Physiotherapy as an adjuvant to the surgical treatment of anterior chest wall deformities: A necessity?: A prospective descriptive study in 21 patients*

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Abstract

Purpose: The authors postulated that physiotherapy as an adjuvant to the surgical treatment of anterior chest wall deformities is only indicated if specific abnormalities can be found that could be corrected by physiotherapy. The purpose of this study is to investigate whether such abnormalities can be found and to evaluate their course during a postoperative period of 18 months. Methods: Twenty-one patients, 16 with pectus excavatum and 5 with pectus carinatum, were evaluated 6 weeks before and 6 weeks, 6 months, and 18 months after surgical correction. Postural impairments, spinal mobility and curvature, muscle strength, and muscle length were evaluated. Results: Preoperatively, poor posture was seen in 10 patients, nonstructural scoliosis in 11, and abdominal muscle weakness in 4 patients. None of the patients had restriction of spinal mobility or shortened pectoral muscles. Six weeks after surgery, poor posture was seen in 9, nonstructural scoliosis in 11, and abdominal muscle weakness in 10 patients. The authors found a higher percentage of recovery for abdominal muscle weakness than for poor posture (90% versus 33%, respectively). Conclusions: The authors found preoperative postural impairments in 52% of their patients, in patients with pectus carinatum as well as in patients with pectus excavatum. In patients without postural impairments, physiotherapy is not necessary, with the exception of postoperative pulmonary care. J Pediatr Surg 35:1440-1443. Copyright © 2000 by W.B. Saunders Company.

Section snippets

Materials and methods

All patients treated surgically for pectus excavatum or carinatum in the period from 1992 through 1995 were evaluated prospectively 6 weeks before surgery and 6 weeks, 6 months, and 18 months after surgery. Patients with musculoskeletal anomalies (Marfan's Syndrome and connective tissue disorders) were excluded. All measurements were performed by the same physical therapist. Informed consent was obtained from patients and parents. Postural impairment, range of motion, muscle strength, muscle

Results

The male to female ratio was 4:1. The majority of the patients had pectus excavatum. Data concerning type of deformity, gender, age at operation, associated diseases, and follow-up period are presented in Table 1.

. Patient Characteristics

Empty CellPectus ExcavatumPectus Carinatum
Number165
Male to Female ratio12:45:0
Age (yr)
 Mean10.314
 Range(5.7-16.1)(5.8-16.7)
Associated diseases
 Asthma40
 BPD10
Follow-up period
 6 wk preoperatively165
 6 wk postoperatively135
 6 mo postoperatively165
 18 mo postoperatively165

Data

Discussion

In this study, we investigated the existence and characteristics of pre- and postoperative postural impairments in children with anterior chest wall deformities. Postural abnormalities, such as slumping shoulders and protuberant abdomen, are described frequently in literature, especially in patients with pectus excavatum.1, 2, 4, 6, 8 To our knowledge, the incidence of these impairments has not been reported before. In this study poor posture was seen preoperatively in patients with pectus

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    *

    Address reprint requests to M.A.G.C. Schoenmakers, BSc, PT, Department of Paediatric Physiotherapy, Room KB 2.056.0, University Medical Center, Wilhelmina Children's Hospital, PO Box 85090, 3508 AB Utrecht, The Netherlands.

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