title: Physiotherapy as an adjuvant to the surgical treatment of anterior chest wall deformities: a necessity? A prospective descriptive study in 21 patients.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Paediatric Physiotherapy, University Medical Center, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Schoenmakers
authors.forename: V A
authors.initials: VA
authors.lastname: Gulmans
authors.forename: N M
authors.initials: NM
authors.lastname: Bax
authors.forename: P J
authors.initials: PJ
authors.lastname: Helders
mesh_terms: D000009:Abdominal Muscles / Q000503:physiopathology; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005660:Funnel Chest / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D006801:Humans; D008297:Male; D009068:Movement / Q000502:physiology; D018908:Muscle Weakness / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000502:physiology; D026741:Physical Therapy Modalities; D011184:Postoperative Period; D011187:Posture; D011446:Prospective Studies; D013131:Spine / Q000502:physiology; D019616:Thoracic Surgical Procedures / Q000379:methods*