Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android

Pectus excavatum

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

  • 754.81 Pectus excavatum

  • Q67.6 Pectus excavatum

  • 4B: Impaired Posture

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

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

Imaging

  • X-ray
  • Auscultation
  • Haller Index
  • Pulmonary 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 intolerance
  • Respiratory
  • Flexibility
  • Strength
  • Circulatory
  • May result in shortening of anterior thoracic muscles and over lengthening of posterior thoracic muscles

  • Posture
  • Respiration

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

  • 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

  • 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 ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MH Privacy Center Close