Orthopedics-Online

Keel chest

Synonyms

Chicken breast

introduction

A keel chest is a bony malformation of the chest. This is expressed in a prominent, i.e. protruding, part of the breastbone in its lower part, so that the chest of the affected patient arches forward in the middle.

This is where the name comes from, as the shape can be reminiscent of a ship's keel in a distant sense. In contrast to the funnel breast, which is usually congenital, this malformation does not occur until the growth phase, i.e. between the first and second decade of life, and occurs far less often than this.

The deformation of the chest is rarely very pronounced and is therefore always harmless from a medical-functional point of view.

Causes of a keel chest

In contrast to Funnel breast, which is innate, a keel breast usually develops in the course of growth from the age of 10 years.
One of the reasons for this is that the ribs have a cartilaginous portion to which the joints are attached Sternum connect, are connected. If it is in that proportion too excessive growth or a structurally reduced stability of the cartilage occurs, the sternum becomes due to the lack of alternative Forward pressed: a keel-like protrusion forms.

A genetic one, well heritable cause for the keel breast is strongly suspected, since the occurrence of a keel breast accumulates in many families, but one could still no gene responsible for it prove or describe an exact inheritance.

The fact that the disease affects other families speaks against this sporadically occurs, i.e. without sick relatives or recognizable triggers. Long-standing poor posture is discussed as one of the causes of the keel chest.

It also occurs more frequently in the Association with certain other underlying diseases in which important metabolic processes are disturbed.
This is an example of this Marfan's Syndromewhere there are weaknesses in the connective tissue, including the cartilage, all over the body. Also one Malformation in the womb due to alcohol consumption in pregnancy is considered to be a cause of the keel breast.

However, what exactly is causing the increased growth of the cartilage is still Subject of intense research.

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Causes of a funnel breast

The genetic component seems likely but has not yet been established. But it is noticeable that in families in which chest wall anomalies - such as funnel chest - occur more frequently, the image of the keel chest is found more often. Furthermore, there is a connection with Marfan's syndrome and a certain sub-form of mucopolysaccharidoses.

Excessive growth of the cartilaginous parts of the ribs at their attachment to the breastbone probably plays an important role in the development of the keel chest. Here, these parts grow too much and push the breastbone forward, or force it to arch forward due to the resulting pressure.

Alternatively, it can also lead to the sternum being pushed backwards by the growth, which then results in the formation of a funnel breast. If the growth on the two sides of the rib cage is different, mixed forms and asymmetrically warped forms of the keel chest can occur. The exact cause of the excessive cartilage growth has not yet been clarified.

Further information also under our topic:

Tricher Breast
Treat the funnel breast with the suction cup

Symptoms of a chest of the keel

The keel breast only arises in the growth phase.

A keel chest is less of a problem in the medical-functional sense than in the mental component. Only with one very strong expression this can also cause physical symptoms. If the asymmetry is very strong, there is one Impairment of breathing possible what is in a shortness of breathcan express themselves, especially under stress.

The lying on the belly is often called unpleasant felt and in rare cases pain in the area of the protruding part can occur. Also are increased in connection with a keel chest Bad posture of the spine observed what then often too Back pain leads.

But here, too, the psychological component has an influence, as this often arises from the attempt to noticeable deformation to conceal from the outside. So the main problem with the keel breast is the mental stress of those affected by their own appearance. Often the front of the keel is not very pronounced, so that the Deformity is not very noticeable.

In the case of strong manifestations, however, the patients often feel very uncomfortable with their appearance, especially since the development mostly in the time of puberty falls. The mental stress caused by the cosmetic impairment should not be underestimated and often has a disease value, especially when through low self-esteem to social isolation leads.

Diagnostics of the chest of the keel

The diagnosis can already be made during the physical examination, so it is a visual diagnosis. This is often supported by x-ray images that allow an exact representation and assessment of the characteristics.

Therapy of a keel chest

In some cases, surgery is also appropriate.

Because of the psychological problems, therapy for those affected with a keel chest consists primarily of psychological care, especially if the severity of the malformation does not justify an operation.

Otherwise the application of a pad bandage can be tried conservatively. A bandage is applied, which exerts targeted pressure on the protruding area of the keel chest and is thus intended to guide growth towards a normal appearance. However, there must be a lot of suffering with a keel chest for this, as the often uncomfortable wearing of the bandage must be carried out continuously over a long period of time for this measure to be successful. In addition, this possibility can only be considered as long as the patient with a keel breast is still in the growth phase. In these cases a good result can also be achieved with it.

Surgery is rarely indicated in the case of a keel chest. This is only given if there is a very pronounced physical finding, for example if

Breathing restrictions exist,
the protrusion protrudes so far that the skin is chafed by clothing
if, in addition to the physical image, there is a great deal of psychological distress.

However, this is really only indicated in rare cases in patients with a keel chest and should only be done after the growth phase has ended.

In most cases, relatively small accesses are chosen for the operation of a keel chest, so that only small scars remain. As a rule, the sternum is detached from the vertebrae and the corresponding parts of the vertebrae are removed without opening up the thorax cavity.

Furthermore, depending on the shape of the keel breast, the sternum is split transversely and parts are removed or the sternum is reassembled at a different angle to compensate for the protrusion. Then the ribs are reattached to the breastbone, usually using metal clips or wires, which have to be removed after a while. A keel chest surgery usually has a good chance of success. But here too, as with any operation, there are risks, which is why an indication must be carefully considered.

How can an orthosis help?

In addition to the surgical treatment, there are now also some conservative approaches in the treatment of a keel chest in which the keel chest is not repositioned immediately, as in an operation, but is slowly repositioned in a longer process. An individually tailored corset is used, which has to be worn for several hours a day.
Treatment should be started as early as possible, which is why it is particularly popular with very young patients, as the chest is more flexible and malleable than in adults.

The success of the therapy and the feeling for an orthosis or bandage depends individually on the patient. Some people find it very uncomfortable to wear a bandage, but pain is rarely reported. Before doing this, you should see a doctor who will write a prescription so that the costs can be covered by the health insurance company.

Bandages on a keel chest

A so-called pelotte can be used for a keel chest. It is a tailor-made, individual bandage, which is strapped to the chest or back in the form of a hemispherical object. Strong external compression corrects the misalignment.

It is a popular method, especially with young patients, as their rib cage is still very malleable. The bandage must be checked and adjusted regularly.

Exercises against a keel chest

A first step against a keel chest is to try to mobilize the chest as much as possible. For example, two small balls or a black roll can be used, which are placed under the thoracic spine to the right and left of the vertebrae. By moving the body up and down, stiffening between the vertebrae can be loosened.

Patients with a keel chest often have breathing problems, which is why breathing exercises are particularly important. These exercises can also be done in combination with the above.For example, one exercise might consist of taking a deep breath, holding your breath for 2-3 seconds, and then exhaling slowly for 6 seconds. Such exercises train the diaphragm and improve breathing with a keel chest.
Sufficient strength training to strengthen the muscles in the trunk and back is also important with a keel chest in order to counteract poor posture. This can take the form of squats or push-ups, for example. It is best to get help and advice from a physiotherapist and work out an individual exercise plan together.

Sports such as swimming and gymnastics are also recommended.

Operation of a keel breast

From a medical point of view, the chest of the keel itself does not cause any physical symptoms in the vast majority of cases. In rare cases, breathing may be slightly impaired; if the chest is particularly protruding, chafing and superficial abrasions from clothing are possible, so that an operation makes sense here.
However, most surgical interventions are due to psychological stress and subjective discomfort.

There are basically two methods of an operative approach:

the open surgery and
minimally invasive corrections

The best time for surgery is after puberty, when growth is complete. The aim of open surgery is to bring the protruding part of the chest down to normal levels.

Usually under general anesthesia, the ribs are first separated from the breastbone in order to then remove a previously determined part of the excess cartilage. The sternum is lowered to the desired height and fastened back to the ribs at the connection with screws or plates.

Another method, the so-called "nut technique", is a minimally invasive procedure, which means that one operates through a very small incision, thus reducing the risk of complications and also the pain after the operation; colloquial Keyhole surgery.
In this procedure, a metal bracket is implanted and the keel chest is pressed down. However, this technique is far more common and well-known for the funnel breast, i.e. the opposite of the keel breast; so she could not yet assert herself for the keel breast.

Overall, there is a good chance of achieving a satisfactory result after an operation on the keel chest. It may have to be corrected again. However, the benefits must always be carefully weighed against the risks of each operation.

OP costs

There are different approaches to a surgical approach to a keel chest, which is why it is difficult to say exactly how much the operation will cost. It often depends on whether it is an open or minimally invasive operation, how pronounced the keel breast is and the age of the patient.

The best thing to do is to consult the attending doctor or the health insurance company and possibly consult one or two additional opinions from other doctors before deciding on an operation.

Is that covered by the health insurance?

The costs for an operation are usually covered by the health insurance. But here, too, it depends on the patient's age, the insurance company and other factors, which is why the insurance company should be consulted before the operation.

For patients under 18 years of age, the costs are usually covered in full, for older patients only partially with some insurance companies. It is important to see a doctor beforehand, also in order to have conservative products such as bandages or orthoses covered by health insurance.

Pain during therapy

The keel chest itself rarely causes pain. Surgical treatment is usually carried out under general anesthesia, which is why there is no pain here either.

With the conservative treatment method, the pain perception depends on the patient himself. Some find the orthotics or bandages very uncomfortable and painful, others feel no pain. Often a short period of acclimatization of 1-2 weeks is necessary, during which pain can occur due to the strong compression, which then decreases.

Who treats a keel breast?

A keel chest is usually treated by specialized orthopedic surgeons or thoracic surgeons in adulthood, and by children's surgeons in younger years. It is advisable to go to specialized centers for chest malformations, as local hospitals often lack the experience for such interventions or examinations.

Forecast at keel chest

After the operation on the chest of the keel, a treatment with a pressure pad bandage should be carried out in order to stabilize the chest and the result of the operation.

Follow-up treatment in the form of breathing and physiotherapy should also be carried out in order to prevent the