The point of contact between the superficial and deep layer of the fascial continuum is referred to as the superficial muscular and aponeurotic system SMAS , with dense and fibrous adhesions between the two layers at the level of the parotid and preauricular portion [ 37 ]. Reproduced with permission Anastasi et al. The thoracic outlet or upper thoracic diaphragm is in myofascial continuity with the tentorium and the lingual complex through some structures, such as the trapezius muscle and all the deep muscles of the cervical tract; the superficial and deep muscles of the posterior column fall within the system of the thoracolumbar fascia [ 25 ].

The cervical posterior superficial fascial layer continues with the trapezius muscle, overcoming the supraclavicular triangle, and involves the clavicle, acromion and the spine of the scapula [ 36 ]. The posterior cervical layer merges with the superficial layer at the level of the scapula, merging with the connective tissue of the subclavian artery [ 36 ]. The prevertebral fascia covers the deep fascia and divides at the level of the carotid tubercle or Chassaignac tubercle at the height of the sixth cervical vertebra; the fascia follows the deep muscles medial to the longus colli and the lateral portion of the anterior scalene , crosses the lateral cervical triangle through the posterior interscalene space [ 35 ].

When the prevertebral fascia divides, it comes into contact with the epidural space between the yellow ligament and the dura mater , creating another important dural contact site; the prevertebral fascia continues its work of connection between the tentorium cerebelli, the lingual complex, the thoracic outlet [ 35 ].

Through the ALL, the prevertebral fascia touches the suprapleural membrane or Sibson fascia, while laterally it merges with the fasciae of the axilla creating the axillary ligament or axillary arch or Langher arch [ 38 ].

The connective tissue that surrounds each structure not only brings together every anatomical aspect solid and liquid fascia but this fascial continuum allows the movement of the different structures and the transmission of innumerable biochemical and mechanometabolic messages [ 24 ].

The hyoid bone plays an important role in that it connects the base of the skull, the tongue and the buccal floor, and the shoulder girdle thoracic outlet ; the omohyoid muscle connects the myofascial infrahyoid portion, the scapula, and the posterior portion of the thoracolumbar fascia. The omohyoid muscle can also arise from the mastoid process of the temporal bone and merge with the SCM muscle in the clavicular portion, creating the sternocleid-omomastoid muscle or affect the hyoid bone and clavicle; it can arise from the transverse process of C6 or come into contact and then merge with the sternohyoid muscle or in rare cases, it may be absent [ 39 ].

Usually, the omohyoid muscle runs posterior to the SCM muscle and passes over the internal jugular vein. The infrahyoid muscles are surrounded by the deep fascial layer, which layer touches the SCM muscle laterally [ 40 ]. The fasciae of the cervical tract will form the various connective layers that relate the diaphragm muscle and the previous diaphragms [ 2 , 7 ]. The deep fascia of the neck when it reaches the thoracic outlet divides, wrapping the intercostal muscles and the internal thoracic chest endothoracic fascia ; the latter is in contact with the parietal pleura [ 41 ].

The endothoracic fascia is in communication with all the viscera of the mediastinum through the visceral fascia. The viscera of the mediastinum are covered by a visceral fascia deriving from the deep fascia of the neck: the fascia covering the parietal pleura communicates with the parietal pericardium; the Morosow fascia or interpleural ligament connects the two lungs posteriorly; the esophagus and aorta communicate with the two lungs via fascial ramifications of the meso-esophagal fascia; the latter also connects the bronchi, the parietal pericardium and the trachea [ 41 ].

The broncho-pericardial or tracheobronchial-pericardial fascia connects the bronchi and the parietal pericardium in the area of the left atrium; the pretracheal anterior fascia originates from the thyroid cartilage merges with the posterior portion of the pericardium and the endothoracic fascia that covers the diaphragm muscle [ 41 ]. The parietal pericardium touches the posterior endothoracic fascia of the sternal body and some ribs fourth to the sixth in the left area , the endothoracic fascia that covers the diaphragm muscle or the phrenopericardial ligament; it continues posteriorly to merge with the endothoracic fascia at the level of DD11, enveloping the aorta and esophagus [ 41 ].

The visceral fascia that covers the bases of the lungs merges with the endothoracic fascia that lines the diaphragm; the triangular or inferior ligaments of the lung created by the visceral and parietal fascia merge with the endothoracic fascia [ 41 ]. The membrane of Laimer or phrenoesophageal membrane above and below the respiratory diaphragm , involves the passage of the esophagus at the level of the esophageal hiatus; this membrane merges with the endothoracic fascia [ 10 ].

Below the diaphragm and in communication with the esophagus we find the muscle of Low and the transverse intertendinous muscle, in conjunction with the fascia transversalis which covers the lower portion of the diaphragm and which fascia derives from the endothoracic fascia [ 10 ].

The Hilfsmuskel muscle derives from the area of the esophageal hiatus below the diaphragm muscle, connecting to the celiac trunk or to another vascular structure such as the superior mesenteric artery; the Hilfsmuskel muscle continues with a connective bridge to connect and merge with the retro-pancreatic fascia or Treitz's fascia or suspensory muscle of duodenum, which last connects the upper area of the duodenum [ 10 ].

The fascia covering the lower diaphragm fascia transversalis merges with some viscera via connective tissue connections or fascial ligaments. Glisson's capsule involves a large part of the diaphragm muscle, the phrenic-gastric ligament connects the fundus of the stomach , the phrenic-colic ligaments connects the ascending colon to the right and descending to the left , hepatic ligaments coronary ligament, falciform ligament, triangular ligaments [ 7 ].

Anteriorly, the lateral pillars merge with the epimysium of the psoas and quadratus lumborum muscles while, posteriorly, they merge with the thoracolumbar myofascial complex [ 7 ]. From the lateral pillars and precisely from the twelfth rib, the lateral raphe arises, a connective portion that is part of the thoracolumbar continuum, which raphe inserts above the iliac crest [ 7 ].

The transversalis fascia covers the viscera of the pelvic space transforming into an endopelvic fascia; the latter is divided into parietal and visceral fascia [ 7 ]. The endopelvic fascia covers the muscles that form the pelvic floor levator ani and the ischiococcygeus muscle , the internal obturator and the piriformis muscle; finally, it merges with the presacral and periosteal fascia of the pubic area [ 42 ].

In the path of the endopelvic fascia, we find other small portions of connective tissue such as the Denonvilliers fascia between the rectum and the seminal vesicles in men or between the rectum and vagina in women or the rectogenital fascia , the Walderyer fascia between the posterior portion of the rectum at the caudal level of the sacrum and the presacral fascia or rectosacral fascia [ 43 ].

The transversalis fascia comes into contact with the Gerota fascia or renal fascia, which covers the kidneys and adrenal glands; the transversalis fascia comes into contact with the Toldt fascia fascia that covers the Gerota fascia anteriorly , which expands to involve many abdominal and pelvic viscera, to merge with the endopelvic fascia and the Fredet fascia between the pancreatic-duodenal visceral peritoneum and the ascending mesocolon [ 44 ]. The fascial system also involves all visceral ligaments periurethral, paraurethral and pubourethral and genital ligaments and all somatic ligaments such as pubic ligaments arcuate pubic, superior pubic , sacral ligaments sacrotuberous, sacrospuberous, sacrospinous, long posterior sacroiliac and short posterior sacroiliac, anterior sacroiliac and sacroiliac interosseous [ 45 ].

The thoracolumbar fascia that communicates with the muscular portion of the respiratory diaphragm posteriorly, continues, involving the lumbosacral and posterior pelvic muscle area biceps femoris, piriformis, gluteus maximus, multifidus, longissimus thoracis, iliocostalis lumborum, erector spinae [ 45 - 48 ].

The posterior-lateral myofascial continuum connects all the mentioned diaphragms, constituting an important tool for osteopathic medicine for the resolution of dysfunction or the maximum clinical help that a patient can obtain [ 2 , 49 - 50 ]. The article reviewed the myofascial relationships of the diaphragms considered by osteopathic medicine, such as the respiratory diaphragm muscle, the tentorium cerebelli, the lingual complex, the thoracic outlet and the pelvic floor.

The text briefly reviewed the anatomy and innervation of the individual diaphragms. The text is updated and with anatomical information not included in the previous single article.

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Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus. The authors have declared that no competing interests exist.

National Center for Biotechnology Information , U. Journal List Cureus v. Published online Apr Bruno Bordoni 1. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Bruno Bordoni moc. Received Apr 3; Accepted Apr This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

This article has been cited by other articles in PMC. Abstract Working on the diaphragm muscle and the connected diaphragms is part of the respiratory-circulatory osteopathic model. Keywords: diaphragm, osteopathic, fascia, myofascial, fascintegrity, physiotherapy. Review Anatomy of the respiratory diaphragm The diaphragm muscle is the main respiratory muscle. Open in a separate window. Figure 1. The area above the diaphragm: the dotted line for the support of heart 3: inferior vena cava; esophagus; 9: aorta; 8: tendinous center; 5: lumbar area Reproduced with permission, from Anastasi G, et al.

Figure 2. The sub-diaphragmatic area 2: tendinous center or phrenic; inferior vena cava; 3: esophagus; 5: aortic orifice; medial pillar; intermediate pillar; pillar lateral; 6: pillar arcuate medial; 7: lateral arcuate ligament; quadratus lumborum muscle; psoas major muscle. Figure 3. A midsagittal slice of magnetic resonance, where the tentorium is visible. Figure 4. Conclusions The article reviewed the myofascial relationships of the diaphragms considered by osteopathic medicine, such as the respiratory diaphragm muscle, the tentorium cerebelli, the lingual complex, the thoracic outlet and the pelvic floor.

Footnotes The authors have declared that no competing interests exist. References 1. Philadelphia, PA: Wolters Kluwer; The continuity of the body: hypothesis of treatment of the five diaphragms. Bordoni B, Zanier E. J Altern Complement Med. Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment.

J Appl Physiol. Dynamic motion planning of 3D human locomotion using gradient-based optimization. J Biomech Eng. Development of four dimensional human model that enables deformation of skin, organs and blood vessel system during body movement - visualizing movements of the musculoskeletal system.

Diaphragmatic breathing is a technique that is used to strengthen the diaphragm, allowing more air to enter and exit the lungs without tiring the chest muscles.

This is also referred to as " belly breathing " and is often used by singers. There are several medical conditions that involve the thoracic diaphragm. Traumatic injuries or anatomical defects can interfere with the muscle's function, and the movement of the diaphragm can also be impaired by issues like nerve disease or cancer.

When the diaphragm is irritated, such as when eating or drinking quickly, it can repeatedly contract involuntarily, resulting in hiccups. The sound of hiccups is produced when air is exhaled at the same time that the diaphragm contracts.

Generally, hiccups tend to resolve on their own, but there are treatments for persistent cases. A hiatal hernia is a protrusion of the lower esophagus and sometimes the stomach, too into the chest cavity. This defect can cause heartburn, indigestion, and nausea. A number of conditions can cause a hiatal hernia , including increased pressure in the abdomen from obesity or pregnancy or straining such as with heavy lifting, coughing, or having a bowel movement.

Smoking increases the risk, as do some genetic conditions such as Ehlers-Danlos syndrome. Sometimes hiatal hernias can be treated with lifestyle measures and medications alone. In some cases, surgery is recommended to reduce the risk of complications, such as volvulus twisting and strangulation cutting off the blood supply of tissues. Surgery may be performed either through an open procedure or laparoscopically. With the latter technique, several small incisions are made in the abdomen and the repair is done through special camera-equipped instruments.

Diaphragmatic hernias are structural defects that allow abdominal organs to enter the chest cavity. They may be present from birth, or, less commonly, can result from trauma. Conditions that affect the nerves that control the diaphragm can result in weakness or complete paralysis of the muscle.

Nerve injury-induced diaphragmatic weakness can result in shortness of breath, especially when lying down. Management may require medication, surgery, rehabilitation, or support with mechanically assisted breathing. Lung disease, especially COPD , can cause weakness of the diaphragm. This happens through a progressive process that involves a number of contributing factors. COPD results in hyperinflated lungs that physically push on the diaphragm.

The whole muscle becomes flattened and its mobility declines. Over time, the cells of the diaphragm are altered due to excessive strain, causing them to lose the ability to function with maximal strength.

Chronic oxygen deprivation due to COPD also damages these cells. The result of COPD-induced diaphragmatic weakness is worsening shortness of breath.

Treatment of COPD can help slow down the damage to the diaphragm. If oxygen levels are affected, treatment with supplemental oxygen may be necessary. Tumors can spread to the diaphragm or may take up space in the chest or abdominal cavity, placing physical pressure on the diaphragm and interfering with its ability to function. For example, mesothelioma —a cancer of the pleura lining of the lungs —can spread to the diaphragm.

Lung cancer , lymphoma , and stomach cancer are other types of cancer that may affect the diaphragm. The symptoms can be gradual or abrupt, and may include shortness of breath, pain with breathing, or loss of consciousness.

Evaluation of the diaphragm can include a variety of tests tailored to the suspected medical problem. Imaging tests such as chest or abdominal computerized tomography CT , magnetic resonance imaging MRI , or ultrasound may identify anatomical variations or tumors.

A hiatal hernia diagnosis may include tests like an upper endoscopy or a barium swallow , which evaluate the structure of the gastrointestinal system. And COPD-associated diaphragmatic problems may be assessed with breathing tests like spirometry or pulmonary function tests.

Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Disorders of the Diaphragm. Clin Chest Med. Bordoni B, Zanier E. Anatomic connections of the diaphragm: influence of respiration on the body system. J Multidiscip Healthc.

Kanwal Naveen S. Bains; Sarah L.