Pectus Carinatum (pigeon chest )

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Introduction

Pectus Carinatum

Pectus carinatum (pigeon chest) refers to a chest wall deformity in which the sternum protrudes anteriorly. It is less common than pectus excavatum. It affects nearly 1 in 1000 teens, and early identification allows for more noninvasive treatment options.

Etiology

The precise etiology of pectus carinatum is unknown, however most consider both pectus carinatum and pectus excavatum to be due to defective elongated growth of the costal cartilage.  A genetic element is suggested by the significant portion of patients with a family history of a chest wall defect or deformity. In about 25% of cases of pectus carinatum, the patient has a family member with the condition.

Pectus carinatum is generally a solitary, non-syndromic abnormality. However, the condition may be present in association with other syndromes: 

• Scoliosis (common)
• Cyanotic congenital heart disease (uncommon)
• Marfan syndrome.

Clinical Presentation

Patients may present with dyspnoea and exercise intolerance. Some studies have shown an association with asthma or chronic bronchitis in up to 16.4% of patients.

Diagnostic Procedures

Diagnosis of pectus carinatum is made by visual inspection, with further details offered by lateral chest Xray or computed tomography (CT).

Management / Interventions

External brace for treatment of Pectus Carinatum

Treatment of pectus carinatum falls into three categories: non-surgical bracing, surgical correction, or cosmetic concealment.  Orthotic braces are the first option for treatment as acceptable results are often achievable.

External bracing technique

Braces are worn either under/over the patient’s clothing for between 14 and 24 hours per day, depending on the manufacturer and the severity of the chest wall protrusion.  Braces are most effective when applied before the patient’s growth spurt and less effective after age 19 due to changes in the flexibility of the chest wall. Unfortunately due to the lengthy treatment period (often months to years) and slow progression of the correction, many patients do not like this option.

Surgical: For patients with severe pectus carinatum, surgery may be necessary. However bracing could and may still be the first line of treatment. Some severe cases treated with bracing may result in just enough improvement that the patient is happy with the outcome and may not want surgery afterward.

Other options: After adolescence, some men and women use bodybuilding as a means to hide their deformity. Some women find that their breasts, if large enough, serve the same purpose. Some plastic surgeons perform breast augmentation to disguise mild to moderate cases in women. Bodybuilding is suggested for people with symmetrical pectus carinatum.

Physiotherapy

Yoga

Postural correction and strengthening chest and back muscles may help with pectus excavatum as bad posture is implicated in the severity and prominence of the condition.

The aim of exercises in this condition is to:

1. Loose and lengthen tight or contractured tissues.
2. Improve chest wall and spinal mobility
3. Strengthen muscles needed for chest expansion and elevation
4. Restore and maintain normal posture
5. Improve and maintain lung compliance

Exercises such as the use of dumbbells to strengthen the latissimus dorsi and rhomboids using a pose termed dumbbell rear delt fly, Yoga poses such as superman (Lie on a mat with your stomach and arms extended and forehead resting on the ground, inhale then lift your head, legs, and arms, hold for 5seconds and then gently relax); seated twist (Sitting straight, engage your core and arms in forward flexion with/without weight in both hands, inhale and as you exhale, perform a lateral rotation to the right, hold for 5seconds and while inhaling relax; do for the other side and repeat for about 10 times); Bow pose for improved chest expansion and deep breathing (Lie on a mat with your stomach with knees flexed, grab your ankles with your hands then inhale and lift your thighs off the floor while your shoulder blades pressing back to open your chest and your gaze forward; hold the pose for 15 seconds and repeat 2 times); Camel pose (In upright kneeling with your shins and the dorsum of your feet pressed to the ground, your hands at the back of your pelvis, lean back, aiming to drop your hands to your heels with your head dropped back and without losing the upright kneeling posture; hold the pose for about 15 seconds and repeat twice)