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Condition/Disorder Synonyms

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  • Hollowed chest

  • Cobbler's chest

  • Sunken chest

  • Funnel chest

  • Dent in the chest

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ICD-9-CM Code

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  • 754.81 Pectus excavatum

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ICD-10-CM Code

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  • Q67.6 Pectus excavatum

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Preferred Practice Pattern1

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  • 4B: Impaired Posture

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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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Demographics

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  • Males 4:1 to females

  • Familial tendency

  • Seen at birth or developed at puberty

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Clinical Findings

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Signs and Symptoms

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  • Present upon clinical observation

  • Often asymptomatic

  • 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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  • Due to outgrowth of ribs or costal cartilage

  • Hypothesized genetic defect

  • Rickets

  • Marfan syndrome

  • Spinal muscular atrophy

  • Celiac disease

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Differential Diagnoses

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  • Scoliosis

  • Pectus carinatum

  • Kyphoscoliosis

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Means of Confirmation or Diagnosis

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Imaging

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  • X-ray

  • Auscultation

  • Haller Index

  • Pulmonary function test

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Findings and Interpretation

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  • X-ray and auscultation to confirm severity of deformity or shifting of heart

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Referrals/Admittance

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  • To orthopedic surgeon to determine if surgical intervention warranted

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Impairments

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  • Exercise intolerance

  • Respiratory

  • Flexibility

  • Strength

  • Circulatory

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

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Tests and Measures

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  • Posture

  • Respiration

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Intervention

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  • Surgical if needed

  • Postural training and strengthening

  • Myofascial release

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Functional Goals

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  • The patient will be able to

    • Ambulate 75' with rolling walker and stand-by assistance in 3 days to improve mobility

    • Regain thoracic mobility to allow for rib expansion during inspiration

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Prognosis

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  • Excellent since seldom requires surgical intervention

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References

1. +
The American Physical Therapy Association. Interactive Guide to ...

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