The medical condition whereby the chest bones sticks out prominently is called pectus carinatum.
The reason why pectus carinatum occurs is due to overgrowth of the costal cartilage of the ribs which results in the sternum (breastbone) protruding outwards.
The mainly involved demographic group seems to be 11-14 years old males who are undergoing a growth spurt. Around 25% of patients with this condition have a family member with the same issue.
Other causes of pectus carinatum can include the following:
- Rickets, which is caused by a vitamin D deficiency.
- As a complication after open-heart surgery.
- In children who have poorly controlled bronchial asthma.
Signs and symptoms
In the mild cases of this condition, signs and symptoms may not be alarming and don't seem to affect the involved person in a negative way.
In moderate to severe cases though, there may be some issues associated with the deformity. The reason for this is because the rigid, outward protrusion of the chest causes respiration to be inadequate which forces the patient to use their accessory muscles, rather than their chest muscles, to aid in their breathing. This then results in inadequate gas exchange in the lungs which leads to the patient becoming tired faster due to shortness of breath and fatigue. These patients may also end up developing asthma.
Other physical issues which may be associated with this condition include the following:
- Localized pain.
- Scoliosis of the spine.
- Mitral valve prolapse of the heart.
- Connective tissue disorders such as arthritis.
In the moderate to severe cases, where the bone deformity is quite pronounced, the involved individual may suffer damage to their confidence and self-esteem. This affects social interactions which can cause them to become uncomfortable through their adolescent years and adulthood.
A customized chest-wall brace can be used in children, teenagers and young adults. This brace applies direct pressure to the protruding bones and produces excellent outcomes, especially in children whose bones can still be molded due to flexibility of the cartilage.
Children need to wear the brace for around 18 hours a day and when the chest shape has normalized, then this is reduced to 8 hours a day. This needs to be done for between 3-6 months.
Surgery is performed in patients where the problem is addressed in the late teen years or early adulthood, and where the deformity is severe or causing symptoms.
On orthopedic surgeon is consulted here and they would discuss the procedure. This would entail reshaping and repositioning the chest bones and the cartilage which attaches the ribs to the sternum may need to be removed. A curved metal bar is then fitted across the chest to help keep the sternum in the correct position. Post-operative pain management is important after this procedure and the patient will have to limit physical activities for up to 6 months after the procedure.
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