Funnel chest deformity

The causes of chest deformation are divided into two groups - congenital and acquired. Deformity can be a consequence (complication) of a number of spinal diseases.

Among the main causes of deformation are the following:

• kyphosis,
• scoliosis,
• chronic obstructive pulmonary diseases,
• marfan syndrome,
• anomalies of osteogenesis,
• achondroplasia,
• Turner syndrome,
• Down Syndrome,
• emphysema,
• rickets,
• keeled deformity,
• funnel chest,
• cleft sternum,
• Poland syndrome,
• Wife Syndrome,
• congenital rib anomalies,
• asthma,
• incomplete fusion of the fetal sternum,
• congenital absence of the pectoral muscle,
• ankylosing spondylitis,
• inflammatory arthritis,
• osteomalacia

As we can see, in most cases, the deformity is caused by genetic reasons leading to abnormal development of the upper spine; it develops against the background of existing anomalies and syndromes.

Genetic causes, in turn, lead to the asymmetric development of bone and cartilage tissue and cause the development of asymmetry of the ribs and sternum, as a result - convexity or concavity of the chest.

Scoliosis, tuberculous bone infection, rickets, as well as all kinds of injuries and damage, including those associated with a person’s professional activity, are among the causes that cause acquired deformation of the chest.

Types of chest deformities

In children, two types of congenital pathology most often occur: funnel-shaped (also called “shoemaker’s breast”) and keeled:

1. The funnel chest is characterized by a sunken shape of the front part, in which it is pressed inward and takes the form of a depression. In this case, the sternum visually appears expanded. Science does not know the exact reasons for the appearance of this defect.
2. Keeled deformity appears already at birth and is expressed in the form of a convex shape of the bone corset of the chest. The cause of pectus carinatum is believed to be excessive growth of the ribs or osteochondral cartilage. Usually the disorder is accompanied by abnormal development of the spine, curvatures (scoliosis, kyphosis), and various types of heart defects. The keeled deformity can also be asymmetrical, with the shape of the sternum being sunken only on one side and protruding on the other.

Most experts agree that congenital chest deformity originates during intrauterine development. A child's rib cartilage grows too quickly, causing increased pressure, resulting in a sunken rib cage. The disease makes itself felt soon after the birth of the baby or in his first years of life. Associated syndromes may include rickets, abnormal development of the spine, heart disease, asymmetric development of bones and cartilage of the sternum. Over time, if left untreated, the deformity can rapidly progress, causing physiological discomfort and disturbances in the functioning of internal organs.

One of the most serious diseases is Poland syndrome. This is a rare congenital syndrome, which is characterized by a complete or partial absence of the muscular frame on one side and an accompanying malformation of the hand. Its cause is considered to be impaired blood circulation in the vertebral arteries during fetal development. In this case, the heart muscle and main arteries are not protected by the bone skeleton of the chest and are at risk of mechanical damage.

3. Symptoms, stages and diagnosis of funnel sternum

Already in the neonatal period, diagnosis of funnel chest is possible. The child’s chest is depressed, and during periods of crying, screaming, or taking a deep breath, the so-called “inhalation paradox” is observed - the depression of the ribs and sternum intensifies. It is noted that in 50% of cases this pathology disappears without a trace in the first months of life. In other children, the symptoms increase and may include:

• raised edges of the ribs and an enlarged abdomen;
• stridotic breathing with difficult wheezing inhalation;
• chronic pneumonia;
• thoracic kyphosis;
• flattened chest and drooping shoulders.

The funnel increases with development and can reach a volume of 200 cm3 in adults. Depending on its depth and accompanying disorders, three degrees of deformation are distinguished:

• Stage I (compensated) – the chest is deepened by 2 cm without displacement of the heart;
• Stage II (subcompensated) - the depth of the funnel is up to 4 cm, the heart is displaced by 2-4 cm;
• Stage III (decompensated) – a deeper depression in the sternum, combined with a pronounced displacement of the heart relative to the normal position.

Diagnosis of pectus excavatum is carried out by electromyographic study. During the study of anamnesis, visual examination and hardware examination methods, the following are revealed:

• structural changes in the respiratory muscles;
• decreased excursion of the chest and diaphragm, decreased vital capacity of the lungs;
• hypertrophy of the right ventricle of the heart;
• tissue hypoxia;
• general asthenia in children;
• retardation in physical development;
• vegetative-vascular dystonia;
• tendency to respiratory diseases, developing into bronchitis and pneumonia;
• cardiovascular and pulmonary failure.

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Symptoms

The first symptom of chest deformation is external changes. The cosmetic defect may be barely noticeable in newborn babies: it can be detected when inhaling, and the ribs recede. As the child grows older, the disease becomes more pronounced and reaches its peak by 3 years.

A sunken chest in a child accounts for more than 90% of cases of the disease. With this pathology, the costal cartilages are not fully developed, the sternum is increased in width, the chest cavity is reduced, and curvature of the spine occurs. As a result of these processes, a child may lag behind his peers in physical development, often suffer from respiratory infections, suffer from autonomic disorders, and respiratory failure. Children react poorly to physical activity, get tired quickly and are not able to play sports on a par with their peers. If there is a disturbance in the upper or middle region, motor function also suffers.

Diagnosis of pathology

Diagnosis of diseases associated with the bone corset of the sternum is usually not difficult and can be carried out by studying external manifestations. At the initial stage, the specialist prescribes an x-ray examination in two projections, which gives a complete picture of the curvature and the severity of the disease. Next, a computed tomography may be prescribed, the results of which will reveal not only the degree of deformation of the bones and cartilage, but also the nature of the displacement of the mediastinum, the heart muscle, and how compressed the lung is. Magnetic resonance imaging gives a complete picture of the condition of bone, cartilage and soft tissues.

Functional examinations of the heart and respiratory system are prescribed as additional methods: electrocardiogram, echocardiogram, spirographic examination, examination of respiratory function and determination of lung volume. The complex of these methods makes it possible to identify functional disorders and track the dynamics of recovery after operations.

Kinds.

1. Funnel-shaped deformation of the HA.
2. Keeled deformity of the HA.
3. Developmental anomalies of the ribs and sternum (aplasia and hypoplasia).
4. Genetic diseases (Marfan, Ehlers-Danlos, Turner syndromes, etc.). Their symptom complex includes musculoskeletal pathology, including HA deformation.

The most common are the first two in a ratio of 10:1. About 30 theories of the occurrence of these deformations are described in the literature.

Basic theories of the occurrence of these deformations.

1. Anomalies of intrauterine development: delayed tissue growth, disruption of the process of normal tissue fusion during the period of 6-9 weeks, disruption of tissue differentiation (various dysplasias): cleft sternum, fusions and defects of the ribs, abnormalities of the pectoral muscles.
2. Metabolic enzymopathies associated with disruption of the synthesis of glycosaminoglycans, which leads to disruption of the formation and development of connective tissues.
3. Anomaly of the diaphragm (underdevelopment of its anterior sections).

Funnel-shaped deformation of the HA.

VGK is a deformation of the HA, characterized by depression of its middle part and epigastric region. The area of ​​greatest retraction occurs on the body of the sternum and the xiphoid process. The deformity extends to the entire cartilaginous part of the ribs, and in children over 10 years of age it also affects the bone part.

Classification according to V.N. Kondrashin.

Shape: Regular and funnel-shaped.

By type of deformation: symmetrical and asymmetrical (left- and right-sided).

According to the degree (depth) of deformation:

I degree 0.7-1. II degree 0.7-0.5. III degree less than 0.5.

The degree of deformation is determined by radiography performed in a lateral projection. The radiograph measures the shortest and greatest distance from the posterior surface of the sternum to the anterior surface of the thoracic vertebral bodies.

Deformation degree = smallest distance/largest distance.

According to the stage of the disease: compensated, subcompensated, decompensated.

Clinic.

In the compensation stage, VGK appears only as a cosmetic defect. There are no functional disorders of the respiratory and cardiovascular systems. Physical activity is well tolerated. In the subcompensation stage, moderately expressed functional disorders of the respiratory and cardiovascular systems are added. Physical activity is poorly tolerated, there is discomfort in the projection of the heart and paradoxical breathing associated with abnormalities of the diaphragm. Paradoxical breathing disrupts GC excursion and reduces pulmonary ventilation, which leads to functional disorders in the pulmonary circulation due to chronic hypoxemia and the occurrence of frequent bronchopulmonary diseases.

In the stage of decompensation, the deformation of the HA is pronounced, and significant functional disorders of the cardiovascular and respiratory systems are noted.

Treatment.

Surgical treatment for grades 2 and 3 deformity. The optimal age is 5-7 years because...

1. Better results due to unfinished skeletal formation.
2. Absence of significant functional disorders and secondary deformations of the HA and spine.
3. Easier execution technique.
4. Smoother postoperative course.

Various options for thoracoplasty are used. Today, more than 30 methods and their modifications are known.

Keeled chest deformity.

KGC is a deformity of the sternum, characterized by a noticeable protrusion of the sternum, horizontal arrangement of the ribs, an increase in the anteroposterior size of the sternum, and the formation of a sternocostal hump. In the first three years of life, the deformation is subtle and rarely detected. During periods of growth, the correct development of the HA structures is disrupted and the deformation becomes clearly visible.

Classification according to G.A. Bairov and A.A. Fokin.

1. Manubriocostal type.
2. Corporacostal type.
3. Costal type.

The second type is much more common.

Clinic.

The manubriocostal type is characterized by forward protrusion of the manubrium and the upper part of the body of the sternum, 2-3 costal cartilages. Corporacostal type . Depending on the shape of the sternum (straight, convex, convex), the size of the angle at the junction of the ribs with the sternum, the degree of deflection of 5-10 ribs, 4 forms of CGC are distinguished: linear, round, pyramidal and trapezoidal. The ribs in the cranial part run more horizontally. At the level of the sternum, the costal cartilages rise vertically, descend in a groove-like manner, or protrude forward in a ridge-like manner. The round shape is characterized by a greater bend in its middle part or middle and lower part. With a pyramidal shape, the sternum with deformed ribs is directed obliquely downwards and anteriorly in a straight line from the manubrium to the xiphoid process. In dynamics, a transition from a round shape to a pyramidal one is possible. The described types of HA are symmetrical and asymmetrical. The costal type is characterized by lateral protrusion of the GC due to excessive growth of the ribs on one side. The sternum can rotate in the direction opposite to the deformity. The ribs on the healthy side are either not deformed or sunken. In children under 10 years of age, functional impairments are mild. After 10 years, a decrease in vital capacity is observed, and the minute volume of respiration increases (the volume of air inhaled in 1 minute). Functional disorders of the heart are noted.

Treatment.

Operative for all types. The optimal age is 10-13 years. Various types of thoracoplasty are used.

Flat chest.

PCH is a deviation from the normal shape of the sternocostal complex, flattened in the anteroposterior direction. Classification according to Wolanski.

Three degrees of flattening : somewhat flattened HA, flat HA and excessively flat HA.

Treatment.

1. Physiotherapy. Breathing exercises.
2. Strengthening the muscles of the back and shoulder girdle.
3. Swimming.
4. In some cases, thoracoplasty.

The article was prepared by an orthopedic doctor at the Tiger Cub children's clinic, Pavel Vyacheslavovich Kravchenkov

How to correct a chest deformity

In the treatment of the spine and joints, a distinction is made between conservative and surgical treatment methods. The tactics are chosen based on the severity of the pathology and the presence of concomitant diseases of the respiratory and cardiovascular systems. Treatment of chest deformity at home includes performing a set of exercises that strengthen the muscle corset, physical therapy complexes, breathing exercises, swimming, wearing a corset, and a massage course. Conservative methods cannot completely correct the situation, but they can significantly slow down the process and maintain the normal function of internal organs. Treatment should be carried out under the constant supervision of an orthopedic surgeon. Drug therapy is aimed at eliminating those problems that have arisen in the internal organs as a result of their deformation under the pressure of the bone skeleton.

In traumatological practice, three stages of deformation are distinguished. With age, the child’s pathology will progress, so conservative treatment can give results only at the first stage. At the second and third stages, conservative methods do not show effectiveness, so doctors recommend surgical reconstruction of the chest. In this way, further deterioration can be avoided and normal conditions for the functioning of the heart and lungs can be created. As a rule, surgery is performed when the child reaches 7 years of age. In the treatment of chest deformity in adolescents, the method of placing two magnetic plates has been actively used over the last few years. One is implanted behind the sternum, and the second is placed on a special corset. The outer plate attracts the inner plate due to the magnetic field, and a gradual change in the position of the bones occurs.

4. Treatment of funnel sternum

Depending on the degree of deformation of the sternum and associated disorders, conservative or surgical treatment is used. Non-operative techniques include:

• exercise therapy;
• breathing exercises;
• massage;
• swimming;
• hyperbaric oxygenation.

Surgical treatment is indicated for severe respiratory and cardiac disorders, as well as significant orthopedic failure. The need for surgery is most often clearly determined in adolescence. After successful thoracoplasty, the anatomical shape of the chest is restored, functional disorders in the heart and breathing are eliminated, and the cosmetic defect is smoothed out.

After surgery, rehabilitation treatment is of great importance, which should be aimed at strengthening the respiratory muscles, eliminating dystrophic changes, and restoring the maximum volume of the vital capacity of the lungs. Physiotherapy, therapeutic exercises, and spa treatment are indicated.