The sternum, which is also commonly referred to as the breastbone, is a long flattened bone that is situated at the upper middle section in the front of the chest. It attaches to the cartilage of the first seven pairs of the ribs and the collarbone on either side and forms the anterior section of the rib cage. While the section in the front is convex, the section at the back is slightly concave. Normally, the sternum is a T-shaped bone, but variations from the shape might be seen in case of some people. Some people might be born with a deformed sternum, whereas some might develop structural chest wall deformities due to certain medical conditions. Pectus carinatum, which is commonly known as pigeon chest, is a deformity that is characterized by protruding ribs and sternum. On the other hand, a sunken sternum is referred to as Pectus excavatum.
Pectum carinatum deformity is attributed to the overgrowth of the rib cartilages. When the rib cartilages grow at an abnormal rate, these cartilages start pushing the sternum outward. Generally, protrusion of the sternum becomes more evident as a child born with a rounded chest reaches the age of three. In case of boys, protrusion might occur due to growth spurts during the period of adolescence. If the condition runs in the family, the chances of one developing this structural deformity are higher. Certain medical conditions associated with bones and connective tissues could also be responsible for chest wall deformities.
Some of these medical conditions could cause sternum pain. Protrusion of the sternum might be a symptom of diseases such as costochondritis, Marfan syndrome, homocystinuria, Sly syndrome, multiple lentigines syndrome, Trisomy 18, Trisomy 21, osteogenesis imperfecta, and Noonan syndrome. If the extent of protrusion is significant, one's physical appearance is greatly affected. Besides the psychological effect this condition might have on the patient, one might even experience certain health problems. The symptoms will depend on the underlying cause of this deformity. For instance, a person affected by costochondritis is most likely to experience sternum pain. Sometimes, breathing problems might be experienced as well. In case of some patients, breathing problems, low stamina, and difficulty while performing strenuous physical activities might also be experienced.
Sometimes, doctors recommend the use of a chest wall compressional brace to correct this deformity, but if that doesn't help, a surgery could be performed in order to get rid of the abnormal rib cartilages that are pushing the sternum out. Generally, aspects such as degree and progression of this chest wall deformity, preexisting medical conditions (respiratory problems, cardiac problems, or the underlying condition responsible for causing the deformity) are considered before performing the surgery. The surgical procedure that is used for removing the cartilages is referred to as Ravitch procedure.
This procedure is used for the correcting the chest deformities. The surgeon first makes an incision across the chest region in order to remove the abnormal rib cartilages. The next step involves the fracturing and repositioning of the sternum. Once the abnormal cartilage is removed and the sternum is directed downward, the surgeon will place a sternum stabilizer bar and close the incision. This bar is generally removed after a year.
While Ravitch procedure is used for correcting pectus carinatum as well as pectus excavatum, Nuss procedure is used for correcting a sunken sternum or a symmetrical pectus carinatum deformity. While performing Nuss procedure, the surgeon makes two lateral incisions on either side of the patient's chest and inserts a curved steel bar under the sternum. After the bar is positioned correctly, the incision is closed. The steel bar is generally removed after two or three years. These procedures are performed under general anesthesia. The hospital stay generally ranges from five to seven days. The patient can resume normal activities after a couple of weeks, but he/she must not participate in contact sports or vigorous strenuous activities for at least three months.
Medical assistance must be sought those who have a protruding sternum, and have been experiencing sternum pain, breathing problems, and fatigue on exertion. Since protrusion of the sternum might be a symptom of certain medical conditions, it's important to identify and treat the underlying cause.
Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.