Pectus Carinatum: Causes, Symptoms, and Treatment Options - Orthopedics

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Pectus carinatum, commonly referred to as "pigeon chest" or "chicken breast," is a condition characterized by an abnormal protrusion of the sternum and rib cage. This deformity can vary in severity and may be associated with other conditions, such as Marfan syndrome or Ehlers-Danlos syndrome, although it often occurs in otherwise healthy individuals. Understanding the causes, symptoms, and treatment options for pectus carinatum is essential for managing this condition effectively.


Causes
The exact cause of pectus carinatum is not fully understood, but it is believed to result from abnormal growth of the cartilage that connects the ribs to the sternum. This growth can lead to the sternum being pushed outward. Genetic factors may play a role, as the condition can run in families. Additionally, it is more common in males than females and often becomes noticeable during periods of rapid growth, such as adolescence.


Symptoms
While pectus carinatum is primarily a cosmetic concern, some individuals may experience physical symptoms. These can include:
- Breathing difficulties: Some patients report shortness of breath, especially during physical activities like sports, which may be exacerbated by the deformity.

- Chest pain: Discomfort or pain in the chest area can occur, particularly after strenuous activities.

- Psychosocial effects: The visible deformity can lead to self-consciousness, anxiety, or social withdrawal, particularly in adolescents.

In your husband's case, his history of shortness of breath and chest pain after playing basketball could be related to the mechanical effects of the chest wall deformity, although normal cardiac evaluations suggest that there may not be an underlying heart condition.


Treatment Options
Treatment for pectus carinatum depends on the severity of the condition and the symptoms experienced by the patient. Options include:
1. Observation: If the condition is mild and not causing significant symptoms, a watchful waiting approach may be appropriate, particularly if the individual is still growing.

2. Bracing: For moderate cases, especially in children and adolescents, a custom-made brace can be effective. The brace applies pressure to the chest wall to help reshape the sternum over time. This non-invasive treatment is typically worn for several hours a day and can lead to significant improvement.

3. Surgery: In more severe cases or when bracing is ineffective, surgical intervention may be considered. The most common surgical procedure for pectus carinatum is the Ravitch procedure, which involves removing the abnormal cartilage and repositioning the sternum. This option is usually reserved for patients with significant physical or psychological distress due to the deformity.

4. Physical Therapy: Engaging in physical therapy may help improve overall chest strength and flexibility, which can alleviate some symptoms. However, it will not correct the deformity itself.


Conclusion
In summary, pectus carinatum is a condition that can have both physical and emotional impacts on individuals. While your husband has experienced some symptoms, it is essential to consult with a specialist, such as a thoracic surgeon or a pediatrician with experience in chest wall deformities, to discuss the best management plan tailored to his specific situation. Early intervention, especially during adolescence, can lead to better outcomes, whether through bracing or surgical options. Regular follow-ups and monitoring are crucial to ensure that any changes in symptoms or the condition itself are addressed promptly.