Integrated Physical Therapy Intervention for a Person With Pectus Excavatum and Bilateral Shoulder Pain: A Single-Case Study

Abstract

Canavan PK, Cahalin L. Integrated physical therapy intervention for a person with pectus excavatum and bilateral shoulder pain: a single-case study. Objective: To examine the effects of an individualized physical therapy (PT) program for a subject with pectus excavatum and bilateral shoulder pain. Design: Single-case study of a man diagnosed with moderate-to-severe pectus excavatum and constant bilateral shoulder pain. Exercise tolerance was measured through the Bruce protocol and home exercise log, pulmonary function, ventilatory muscle strength, echocardiography, chest wall and abdominal excursion, self-perception of pectus excavatum, and a variety of anthropometric and volumetric tests before and after PT. Setting: University laboratory. Participant: A 22-year-old man. Intervention: A 3-month PT program including breathing exercises and therapeutic exercises. Main Outcome Measures: Exercise tolerance, ventilatory muscle strength, chest wall and abdominal excursion, self-perception of the pectus excavatum, and other anthropometric and volumetric tests. Results: The most striking anthropometric and volumetric test change was the pectus severity index (in H2O), which decreased from 50 to 20mL H2O (60% change). The subject reported no shoulder pain at rest and with recreational activity after 8 weeks of intervention. Conclusion: An individualized PT program provided minimal-to-moderate improvements on many characteristics of pectus excavatum. Bilateral shoulder pain was eliminated. An individualized PT program integrating cardiopulmonary and musculoskeletal interventions that is provided to other patients with pectus excavatum may provide similar results. However, PT provided to younger patients with the pectus excavatum may be of even greater benefit because of a less mature skeleton. Further investigation of the effects of PT intervention provided to younger and older persons with the pectus excavatum is needed. © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.