Post-Thoracoplasty Care

Scoliosis, Pain and Rehabilitation

¹ Dallas, Texas

The modern extrapleural thoracoplasty has become a most effective collapse measure for the closure of tuberculous cavities. Most reports of the results of thoracoplasty deal with its main object, that is, cavity closure and sputum conversion. There are, unfortunately, certain sequelae of thoracoplasty that must be evaluated in a full appraisal of the end results of this procedure.

The chief mechanical effects of thoracoplasty that may contribute to invalidism or disability are: (1) pain in the chest or shoulder; (2) scoliosis; (3) limitation of motion of the shoulder. Proper technique in the fashioning of a thoracoplasty will minimize to a great degree the resultant deformity and disability. Attention to details in post-operative care will prevent pain and limitation of motion in the involved shoulder.

Residual pain following thoracoplasty may be (1) constant or (2) present only upon motion of the shoulder. Constant pain is often due to the contraction of the underlying flbrotic lung or thickened pleura or to intercostal neuritis caused by pinching of the nerves by the rib stumps. Pain present only upon motion of the shoulder is usually due to contact of the scapula with some bony prominence.

Scoliosis in some degree follows almost every thoracoplasty. The amount of residual scoliosis is influenced by: (1) the age of the patient; (2) the extensiveness of the thoracoplasty; (3) the degree of flbrosis of the underlying pleura; and (4) the manner in which the operative procedure is carried out.

Limitation of motion of the shoulder girdle and arm following extrapleural thoracoplasty is due to: (1) pain due to an ill-fitting scapula; (2) subscapular adhesions; (3) intra-articular adhesions; and/or (4) contracture of the muscles of the shoulder girdle that have been cut during the operative approach.

The post-thoracoplasty convalescent period should be a minimum of six months. The amount of rest necessary will be influenced by (1) the general condition of the patient. (2) type of lesion present (that is, exudative or fibrotic), (3) rapidity of sputum conversion, (4) condition of the contralateral lung and (5) presence of important extrapulmonary tuberculosis. The importance of this period of rest must be impressed upon the patient and, at the same time, the goal of eventual return to normal activity must be continually held before him. The majority of patients that have obtained sputum conversion following thoracoplasty should eventually become normal healthy citizens.