In this video, Kate Grace, RPT, OPA-C (Evolve Physical Therapy + Advanced Wellness) and Dr. Barry LoSasso (Director of the Center of Excellence since 2006), discuss the role of physical therapy and how it can enhance and improve the results of the Nuss Procedure. They hope this video will fill an existing void in a rehabilitation protocol and empower patients to have a speedy and advanced recovery.
Dr. LoSass is a general adult and pediatric surgeon, who has completed over 1000 corrective Nuss Procedures in patients ranging in age from 10 to 52. Recently, Dr. LoSasso relocated his office to Paramus, New Jersey from San Diego, California, in order to bring his expertise to more Pectus Excavatum patients – adults and teens.
Kate Grace is a Physical Therapist and Orthopedic Physician Assistant. She founded Kate Grace Physical Therapy in 1985. This very progressive rehabilitation clinic treats a wide variety of patients with acute and surgical orthopedic injuries, postural dysfunctions and athletic and industrial injures of the spine and extremities. Kate received her degree in Physical Therapy from Ohio State University in 1979. From 1979 to 1982 Kate was a staff Physical Therapist at Children’s Hospital in San Diego.
As an introduction: there are three types of deformities Excavatum (sunken), Carinatum (protruding), and a hybrid of the two types (mix). Pectus deformities are very common. One in every 350-450 people on the planet suffer from some sort of pectus deformity, and it is more common in men than women in a ratio of 4-1.
Pectus Excavatum is a defect involving the anterior cartilaginous ribs. The defect worsens as the patient grows. The sunken chest compresses the heart and shifts it out of place. When at rest, there are fewer symptoms but during exercise the patient becomes increasingly out of breath and fatigued.
The Nuss Procedure is a minimally invasive surgical procedure done under general anesthesia. It involves using a telescope in the chest to visual the deformity relative to the heart. It requires a skilled surgeon to bend the bars perfectly to conform to the dimensions of the anterior chest. It then requires forming tunnels both superficially to the skin laterally and beneath the defect and above the heart internally. The bars are flipped into place and the chest responds to the bars immediately. The bars are sutured into the lateral chest wall. The patient stays in the hospital for 3-5 days and the bars remain in the chest for approximately three years. During that time, the bars are permanently correcting the position of the chest. The bars will be removed in three years under general anesthesia, at which point the bars can be removed and the chest will remain in a corrected position.
Dr. LoSasso and Kate Grace have developed this video in order to present their approach with regards to physical therapy for a patient who has undergone Pectus Excavatum Surgery in the form of the Nuss Procedure. They have developed it over the last 10 years to empower patients to achieve an optimal surgical result post-op.
“With Nuss Procedure patients, we see many physical challenges including postural mal-alignments including chest pain, tight pec muscles, internal rotation and anterior translation in their shoulders, shortened soft tissue around the neck, pecs, and checks, decreased range of motion and weakness in a number of muscle groups. They also have historically been unable to participate in aerobic exercise. Post-operative all of the mal-alignments have been corrected and normal chest anatomy and chest functions have been corrected. From a psycho-social standpoint, suddenly a patient can participate fully in sports and aerobic activity with their peers,” Summarizes Kate Grace.
The below video features a 15-year-old patient who is one-year post-op, and is now able to participate successfully in his chosen sport, volleyball. He states that his stamina has improved and his shortness of breath has gone away.
Please watch the video to learn more about Pectus Excavatum surgery and recommended post-operative physical therapy techniques.