One of the most common congenital wall deformities of the chest is the Pectus excavatum, also known as a sunken chest or a funnel chest. Pectus excavatum is described as a deformity with the breastbone or the sternum where the sternum is sunken inwards and this makes the chest look hollow. This current article will talk about the causes, symptoms, treatments and various exercises recommended for Pectus Excavatum or the Sunken Chest.

Pectus Excavatum or Sunken Chest

An Overview on Pectus Excavatum or Sunken Chest:

Pectus excavatum or Sunken chest is one type of pectus anomaly where there is a congenital deformity in the anterior wall of the chest, which causes the sternum to become sunken inward which gives a caved-in or hollow appearance to the chest. Actually, Pectus anomaly is described as the deformity of the sternum and there are two such prime types of pectus anomaly; namely the Pectus excavatum and the Pectus Carinatum. In the former case the chest is sunken in, while in the later case the sternum is raised up or pushed out like a pigeon chest. In the following array of our article, we will take a look on Pectus excavatum or the sunken chest.

Though, Pectus excavatum or sunken chest is at times considered to be cosmetic, it can also impair cardiac and respiratory functions, depending on its severity and can cause pain in chest and back. This condition may keep a person away from activities which requires an exposure of the chest.

Symptoms of Pectus Excavatum or Sunken chest:

Following are some of the most common symptoms of Pectus excavatum or sunken chest:

  • Sunken appearance of the sternum.
  • Physical capabilities may be limited due to a decreased lung capacity in patients with Pectus Excavatum or Sunken Chest.
  • Fatigue may be common
  • There may be symptoms of chest pain.
  • Faster heart rate and shortness of breath are other symptoms in Pectus excavatum or Sunken chest.

Causes of Pectus Excavatum or Sunken Chest:

Researchers believe that the poorly co-ordinated and the excessive growth of the rib cartilages cause Pectus excavatum or Sunken chest. Usually the deformity is seen at birth; however it looks more obvious during early adolescence when there is a rapid growth. Now, when we look at the causes of Pectus excavatum or Sunken chest; here we can come up with the list below mentioning the conditions associated with the pectus excavatum or Sunken chest.

  • Marfan's syndrome: Marfan's syndrome is an inherited disorder of the connective tissue which can lead to Pectus excavatum or sunken chest.
  • Poland's syndrome: This is a rare inherited condition which involves the underdevelopment or a complete absence of the chest muscles on one side of the body.
  • Scoliosis: In such a condition, the spine curves and gets deformed. Pectus excavatum or Sunken chest can be seen in people with scoliosis
  • Rickets: Rickets is a disease, mostly seen in children who lack vitamin D or calcium and who are not more exposed to the sunlight. Here there is a disturbed normal bone growth which can be associated with a Pectus excavatum or sunken chest.

Epidemiology of Pectus Excavatum or Sunken Chest:

  • Pectus excavatum or Sunken chest occurs more in men as compared to the women. It is estimated that one in around 1000 person suffer from Pectus excavatum or Sunken chest at their births. There is a Male predominance among the patients which equals to a 3:1 male-to-female ration.
  • Approximately 40% of the patients with Pectus excavatum or Sunken chest are known to have one or more family members suffering from the same deformity.

Diagnosis for Pectus Excavatum or Sunken Chest:

There are several tests, physical exam and diagnosis for knowing about the condition of Pectus excavatums or Sunken chest. Following are some of the diagnosis tests and examinations for pectus excavatum or sunken chest

  • A physical examination of the sternum
  • Chest X-ray
  • CT or Computed Tomography scan of the scan
  • An Echocardiogram or an ultrasound study of the heart
  • Pulmonary function or breathing tests
  • Exercise or stress test
  • Electrocardiogram or EKG
  • Laboratory studies with the blood samples.

Treatments for Pectus Excavatum or Sunken chest

Treatments for Pectus Excavatum or Sunken chest:

As mentioned above, pectus excavatum or Sunken chest can cause problems to the heart or the lungs in severe conditions; so it must require some serious medical treatments including the surgical as well as non surgical treatments. There are a number of surgical approaches through which the condition can be corrected or improved for better living. Below we will talk about the various surgical processes as well as the non-surgical processes which have shown to cause great improvements in the symptoms of Pectus Excavatum or Sunken Chest. However, we will also know about few of the most effective non surgical treatments for pectus excavatum or sunken chest

Surgical Treatments for Pectus Excavatum or Sunken Chest:

  1. The Nuss Procedure for Treatment of Pectus Excavatum or Sunken Chest:

    This is a minimally invasive surgical technique for correcting Pectus excavatum or the sunken chest. Here, a small incision is made so as to insert a camera to allow the surgeon to visualize the inside of the chest while the surgery. A curved steel bar is inserted via two other small incisions on either side of the chest, under the breastbone or the sternum for reversing the depression or the sunken chest. This steel bar is then fixed to the ribs on both the sides. There may be a use of a steel grooved small plate at the end of the steel bar so as to help stabilize and attach the bar to the rib. This bar remains in the place for about two or three years and then surgically removed after that. The patient may require a stay of one week after the surgery to correct Pectus Excavatum or Sunken Chest for appropriate pain management.

  2. The Ravitch Procedure for Treatment of Pectus Excavatum or Sunken Chest:

    This is another surgical procedure for correcting the Pectuatus excavatum or sunken chest and requires an incision in the mid-chest area for removing the anterior cartilage. Here, stainless-steel struts are placed across the anterior chest so as to support the breastbone or the sternum and are then wired to the appropriate ribs on both sides; thus allowing the breastbone or the sternum to be raised up for treating the sunken chest condition. These struts are again removed later with another surgery.

    This surgical procedure for Pectus Excavatum or Sunken Chest requires a shorter stay at hospital and involves lesser pain after the treatment. Usually the outlook of such a treatment is very good and patients undergoing such a surgical treatment have satisfying results.

  3. Robicsek Procedure for Treatment of Pectus Excavatum or Sunken Chest:

    This is a surgical procedure developed by Dr. Francis Robicsek during 1965 and it involves a small incision of 4-6 cms. Here, the pectoralis major muscles are detached from the breastbone or the sternum. By using the upper limit of the depression on the sternum as a guide; the deformed cartilages are removed with the help of a sharp and blunt dissection. Then, the lower top of the breastbone is grabbed with a towel clip and with the help of a blunt dissection, it is freed of the tissue connections with the pleura and the pericardium. Then, the breastbone is made to bend forward to correct the position. A piece of mesh is placed under the mobilized sternum and sutured under a moderate tension bilaterally to the stumps of the ribs so as to keep the sternum raised up. Then, the pectoralis muscles are united in front of the sternum after appropriate hemostasis and the wound is closed without extra drainage.

  4. Magnetic Mini-Mover Procedure for Treatment of Pectus Excavtum or Sunken Chest:

    Also called the 3 MP technique, the magnetic mini-mover procedure is one more surgical treatment for pectus excavatum or sunken chest. This technique makes use of two magnets for realigning the breastbone or the sternum with the rest of the chest or the ribcage. This technique is more cost effective and less painful than other surgical treatments for pectus excavatum or sunken chest. It must be noted that the young children having pectus excavatum or sunken chest find more success with such kind of treatments.

Risks Involved in the Surgical Treatment for Pectus Excavatum or Sunken Chest:

There are some risks involved with the surgical treatments for Pectus Excavatum or Sunken chest. Following are some of the noted risks:

  • Excessive bleeding
  • Pleural effusion, or build up of fluid around the lungs
  • Pneumothorax or a buildup of air or gas in the pleural space present around the lungs
  • Infections
  • Recurrence of Pectus excavatum or Sunken chest.

Non-Surgical Treatments for Pectus Excavatum or Sunken Chest:

  1. Treatment for Pectus Excavatum or Sunken Chest via Vacuum Bell:

    Correcting the pectus excavatum or sunken chest via an advanced non surgical procedure known as the Vacuum bell technique has been in news in recent times. This is a new alternative treatment for replacing the surgical procedures for correcting pectus excavatum or sunken chest. This procedure makes use of a vacuum bell device which looks somewhat like a large silicone doughnut carrying an attached bulb for removing the extra air pressure. This device fits over the caved-in or the sunken area in the chest and the air is then removed. The, vacuum generated by this lifts the breastbone or the sternum upwards, and thus reduces the severity of the deformity. For having a permanent correction of the sunken chest; it requires couple of additional years of the use of the vacuum bell device once the defect disappears visually.

    It must be noted that the device must be kept for about one hour in a day which would slowly pull up the depressed portion of the cartilage. In about six months, maximum correction in the depression of the chest can be seen; however the patients must continue using the device for two more years to have a permanent solution of the condition.

  2. Exercises for Pectus Excavatum or Sunken Chest:

    It is also noted that in mild cases of pectus excavatum or sunken chest; exercise has brought some fine improvements in the symptoms. There are some noted exercises which can help you reduce the sunken chest; which we will note down in the following section of our article.

Exercises for Pectus Excavatum or Sunken Chest:

"Exercises can heal you for a better being!" There are some exercises which can work great in improving the condition of Pectus excavatum or sunken chest in both men and women. However, it must be noted that recovery through exercises can take a longer time and a lot of patience. In this section we will talk about some of the most effective exercises for pectus excavatum or sunken chest. You can try out these exercises to help our pectus excavatum or sunken chest bulk up.

It must be informed that in our exercises to bulk up the sunken chest we will be targeting primarily on two sets of muscles in the chest; namely the Pectoralis major and the Pectoralis minor.

  1. General Exercises to Correct Pectus Excavatum or Sunken Chest:

    General postures including standing straight and marching can get you some positive effects on the pectus excavatum or sunken chest conditions. Adding up the general exercises like walking, jogging, running, swimming along with yoga can greatly help in improving the condition.

  2. Breathing Exercises for Pectus Excavatum or Sunken Chest:

    Breathing exercises can also be beneficial in correcting of improving the pectus excavatum or sunken chest condition. All you need is standing straight to maintain a good posture, keep your hands on the sides and breathe deeply. Try to make the breath as big as you can and push your chest out. Now, hold the breath for at least 10 to 30 seconds and gradually place your hands behind the upper neck. This help in expanding the ribcage and pushing out the breastbone or the sternum.
    This exercise can also be done in sitting or lying position. There will be improvements in 3 months.

  3. Broom Twist Exercise for Pectus Excavatum or Sunken Chest:

    Broom twist is pretty simple exercise which can help you in improving the condition of pectus excavatum or sunken chest. In this case, you need to place a broomstick behind your neck. Make sure you are trying to hold the broomstick with each hand held about the width of the shoulder apart. Now, start twisting the stick slowly and control it at the waist. This can help you bringing back the ribs in shape.

  4. Chest Dip for Pectus Excavatum or Sunken Chest:

    Chest dip is one of the best exercises recommended for working on both the sets of chest muscles, i.e. the Pectoralis major and Pectoralis minor. This exercise can help you treat pectus excavatum or sunken chest. For doing this, you need to mount yourself on a dip bar with hands in an overhand grip, on foot crossed over the other behind you. Make sure your back is straight and both the hands are aligned properly with the shoulders. You then need to flex you elbows by lowering your body down until you feel a light stretch in your chest. Raise yourself back up for completing one rep.

  5. Dumbell Decline Fly for Pectus Excavatum or Sunken Chest:

    There is another exercise for pectus excavatum or sunken chest which can be added to your exercising routine. Dumbell decline fly is an isolated exercise which targets the chest muscles, especially the pectoralis major muscles and helps you improve the sunken chest. You need to lie on a weight bench with your legs bent and feet secured under the foot pad and your arms extended above you with hands directly above your shoulders. You need to hold a dumbbell in each hand with your palms facing in and then move both arms out to the sides until they are almost lying parallel to the floor. This should bring a light stretch in your chest and shoulders. For completing one rep, you need to return to your starting position.

  6. Lying Dumbbell Pushover Exercise for Pectus Excavatum or Sunken Chest:

    The lying dumbbell pushover exercise helps in improving the condition in pectus excavatum or sunken chest by increasing the strength and the size of your pectoralis muscles in the chest. For doing this, you require lying flat on a weight bench, keeping shoulders back, legs bent off the edge with your feet flat on the floor. Now, holding on to the top end of a dumbbell in both your hands, extend the arms straight above you making sure that your hands are properly aligned with your shoulders. Hold the dumbbell with a heart-shaped grip in a way that your palms are facing away from you and the weight directly above your face. Now, flex your elbows slowly lowering your arms, bring the weight behind your head. Returning to the starting position will complete one rep.

Conclusion:

"It is okay if something is out of shape. But it is essential to get the thing in shape!" There are treatments and there are exercises. If you or your known ones are suffering from Pectus excavatum or sunken chest, you can go to a health professional for a diagnosis on the same and take his prescribed treatments or follow the recommended exercises for improving the condition of your pectus excavatum or sunken chest.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: September 22, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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