Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Hollowed chestCobbler’s chestSunken chestFunnel chestDent in the chest ++ 754.81 Pectus excavatum ++ Q67.6 Pectus excavatum ++ 4B: Impaired Posture +++ Description ++ Most common thoracic deformitySternal depression resulting in sunken appearanceCan cause right sternal rotation resulting in heart to shift to leftCan cause pain in the back and ribsMay 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 flowMitral valve prolapse may be presentLung capacity can decrease with changed rib cage shape +++ General Considerations ++ Primarily, only of concern for cosmetic or psychological reasonsDeformity continues to grow until post-pubescenceSeen in Marfan syndrome and Ehlers-Danlos syndrome +++ Demographics ++ Males 4:1 to femalesFamilial tendencySeen at birth or developed at puberty +++ Signs and Symptoms ++ Present upon clinical observationOften asymptomaticAdolescents may report fatigue, exercise intolerance, chest or back painRarely 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 cartilageHypothesized genetic defectRicketsMarfan syndromeSpinal muscular atrophyCeliac disease +++ Differential Diagnoses ++ ScoliosisPectus carinatumKyphoscoliosis +++ Imaging ++ X-rayAuscultationHaller IndexPulmonary function test ++ X-ray and auscultation to confirm severity of deformity or shifting of heart ++ To orthopedic surgeon to determine if surgical intervention warranted ++ Exercise intoleranceRespiratoryFlexibilityStrengthCirculatoryMay result in shortening of anterior thoracic muscles and over lengthening of posterior thoracic muscles ++ PostureRespiration ++ Surgical if neededPostural training and strengtheningMyofascial release ++ The patient will be able toAmbulate 75’ with rolling walker and stand-by assistance in 3 days to improve mobilityRegain thoracic mobility to allow for rib expansion during inspiration ++ 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 ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.