What Is Pectus?

“Pectus” is a Latin word meaning “chest” and has become the medical term to describe an irregularly shaped chest or other conditions affecting the shape of the chest.  Doctors may refer to the chest as – the ‘chest wall’.  

The chest also known as the thorax can be described as the part of the human torso between the base of the neck and the top of the abdomen / stomach, and from armpit to armpit. The bones of the chest include the sternum and ribs that house and protect several vital organs such as the heart and lungs. In kids the section of the ribs closest to the sternum are made of cartilage (costal cartilage) and are flexible. The chest is also involved in the breathing / the respiratory system, helping to facilitate the process of breathing. The rib cage and associated muscles expand and contract to allow the lungs to take in oxygen and expel carbon dioxide. We believe that when a ribcage is mishapen it most commonly affects breathing making many kids short of breat or ‘winded’ during sports or just even basic activity.

There are two types of pectus defects: Carinatum and Excavatum.

Excavatum is a sunken chest.This is a congenital deformity where the breastbone (sternum) is sunken into the chest. It can give the chest a caved-in or sunken appearance. It is sometimes referred to as “funnel chest.” This condition can sometimes affect heart and lung function and may cause issues with physical activity or self-esteem due to its appearance.

Carinatum also known as “pigeon chest,” this is a deformity where the sternum and associated ribs protrudes outward. While it often does not cause serious health problems, it can sometimes affect respiratory function or cause pain and discomfort.

Both conditions can be treated with a variety of methods, including physical therapy, braces, or surgery, depending on the severity and the symptoms experienced by the patient.

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 means ‘keel of a boat’. It is used to describe any protrusion of the chest. Pectus Carinatum is frequently referred to as “pigeon 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 experience, we at Pectus Services regard pectus as a syndrome. The definition of a syndrome is: “a group of signs and symptoms that occur together and may characterize a particular abnormality or condition, they may occur concurrently and usually form a pattern”. Some of the signs and symptoms that may accompany pectus are things like – orthopedic challenges such as curved spine, rounded shoulders, forward head, joint laxity / double joints like Ehlers-Danlos. Other things include dyslexia, learning challenges, behavioral things like ADD or ADHD, and on rare occasion Marfan symptoms.

Spine

Spine problems always 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 uneven 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 – we feel this is due in 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 firsthand when kids are put on the tread mill in our exercise area by how uncoordinated they become – even kids who are good athletes. In our opinion, this is due to the realignment of the body and correction of the body weight and its center of gravity.

Shoulders

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.

 

10 Years Old

 

 

15 Years Old

 

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 effects on the body. These effects 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 worse on them. Anytime a teenager is different from 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.

Pectus Severities

We use 4 classifications for the severity of a pectus carinatum deformity: Mild, Moderate, Severe and Extreme. Pectus Services has nearly three decades experience successfully treating all severities of pectus defects.  The images below highlight those classifications.

Mild

Mild_Side_Sm

Mild_Top_Sm

Moderate

Moderate_Side_Sm

Moderate_Top_Sm

Severe

Severe_Side2_Sm

Severe_Top_Sm

 

Extreme

Extreme_Side_Sm

Extreme_Top_Sm

 

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