Thursday, August 27, 2015

Pectus Excavatum complications - beware neck strike during barbell Clean

I am deformed

Current Management of Pectus Excavatum [jf: depressed sternum associated upper chest]

Pectus excavatum (PE) is one of the most common anomalies of childhood. It occurs in approximately 1 in every 400 births, with males afflicted 5 times more often than females. PE is usually recognized in infancy, becomes much more severe during adolescent growth years, and remains constant throughout adult life. Symptoms are infrequent during early childhood, but become increasingly severe during adolescent years with easy fatigability, dyspnea with mild exertion, decreased endurance, pain in the anterior chest, and tachycardia. The heart is deviated into the left chest to varying degrees causing reduction in stroke volume and cardiac output. Pulmonary expansion is confined, causing a restrictive defect.

Repair is recommended for patients who are symptomatic and who have a markedly elevated pectus severity index as determined by chest X-ray or computed tomography scan…. Operation rarely takes more than 3 hours, and hospitalization rarely exceeds 3 days. Pain is mild and complications are rare, with 97% of patients experiencing a good to excellent result. The new minimally invasive Nuss repair avoids cartilage resection and takes less operating time, but is associated with more severe pain, longer hospitalization and a higher complication rate, with the bar remaining for 2 or more years…

My chest wall deformity is moderately severe, not as impressive as the wikipedia photo. A correction attempt was made at age 15 or so, but without the reinforcing “bar” used now. The post-operative pain then was not “mild”, it was exquisite — at least during breathing. The collapsed lung or two probably didn’t help. (I suspect my surgeon was pleased I survived). The deformity recurred, but my operative experience cured my psychic distress. I decided having an “ant’s swimming pool” wasn’t so bad after all.

Reading the above description it seems I can blame my unimpressive athletic career on my chest wall. Come to think of it, I did feel quite tired this morning on the fourth round of 400 meter sprints and as-many-reps-as-possible box-jump-over burpees. [1]

All of which is a prequel to new knowledge. I’ve figured out why I’m the only person at CrossFit who tends to hit their neck when doing a barbell “Clean”. With most people, even with poor technique, the upper chest pushes the bar away from the throat. With me it directs the bar towards my throat.

So there you go. For all the other persistent Pectusoids out there, if you are doing a barbell Clean pay attention to hitting your mid-body target and work on your technique — your pectorals will not save you.

[1] Sarcasm here should hint that this abstract’s disability description is debatable. In reality it is unclear how much cardiopulmonary compromise there is, and whether surgery really helps. Some articles suggest it helps cardiac function but worsens pulmonary function. There are big nocebo (deformity) and placebo (surgery) effects that make outcome evaluation difficult.

Update 8/31/2015: After writing this I realized I have a genuine CrossFit disability. I can’t do an “Rx” pushup, because I can’t touch my upper chest to to the ground (lower chest gets in way, not to mention my shoulders and head). During WODs I use an Ab Mat as a target, but I couldn’t do that in competition.

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