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Condition/Disorder Synonyms

  • Hollowed chest

  • Cobbler's chest

  • Sunken chest

  • Funnel chest

  • Dent in the chest

ICD-9-CM Code

  • 754.81 Pectus excavatum

ICD-10-CM Code

  • Q67.6 Pectus excavatum

Preferred Practice Pattern1

  • 4B: Impaired Posture

Key Features

Description

  • 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

Essentials of Diagnosis

  • 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

General Considerations

  • Primarily, only of concern for cosmetic or psychological reasons

  • Deformity continues to grow until post-pubescence

  • Seen in Marfan syndrome and Ehlers-Danlos syndrome

Demographics

  • Males 4:1 to females

  • Familial tendency

  • Seen at birth or developed at puberty

Clinical Findings

Signs and Symptoms

  • Present upon clinical observation

  • Often asymptomatic

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

  • Rarely may report dyspnea or palpitations

Functional Implications

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

Possible Contributing Causes

  • Due to outgrowth of ribs or costal cartilage

  • Hypothesized genetic defect

  • Rickets

  • Marfan syndrome

  • Spinal muscular atrophy

  • Celiac disease

Differential Diagnoses

  • Scoliosis

  • Pectus carinatum

  • Kyphoscoliosis

Means of Confirmation or Diagnosis

Imaging

  • X-ray

  • Auscultation

  • Haller Index

  • Pulmonary function test

Findings and Interpretation

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

Referrals/Admittance

  • To orthopedic surgeon to determine if surgical intervention warranted

Impairments

  • Exercise intolerance

  • Respiratory

  • Flexibility

  • Strength

  • Circulatory

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

Tests and Measures

  • Posture

  • Respiration

Intervention

  • Surgical if needed

  • Postural training and strengthening

  • Myofascial release

Functional Goals

  • 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

Prognosis

  • Excellent since seldom requires surgical intervention

References

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

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