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What is Pectus?

Pectus has become the term used to describe an irregularly shaped chest. Webster’s definition of Pectus is: “the part of the human torso between the neck and the diaphragm”. The word Pectus is latin derived and most medical terminology is latin as well. There are two types of Pectus defects: Carinatum and Excavatum

The chest is sometimes referred to by doctors as the ‘chest wall’. Pectus Services would like to add to the definition of the word ‘Pectus’ to include ‘… and from axilla to axilla (armpits)’

Pectus:  The part of the human torso between the neck and the diaphragm, and from axilla to axilla.

 

Pectus Carinatum 
This word is latin derived and it means ‘keel of a boat’. It is used to describe any protrusion of the chest.

Pectus Excavatum
Describes a chest that is sunken inward.  This is also a latin word meaning ‘hollow or to hollow out’. 

Pectus ‘Syndrome’
Based on our opinion and experience, we at Pectus Services feel Pectus is a syndrome.  Using Webster’s definition a syndrome is:  "a group of signs and symptoms that occur together and characterize a particular abnormality or condition, they may occur concurrently and usually form an identifiable pattern."

In our experience we have found that kids with pectus usually have at least one or more other medical occurrences. They may include; cardiac anomalies like marfan’s syndrome, ehlers-danlos syndrome, or enlargement of the aorta. In addition there may be learning challenges, such as dyslexia, ADD or ADHD.

 

Spine problems always allows occur.  They include curvature of the spine such as  scheurmann’ s syndrome, kyphosis of the head and neck, lordosis of the lower spine and what we at Pectus Services call – ‘Pectus induced spinal curvature’.  This occurs mostly when there is an asymmetric pectus defect, either excavatum or carinatum that produces eneven pressure onto the ribs, then around to the vertebrae and then causing them to bend or bow to the left or right side depending on where the pectus is located.  

 

Head and Neck
Many pectus kids will lurch their head.  We feel in part this is due to the altered center of gravity caused by a pectus defect, in addition to very tight pectoralis muscles and weak upper back muscles.  Something we feel is part of the Pectus Syndrome.  It is our experience with pectus carinatum patients that after their brace is applied and their chest is corrected it may take them about a month to be able to jog and run again.  We have seen this first hand when kids are put on the tread mill in our exercise area how uncoordinated they become. Even kids who are good athletes.  This in our opinion is due to the realignment of the body and correction of the body weight and its center of gravity.
 
 

Lastly, the shoulders may also be uneven.  One may dip or drop compared to the other.  In addition the shoulder blades may stick out of the skin sharply on one side or both. Some parents call this ‘chicken wings’  but the correct term is scapular winging.

 
 

Pectus is one of the most common chest wall deformities. It generally occurs more often in boys than girls. This may be due to the more intense and sudden adolescent growth spurt of males.  Girls do get pectus however in our experience it tends to occur a little younger in age than boys. The ratio in our experience is 5:2 that is 5 boys to 2 girls.

During adolescent growth is when the condition tends to occur and steadily gets worse as the child grows. Some parents report their child’s pectus deformity literally popped up overnight. In the photos below you can see a normal chest on a 10 year old, but then in the other photo a severe pectus carinatum deformity at age 15 just 5 years later.

 

 

 
 

Some kids hide it from their parents and friends or don’t know they have pectus. The most common phone call we get is when parents see their child at the beach or pool without a shirt for the first time when the warm weather begins. Pectus deformities may appear suddenly, or may develop slowly from when the child is young. Nonetheless a pectus defect gets worse until some intervention is taken. Younger is better for getting an assessment and treatment plan for pectus defects.

Pectus deformities have several affects on the body. These affects are medically referred to as signs and symptoms.

The most obvious sign is the irregular appearance of the chest. Since teenagers suffer from this the most the psychological aspect is the worst on them. Anytime a teenager is different than another they can be the target of criticism and being made fun of. 

Teens and kids may hide their chest deformity, and may not even show their parents either because they think this is just how they are, or they may not know they have pectus and that something can be done about it. Most suffer from low self-esteem. The child may have been happy and outgoing but after the pectus defect formed their self confidence may have dropped and they may become more withdrawn.

They will avoid events like pool parties or school trips to a water park to not be seen bare chest. Some will even wear baggy clothes such as jackets or hoodies even in the summer time. See this testimonial from a mom below:

 
 

On Fri, 6 Aug 2010 "Susan" wrote:

Hi Joe,

We are here at Soak City (a water park) and Evan is walking around bare chested (looking great) with his buddies having tons of fun ... and I was just thinking how very difficult this moment would be if he hadn't seen you. 

So thank you again for changing his life!

Susan (Evan's mom)

 
 

Many kids report to us that other kids will poke their chest in the hallways at school or recess; they may also point it out to others telling them ‘hey look at this’.  There are also names like ‘uni-boob’ and ‘third nipple’. 

Girls are affected emotionally by the inability to wear certain clothes, especially when the pectus deformity is uneven or asymmetric. As girls grow this may also lead to uneven development of the breasts emphasizing the pectus deformity even more. This in our opinion is why early intervention is the key to a successful outcome.    

Many kids with pectus especially boys will avoid sports and possibly having to change their clothes or the pectus being seen through a skimpy shirt uniform like wrestling or basketball where shirts and skins games can be emotionally devastating. Sadly we have seen a lot of kids with great athletic ability avoid sports because of pectus.

In today’s modern era of medicine there are many avenues to improve a pectus defect both emotionally and physically. We at Pectus Services want to emphasize getting early intervention as soon as a pectus defect is noticed.  This will include seeing multiple health care providers to diagnose and then develop a treatment plan for pectus.

In our experience multiple health care providers all coming together will have the most benefit in treating pectus.  Some of those health care providers may include:   Physicians of several types - Thoracic Surgeons, General Surgeons, Cardiologists, Pulmonologist, and Chiropractic Physicians. In addition you may see others such as: Physical Therapists, Personal Trainers, Orthotists, Family Counselors, and Massage Therapists just to name a few.

This team approach will provide the best possible care for successful pectus improvement.