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  • Hollowed chest
  • Cobbler’s chest
  • Sunken chest
  • Funnel chest
  • Dent in the chest

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  • 754.81 Pectus excavatum

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  • Q67.6 Pectus excavatum

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  • 4B: Impaired Posture

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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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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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Imaging

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  • X-ray
  • Auscultation
  • Haller Index
  • Pulmonary function test

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

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  • To orthopedic surgeon to determine if surgical intervention warranted

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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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  • Posture
  • Respiration

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  • Surgical if needed
  • Postural training and strengthening
  • Myofascial release

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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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  • Excellent since seldom requires surgical intervention

1. The American Physical Therapy Association. Interactive Guide to Physical Therapist Practice. Alexandria, VA: The American Physical Therapy Association; 2003. http://guidetoptpractice.apta.org/. Accessed July 20, 2012.

DeTurk WE, Cahalin LP. Cardiopulmonary concerns in the patient with musculoskeletal and integumentary deficits: an evidence-based approach. In: DeTurk WE, Cahalin LP, eds. Cardiovascular and Pulmonary Physical Therapy: An Evidence-Based Approach. 2nd ed. New York, NY: McGraw-Hill; 2011. http://www.accessphysiotherapy.com/content/6879247. Accessed September 8, 2011.
Dutton M. The thoracic spine and rib cage. In: Dutton M. Dutton's Orthopaedic Examination, Evaluation, and Intervention. 3rd ed. New York, NY: McGraw-Hill; 2012. ...

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