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CONDITION/DISORDER SYNONYMS

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  • Cobbler’s chest

  • Dent in the chest

  • Funnel chest

  • Hollowed chest

  • Sunken chest

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ICD-9-CM CODE1

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  • 754.81 Pectus excavatum

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ICD-10-CM CODE2

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  • Q67.6 Pectus excavatum

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PREFERRED PRACTICE PATTERN

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  • 4B: Impaired Posture

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PATIENT PRESENTATION

An 18-month-old is referred to physical therapy for developmental delay. Upon examination, the therapist notes the child has hypotonia and pectus excavatum. The mother states she had a viral illness during her first trimester but a normal vaginal delivery. She reports that the orthopedist states no current surgical intervention is necessary for the pectus unless the child’s respiratory system becomes compromised as the child ages. The physical therapist plans on treating the gross motor delay with weekly therapeutic activities and strengthening.

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KEY FEATURES

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Description
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  • Most common thoracic deformity

  • Sternal depression resulting in sunken appearance

  • Can cause right sternal rotation resulting in heart to shift to left

  • Can cause pain in the back and ribs

  • May result in shortening of anterior thoracic muscles and over-lengthening of posterior thoracic muscles

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Essentials of Diagnosis
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  • May be associated with congenital heart disease or murmur due to disrupted blood flow

  • Mitral valve prolapse may be present

  • Lung capacity can decrease with changed rib cage shape

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General Considerations
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  • Primarily, only of concern for cosmetic or psychological reasons

  • Deformity continues to grow until post-pubescence

  • Seen in Marfan syndrome and Ehlers–Danlos syndrome

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FIGURE 249-1

Marked pectus excavatum. (From Fuster V, Walsh RA, Harrigton RA. Hurst’s The Heart. 13th ed. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
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Demographics
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  • Males to females, 4:1

  • Familial tendency

  • Seen at birth or developed at puberty

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CLINICAL FINDINGS

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SIGNS AND SYMPTOMS

  • Present upon clinical observation

  • Often asymptomatic

  • Cardiovascular limitations3

  • Adolescents may report fatigue, exercise intolerance, chest or back pain

  • Rarely may report dyspnea or palpitations

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Functional Implications
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  • If severe, may result in decreased lung capacity that requires surgical intervention

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Possible Contributing Causes
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  • Celiac disease

  • Due to outgrowth of ribs or costal cartilage

  • Hypothesized genetic defect

  • Marfan syndrome

  • Rickets

  • Spinal muscular atrophy

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Differential Diagnoses
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  • Scoliosis

  • Pectus carinatum

  • Kyphoscoliosis

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FIGURE 249-2

Transverse and sagittal views of the diaphragm. (From DeTurk WE, Cahalin LP. Cardiovascular and Pulmonary Physical Therapy: An Evidence-Based Approach. 2nd ed. http://www.accessphysiotherapy.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
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MEANS OF CONFIRMATION OR DIAGNOSIS

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