Unfortunately, exercising alone will not fix pectus excavatum and pectus carinatum. Therefore you may want to consider getting surgery. The cost is extremely high considering that most insurance won’t cover it but, if you are seeking ways to manage your pectus condition and lessen the cosmetic look of it, there are some exercises and braces that you may want to consider. Learn more about the pectus condition below.
Chest or thorax is made up of several bones, muscles, ligaments and tendons. Each of the structures that make the chest plays an important role in maintaining the shape and size of the chest cavity or thoracic cavity. The chest cavity encompasses vital organs of our body including heart and lungs. This cavity of chest act as a protecting shield for these vital organs. Sometimes, due to various reasons anomalies or deformities of the chest develop.
Chest deformity is defined as a condition, in which an abnormal development or formation of the bones of the chest takes place instead of the normal developmental pattern of the bones of the chest. The deformities of the chest can be classified into two wide groups: Congenital chest deformities and Acquired chest deformities. Almost 90% of the chest deformities are congenital while the most common congenital deformity is known as the overgrowth of the ribs. The overgrowth of the ribs can cause two types of chest defect; depression of the anterior wall of the chest or protrusion of the anterior wall of the chest.
Two Types of Chest Deformities
The depression of the anterior wall of the chest is otherwise called as Pectus Excavatum, while the protrusion of the anterior wall of the chest is called as Pectus Carinatum. The other congenital chest deformities are aplasia or dysplasia of the organs of the chest or the structures that form the thoracic cavity. The most common and the serious form of aplastic chest deformity is the aplasia of midline or the aplasia of the sternum. This gives the appearance of a bifid sternum. Further, complete or partial failure of the fusion of sternum results in a serious condition called as ectopia cordis or the localization of the heart outside of the chest or thoracic wall.
In addition, an aplasia can affect the adjacent structures of the thoracic cavity and due to this develops another serious condition known as Pentalogy of Cantrell. Sometimes, the aplastic changes can be one sided and the development of the chest muscles (pectoral), breast tissue and ribs can be equally affected, which is also known as Poland’s syndrome.
On the other hand, the acquired chest deformities are a result of an illness as if rickets, tuberculosis of bones, pulmonary diseases (lung diseases), etc. Typically, the chest deformities of this type involve the back and side surfaces of the thorax. Based on the shape, size, and localization, acquired chest deformities can be classified into different types of chest deformities:
This type of chest deformity develops in chronic pulmonary emphysema. The front part of the chest as well as the back part of the chest increases in size, which gives an appearance of a barrel. An emphysematous chest is otherwise called as barrel chest due to its peculiar shape.
It is characterized by a decrease in front, back and sides of the chest size. This is a result of the chronic diseases that affects the lungs and pleura.
It occurs in patients with a condition known as syringomyelia. This form of acquired chest deformity is characterized by a navicular depression in the middle and in the upper parts of the sternum.
Kyphoscoliosis type of chest
It develops as a result of the pathological process in the spine, accompanied by a pronounced change in its shape, which is confirmed by X-ray and CT scan of the spine. It may also occur in the tuberculosis of the spine. Severe expression of Kyphoscoliosis type of chest deformation causes severe disturbance to the internal organs of the chest especially, heart and lungs.
The other types of acquired chest deformities are also noted in a person suffering from severe cerebral palsy. Cerebral palsy exerts abnormal pressure and spasticity on the chest, and this leads to the formation of abnormal chest configuration. Furthermore, acquired chest deformities are also evident in the person who has undergone a rib resection. The extensive or too early rib resection in patients with a congenital chest deformity, Pectus Excavatum, destroys the growth center and thus leads to a condition known as acquired chondrodystrophy.
Furthermore, the chest deformities of congenital and acquired types are asymptomatic in most of the cases. If symptoms are present, they can be chest pain or chest discomfort, dyspnea, or some cases, asthma, which depends on the degree of chest deformity. Other than these symptoms, there can be more serve symptoms in situations where internal organs of the chest are compromised.
Screening Chest Deformity
The diagnosis of chest deformity is more usually by their appearance and also through physical examination. However, the exact type of the chest deformity can be easily identified with the help of instrumental diagnostic methods as if X-rays, which allows in assessing the form and extent of deformation. Computed tomography (CT) of thorax determines the bone defects, the degree of deformation, the presence of any compression and the presence of mediastinal shift. Magnetic resonance tomography is carried out to obtain more information regarding the bone and soft tissues in the area of deformity.
In addition, the chest deformities can cause compression of the internal organs and the disturbance to the vital organs can be ruled out with the help of more complex examinations including echocardiography, radiography of lungs and Holter monitoring of the heart, which will assess the functions of these organs. This will also rule out any disturbances to these organs resulted due to the chest deformity.
The treatment of chest deformity depends on the degree of deformation and the presence of functional disorders of the heart and respiratory system. The less complicated chest deformities are treated with conservative treatment methods involving massage, chest deformity exercise, swimming, breathing exercises and physical therapy. If the chest deformation is in an advanced stage, the conservative treatment won’t be effective. However, the conservative therapy at this stage can only be able to stop the progression of this condition and also helps to preserve the respiratory functions. The most effective treatment option at this stage of the chest deformity is surgery.
Funnel chest or Pectus Excavatum is the retraction of the sternum and the ribs, accompanied by a variety of functional disorders of the respiratory and cardiovascular systems. It is a congenital type of chest deformity due to the overgrowth of the ribs. This type of chest deformity affects 1 in 400-1000 children and also pectus excavatum shows greater incidence among male gender than in female gender.
Furthermore, the exact cause of Pectus Excavatum is not yet known. Some of the evidence suggests a genetic linkage to the development of this condition. However, other evidence suggests that this is a result of other medical conditions as if Marfan syndrome, a connective tissue disorder, which plays a pathogenic role in the development of Pectus Excavatum. The other hypothesis for the development of Pectus Excavatum are abnormal growth of the cartilages of the ribs, defects of diaphragm, scoliosis or family history of scoliosis, increased intrauterine pressure during childbirth and rickets.
There is no solid evidence to support these hypotheses. However, there are many ongoing types of research carried out with the aim of finding the exact cause of the development of Pectus Excavatum. The cause of this defect is not so important to treat the condition, as most of the treatment methods are aimed at eliminating the symptoms associated with Pectus Excavatum and to correct the cosmetic defect of the depression of chest.
Stages of Pectus Excavatum
However, the Pectus Excavatum can be classified into three degrees. The degree of deformation of the sternum determines the clinical course of the disease. The degree of Pectus Excavatum is measured by measuring the depth of the defect and the localization of the heart. The three degrees of Pectus Excavatum are:
- I degree – the depth of the defect is 2 cm; no disturbance to the location of the heart.
- II degree – the depth of deformation is up to 4 cm; displacement of heart by 2-3 cm.
- III degree – the depth of deformation is more than 4 cm; the heart is displaced by more than 3 cm.
This classification helps in the determination of the treatment procedure. Furthermore, the classification of the stages of Pectus Excavatum also aids in deciding the treatment approach.
The stages of Pectus Excavatum or funnel chest are:
- Stage I or Compensated stage – This stage of Pectus Excavatum shows only a cosmetic defect less than 2 cm and the functional disturbances are absent or to a minimal amount.
- Stage II or Sub-compensated stage – This stage shows the extensive defect corresponds to the defect depth up to 4 cm and also mild functional disturbance of the heart and lungs are noted.
- Stage III or Decompensated stage – This stage shows a greater degree of chest deformation with defect depth more than 4 cm and also shows significant functional disturbance of the heart and lungs.
First Signs of Pectus Excavatum
This type of chest defect is usually present at birth, however, in some cases, the appearance of this deformity occur shortly after the birth. This deformity is progressive in nature and can be very prominent with age. There are no physiological changes in the functions of the vital organs which lies in the chest region. However, the most common complaint is chest pain in the middle part of the chest after a vigorous workout. Some children who have this deformity show signs of palpitation. This is not a direct sign of the chest deformity but is a result of a common occurrence of mitral valve defect (Mitral valve prolapse). Some cases are also reported with the symptoms of asthma. It is very difficult to list the symptoms and these symptoms vary among individuals.
Pectus Excavatum Screening
The diagnosis of this deformity is not based on a single test. The medical history of the person should be collected along with the physical examination. These two features are enough to state the diagnosis. However, the use of the instrumental diagnostic methods as if X-ray examination of the chest and CT or Computer Tomography of the chest, helps to visualize the structural defect. But, before stating the diagnosis, evaluation of the functional disturbance of the lungs and heart should be done. The functional state of the heart can be examined with the help of ECG, Echocardiography and stress ECG. Further, the functions of the lungs can be evaluated with spirography. The final diagnosis is stated after evaluating all of the tests and also after collecting the opinions from cardiologist and pulmonologist to learn the degree of the functional disturbance by Pectus Excavatum.
Pectus Excavatum does not need any treatment in most of the cases. This defect does not pose any threat unless any functional disturbances of the chest organs are noted. Most of the time surgical option is the second option because of the seriousness of the surgical procedure. However, the surgery is not a single option available for children with Pectus Excavatum. There are conservative treatment options available to correct this condition. This option includes funnel chest exercises, breathing exercises for Pectus Excavatum, chest massage, physiotherapy, hyperbaric oxygen therapy and swimming.
These Pectus Excavatum exercises and therapies do not relieve the patient from chest wall deformity, but it helps to improve the quality of life and also aids in the symptoms reduction. In addition, a conservative treatment approach helps to prevent the progression of the chest deformity by strengthening the muscles of the chest, preventing the development of spinal deformities, normalization of posture and also helps to increase the lung capacity.
Pectus Excavatum Brace
Moreover, the use of Pectus Excavatum braces does not help to change the cosmetic defect. However, the use of braces aids widely in reducing the symptoms associated with Funnel chest. Pectus Excavatum braces cost around $200. This is a reasonable cost to invest in order to smoothen the quality of life. Use the link below to learn more about the product.
LaceIT Pectus Excavatum – Adjustable Medical Chest Brace for Pectus Excavatum (Medium)
Apart from the conservative approach of treatment and Pectus Excavatum braces, surgery is an option ideal and reliable to remove the defect caused by this condition. The repair of this chest deformity is usually done in the teen years after the person undergoes the puberty changes. This is because, if the surgery performed during childhood or before teen years, there are plenty of chances to get remission of this deformity, once again in the adolescence years. In order to avoid exposing the body to surgery twice, it is okay to wait until the person reaches his or her teen years to get this fix for Pectus Excavatum.
Nuss Procedure Cost
The cost of nuss procedure or pectus excavatum surgery will range between $40,000 and $80,000. This is due to the evasive procedure that goes into surgery.
Reasons For PE Surgery
Before going more detail into the surgical approach of treatment for Pectus Excavatum, we need to know more about the indications that are available for these surgeries. One of the major indications for this surgery is purely psychosocial. The self-esteem of the person who has the defect is very low due to the prominent defect on their chest. The most important reason to undergo this surgery can be is to restore the lost confidence and self-esteem. Another group of people who have the need to get this funnel chest fixed is athletes. Some slight decline in the tolerance to exercise in such athletes due to this form of deformity can be the indication for the correction of the defect.
Another indication for the surgical correction of Pectus Excavatum is when performing cardiac surgery. Cardiac surgery can be combined with the Ravitch procedure, and this eliminates the need performing a second surgery once again. And the last option to choose surgical repair of this funnel chest is after a failed previous surgery. These are most common indications for the need to repair this type of chest deformity.
Two Major Types of Surgery
The surgery for Pectus Excavatum correction has two major types: Ravitch procedure (open surgical procedure) and Nuss Procedure (minimally invasive surgery). However, both the procedures are performed under general anesthesia and requiring the patient to spend at least 5 – 7 days post-operatively in the hospital. Most of the Pectus Excavatum candidates are ideal for Nuss Procedure than Ravitch procedure. However, the choice of the procedure depends on various factors as if the degree of the funnel chest, the age of the person undergoing the surgery and the choice of the surgeon, who is going to perform the surgery. The choice of the procedure is decided after checking all of those above-mentioned features.
Furthermore, if the surgery of choice is Ravitch procedure, it is always better to have a rough idea about the procedure without going too deep into the technicality of the procedure. Ravitch procedure is an open surgical procedure, where the surgical line will pass in the horizontal line of the middle part of the chest. The procedure involves the removal of the abnormally grown cartilages of our ribcage. This allows the central chest bone, sternum to move forward to its usual location. Usually, this procedure needs at least 4-6 hours. However, this procedure might need more time, if there is any complication during the surgery. Sometimes, this procedure involves the breaking of the central chest bone (sternum) to facilitate its movement to the usual location. In such cases, metal chest bar may need to be placed for a short period of time.
On the other hand, if the surgery of choice is Nuss Procedure, the metal chest bar is used in this procedure. The stainless metal bar of the length of the chest is inserted through a small cut in the chest with the help of endoscopy technique. The metal bar is placed in a way that this bar goes below the level of the sternum and over the level of ribs so that this bar can aid in the elevation of the sternum (chest bone). This procedure usually takes about 2 hours to complete and can be safer as there is no open wound. This minimally invasive surgery reduces the major life-threatening risk associated with the open surgery as if bleeding and infection.
Whichever the surgery chosen, the recovery time of the patient solely depends on the individual. The pain management is one of the important problems after the surgery. The duration of hospital stay is decided by the doctor, depending on the degree of pain and also on the pain management technique used. The person who has undergone Nuss procedure has to stay less duration in the hospital than the Ravitch procedure.
The effectiveness of the surgery does not solely depend on the surgery, but also on the person who underwent the surgery. After the surgical correction of the chest, the person should undergo rehabilitation therapy including posture correction. In the following week after the surgery, the first follow-up after surgery is done. The person who undergone the surgery is given the details about the subsequent visits to the hospital in order to follow the development after the surgery. These follow-ups are highly important as the surgeon remind and insist on maintaining the correct posture in order to produce better results from the surgery.
Even though Ravitch procedure may seem to be more complicated due to the risk of severe infection and bleeding, Nuss procedure also has very much similar risk as the metal bar can pierce our heart or lungs and the bleeding will be uncontrolled and can even lead to a lethal outcome. Anyhow, if these risks are well managed, the surgeries can provide a very good clinical outcome.
However, an experienced surgeon can avoid most of the complications that arise during and after the surgery. The more effective way of treatment post-surgically is to combine funnel chest exercises, breathing exercises for Pectus Excavatum and physical therapy under the direct control of the surgeon. However, heavy physical activities are avoided in the first 3 months following surgery.
Pectus Carinatum is the second most common congenital deformity of the chest after the funnel chest or Pectus Excavatum. Pectus Carinatum has a very much peculiar appearance of the chest. The overgrowth of the ribs leads to the formation of protrusion of the front thoracic wall. Due to this peculiar appearance of the chest, Pectus Carinatum can be also called as pigeon chest. It is about 7% of the total number of chest deformities that affects the front chest wall. Men are usually affected 4 times more often than women. This deformity of the chest is very apparent at birth and also tends to become more prominent with the age.
Cause of Pectus Carinatum
The pathogenesis of Pectus Carinatum is not clearly understood yet. The genetic link for the development of this type of deformity is apparent that 26% of the people with Pectus Carinatum have a family history of this peculiar deformity. Among the people with Pectus Carinatum, 15% of them have associated or concomitant disease.
Most commonly, the chest deformities are combined with Marfan syndrome – a systemic disease caused by connective tissue disease and comprising of high growth, long fingers, underdevelopment of adipose tissue, increased mobility of joints and disorders of the cardiovascular system and organs of vision. It is also possible that Pectus Carinatum or pigeon chest can be combined with congenital heart disease and scoliosis of the spine.
At birth, this chest deformity is hardly noticeable, but with the progression of this deformation with age forms a cosmetic defect, which can vary greatly on the degree of the chest deformity. Normally, the functional disorders of the respiratory and circulatory system are not expressed in the first years of life. However, some older children complain of shortness of breath, fatigue, and palpitations. These disturbances are usually not caused by strain and are very common in people with the asthenic type of body. Currently, most experts believe that Pectus Carinatum does not entail negative consequences in the form of disturbances in the physiological functions of the heart and lungs and is a purely cosmetic defect.
Two Types of Pectus Carinatum
Furthermore, Pectus Carinatum is usually classified into two major types and they are:
- Chondrogladiolar prominence – This type of Pectus Carinatum is otherwise called as a keel or chicken chest. The middle and the lower part of the sternum bone is protruded to the front giving an appearance of an outward sternum. The costal cartilages of the ribs are depressed and give a very prominent appearance of the chest.
- Chondromanubrial prominence –Chondromanubrial prominence is also known as pigeon chest. This type of Pectus Carinatum is usually very rare than keel chest. The chance of occurring of such chest deformity is about 5% in Pectus Carinatum.
Pectus Carinatum Early Diagnosis
The next important hurdle is to state the diagnosis of Pectus Carinatum clearly. The diagnosis is based on the physical examination, history and also on the instrumental diagnostic methods as if X-ray of chest and CT or Computer Tomography of the chest. These instrumental diagnostic methods help to show the structural defects of the chest. In addition, the extent of the disturbance to the vital organs of the chest is evaluated through advanced instrumental diagnostics including spirography, ECG, and echocardiogram. The results of these examinations should be checked by the specialists in the field of cardiology and pulmonology (to check the functions of lungs). The final diagnosis of the Pectus Carinatum and its subtype are made after thoroughly analyzing all data from the instrumental diagnostic methods and the interpretation of the results by specialists in the specific field.
Pectus Carinatum Treatment
Once, it was widely believed that Pectus Carinatum deformity can be corrected with the help of physical therapy, correction exercises, and braces. Unfortunately, the experts have a different opinion in order to restore the normal shape of the chest which is only possible with the use of surgical techniques. All other methods other than surgical correction only improve the patient’s physical form and also helpful in easing the symptoms of Pectus Carinatum.
Even though different surgical techniques are used to correct Pectus Carinatum, Ravitch procedure is one of the most widely used procedures to correct this type of chest deformity. Ravitch procedure removes the abnormally grown cartilage and leaves the area of the cartilage that lines the external part of the rib cage. This removal of the excessive growth allows the sternum to move back inside and to the correct localization. Even the procedure seems to be an easy procedure, Ravitch procedure takes time. The surgery takes around several hours to complete.
The Ravitch procedure recovery time usually varies from person to person. However, the person undergoing surgery can be sent home, as soon as the person learns to control the pain. After 2 weeks of the surgery, the person is asked to visit the doctor. The doctor will assess the wound and remind the patient about the posture. As a precautionary measure, the person who had the surgery is refrained from heavy physical activities including sports. This can last for a period of 3 months.
On the other hand, Ravitch surgery is usually costly and costs about $40,000 and above. Even though Ravitch procedure is costly, the effectiveness of the surgery is highly reliable. This procedure is not a fix for physiological disturbance, but is solely the cosmetic correction of the Pectus Carinatum. The disturbance to the function of heart and lungs can be addressed by the cardiologist and pulmonologist.
However, there are modern surgical techniques available with a minimally invasive option. You do not need surgery in this procedure. The endoscopy is used to remove the abnormally grown cartilage. This procedure is new and has less invasive option than Ravitch procedure. Nevertheless, the effectiveness of this procedure is not reliable as Ravitch procedure.
Pectus Carinatum Brace
One can also consider trying the Trulife Pectus Carinatum Orthosis brace to maintain their condition. Though this device will not cure you completely, it may help lessen the cosmetic look of P.C. If you have an extreme case of P.C. this device will have little effect. The only recommended correction is through surgery.