Orthopedics-Online

Sternum pain

introduction

The sternum (lat. sternum) is a flat bone which, together with the ribs, forms part of the thoracic skeleton. The breastbone takes on an important stabilizing function in the bony chest.
Due to the functional integration into a complex system of muscles, joints, vision and bones on the chest, the sternum is exposed to strong forces and movements (e.g. when breathing).

Possible causes of sternum pain

The most common causes of sternum pain are listed below:

Diseases of the lungs e.g. Bronchitis or pneumonia
aching
Sternum fracture
Scoliosis
Funnel breast
Keel chest

Temporary sternum pain can be triggered by a variety of events. Sternum pain can be localized purely on the breastbone (then often local diseases such as fractures or inflammatory processes) or be part of radiating pain in the chest (then often organic causes such as acute myocardial infarction or angina pectoris).
Congenital malformations of the sternum can theoretically lead to problems in the area of the sternum (e.g. funnel chest, keel chest, Harrenstein deformity).

Lung disease as a cause of sternum pain

If a patient complains of sternum pain and cough, acute bronchitis may be present, i.e. an inflammation of the bronchi of the lungs, usually caused by a virus.
In addition to the sternum pain and slimy cough, there are also frequent increases in temperature and hoarseness. In the further course the cough can become increasingly dry, the pain in the sternum but also any pain behind the sternum intensify more and more. After about 2 weeks, however, the cough and sternum pain should subside.

If the pain occurs suddenly and if, in addition to the sternum pain, there is also pain in the entire thoracic area, along with coughing and shortness of breath, you should think of a pulmonary embolism (especially if you are an elderly patient or recently operated patient) and call an emergency doctor immediately !

If the symptoms appear rather insidious and if, in addition to the cough and pain in and around the breastbone, there is a high fever and labored breathing, one should think of pneumonia. If, however, in addition to the cough, the pain occurs in isolation in the sternum and not in the entire thoracic area, it can also be that the increased coughing irritates and overstrains the muscles that are attached to the sternum and thus leads to "sore muscles" leads to sternum pain.

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Sternum pain from sore muscles

Many patients come to the practice with sternum pain after a gym workout.
This can be due to various exercises, such as dips. During the dips, the main load is the pectoralis major muscle, a muscle that stretches from the sternum (sternum) to the upper arm bone (humerus). If the muscle is overloaded, discomfort in the area of the sternum can easily occur.
In addition, dips stress the abdominal muscles, which are also attached to the lower part of the sternum. If you made a wrong movement during the dips or if you overloaded yourself, the dips can lead to sternum pain, as the muscles pull too much on the sternum or are easily inflamed. It is important to have the exercises shown by an experienced trainer in order to avoid renewed sternum pain. Acute sternum pain caused by dips should try to relax the muscles by placing a warming pillow on the sternum or taking a hot bath.
If the sternum pain does not improve, a physiotherapist or an osteopath should also be consulted.

Sternum fracture

Diseases of the sternum (sternum fracture / sternum fracture) and thus sternum pain are rare. As a result of an accident, direct impact can break the sternum and cause sternum pain. In most cases, no therapy is necessary, as the sternum heals together again under the constant breathing movements.

You can find further information under our topics:

Sternum fracture
Bruised sternum

Scoliosis as a cause of sternum pain

The sternum is in the thorax and can be felt from the front all along the line. The sternum is connected to the thoracic spine in the back via the first to the tenth rib. Therefore, in addition to sternum pain, back pain can also occur, especially when sitting incorrectly.
Above all, patients who sit at their desks a lot and who have acquired relieving postures, such as supporting with their elbows or a hump, are affected by combined sternum and back pain. This is due to tension in the muscles, which in the end stress the joints. Above all, the joints that connect the ribs to the sternum (sternocostal joints) are put under incorrect strain and can then cause sternum pain. However, since the spine is also improperly stressed, back pain also occurs. It is therefore always an incorrect load; congenital malpositions, such as scoliosis, a curvature of the spine, are to blame for combined sternum pain and back pain.
In any case, it is important to consult a physiotherapist or an osteopath so that they can help correct the misalignment and thus avoid sternum pain and back pain.

Also read our article: Pain associated with scoliosis

Funnel breast

The most common in most cases harmless standard variant is the so-called funnel breast (Pectus excavatum).
This is a funnel-shaped indentation of the front wall of the chest. The cause is an incorrect growth of the breastbone / sternum and the chest. However, sternum pain is hardly noticed.
In most cases it is only a cosmetic problem. Surgical correction is only necessary in very severe cases with impairment of the heart and lungs.
You can find further information under our topic: Funnel breast

Keel chest

The keel breast (pectus carinatum), which occurs around 10 times less often, is the counterpart to the funnel breast.
The sternum and chest bulge forward.
Even with the chest of the keel there is usually only one cosmetic - psychological problem without disease components such as sternum pain.

Read more on this topic: Keel chest

Tietze syndrome

The Tietze Syndrome (Chondroosteopathia costalis) is a possible cause of sternum pain.

With this clinical picture, there is still an unexplained cause of painful swellings in the area of the joint transition from the 2nd and 3rd rib to the sternum (costosternal joint). Systemic signs of inflammation can usually not be found diagnostically.
However, since Tietze syndrome heals spontaneously within a few months, it is a temporarily painful disease with a favorable prognostic outlook.

Tietze syndrome is more common in older people. These usually present themselves to emergency clinics with the fear of a cardiovascular event. Ultimately, however, this is not an organic but a musculoskeletal chest pain.

Tietze syndrome can be clearly differentiated from other causes (such as organic causes without swelling in the sternum area) by means of the painful swelling without any radiation.

Find out more about the topic here: Tietze Syndrome.

Concomitant symptoms

Depending on the underlying cause, sternum pain can appear as a single symptom or together with other accompanying symptoms.

The upper ribs of the chest attach to the breastbone in the form of a cartilaginous connection. This articulation (Articulationes sternocostales) represents a predilection point for inflammatory processes that can cause localized pain in the sternum (Costochondritis). In general, however, this clinical picture occurs rather rarely.
If costochondritis is present, the underlying disease is usually a systemic disease (e.g. Reiter's disease).

Due to the three-part structure of the sternum with an additional very flat bone structure, the sternum is basically also prone to fractures. The breastbone can fracture e.g. as part of cardiopulmonary resuscitation (CPR) or postoperatively after bypass surgery.

However, if there are additional complaints such as in the form of a radiating pain to the area behind the breastbone (retrosternal tenderness), into the armpit, the left arm or down to the neck, an organic first manifestation is often the cause.
These radiating symptoms are typical for a myocardial infarction as well as for angina pectoris. Frequent accompanying symptoms are shortness of breath, an increased breathing rate, increased sweat secretion, fear and inner restlessness.
The occurrence of retrosternal pain in particular indicates an organic cause, which, among other things, can also be a gastric tube disease (inflammation, reflux in the form of heartburn or tumors). Ulcerations in the stomach area can also be accompanied by pain in the breastbone area.

In the context of traumatic injuries (sports injuries or accidents with bruises, bruises, etc.) can also be associated with sternum pain.
In this case, there are usually accompanying traumatic injuries elsewhere. Periostitis (unspecific, aseptic periosteum inflammation) is usually the trigger for sternum pain in the context of injuries. The periosteum is the periosteum, which is very well supplied with blood and is also very sensitive to pain.

When can sternum pain occur?

Sternum pain when breathing

The breastbone (sternum) is located in the thorax above the lungs.
In addition, it is connected to 10 of the 12 ribs via cartilaginous joints (sternocostal joints) and various auxiliary respiratory muscles such as the pectoralis muscle. This means that with every inhalation (inspiration) and thus also during exhalation (expiration), the sternum is stretched a little and also strained.
Breast pain in the sternum is particularly common in cases of inflammation of the bronchial tubes, which is mostly viral (bronchitis). This then lasts for about 2 weeks and is accompanied by a slimy and then dry cough.
Inflammation of the lungs (pneumonia), which is usually caused by bacteria, can lead to sternum pain when breathing or when breathing in (pain when breathing in). There is also a rapid rise in temperature and shortness of breath.
Pulmonary embolism is also characterized by sternum pain and general pain when breathing, but this is accompanied by a bloody cough. This notice is always an emergency indication and the patient should be taken to a hospital as soon as possible. In some cases, the sternum pain when breathing is also psychological and is usually associated with extreme anxiety and very rapid, increased breathing (hyperventilation).

Sternum pain after heart surgery

Postoperative sternum pain is not an isolated case after surgery on the heart or generally in the chest.

In the context of bypass operations e.g. can be obtained through the anatomical position of the sternum (lat. sternum) an access route to the operating area. The surgeon deliberately fractures the breastbone and stabilizes it with metal spirals after the operation.
Especially with bypass operations, in addition to the typically pressing pain on the sternum, numbness in the chest area can occur. This is due to the fact that in most cases a section of the internal thoracic artery is used as a vascular replacement for a bypass, which among other things supplies the chest with arterial blood.
If the pain persists for more than six months after a sternotomy, advice can be given to remove the metal coils from the sternum.
The numbness caused by the removal of the internal thoracic artery in parts should subside after a few weeks.

If there is pain in the sternum after a heart operation, the patient has various options.
In the vast majority of cases, the bypass was placed because of arteriosclerotic vascular diseases of the coronary arteries. Therefore, in the postoperative course, care should be taken to ensure that the predisposing factors of increased blood lipid levels (especially cholesterol) and increased blood sugar are kept within the normal range.

Find out more about the topic here: Heart bypass - when is it used?

Sternum pain from heartburn

One possible cause of sternum pain is heartburn.
This occurs when acid flows from the stomach back into the esophagus. This causes an inflammatory reaction in the lining of the esophagus (medically called reflux esophagitis). There is usually a burning or pulling pain behind the breastbone. An irritation of the throat can also trigger a dry cough. The symptoms can be alleviated by changing your eating and drinking habits and taking other measures such as sleeping with your upper body elevated. Spicy foods, alcohol and sweets should only be consumed in small quantities. It is also advisable not to take the last meal too late but a few hours before going to bed.
If the above measures are not sufficient, drug treatment can be used. An active ingredient that reduces the production of stomach acid can often relieve heartburn and the associated sternum pain.

This topic might interest you: Diet for heartburn

Sternum pain from the diaphragm

The diaphragm is a flat muscle that internally separates the chest cavity from the abdomen.
When you breathe in, the diaphragm contracts and lowers on both sides of the body and when you breathe out it rises again in a dome-shaped manner. Under certain circumstances, sternum pain can result from damage to the diaphragm. Abdominal organs can press into the chest cavity through holes or weak points in the muscle layer. In most cases, the stomach is affected by what is known as an internal hernia. Sternum pain can be caused directly by the incorrectly positioned organ parts. The hernia also promotes heartburn, which can also be a cause of pain behind the breastbone.
If there is a suspicion that sternum pain originates from the diaphragm, imaging may be required.

Sternum pain after exercise

Sternum pain after a training session is in most cases a harmless side effect.
Especially when exercising muscles that are located in the area of the sternum, pain can then occur. These are mainly the pectoralis major and minor muscles. In theory, muscle pain after the training is also possible with targeted training of the serratus anterior muscle.

Since the pain is mostly due to sore muscles, the pain usually improves within a week.

Sternum pain after dips

After a strength training session with dips, sternum pain is not uncommon.
The exercise mainly trains the large pectoral muscle (musculus pectorales major), as the entire body weight is pushed up with each repetition. The muscle arises from the chest wall, with some fibers also starting from the sternum and running to its muscle attachment on the upper arm. The exercise can lead to tiny tears in the muscle fibers, into which tissue water penetrates. The result is pain known as sore muscles. This usually only occurs twelve hours after training at the earliest, but sometimes not until the day after that.
When training the chest muscles, for example through dips, sternum pain can therefore also occur. These are movement-dependent and are amplified when the arm moves. Muscle soreness occurs particularly when no other strength training of the chest muscles has been carried out and can last between two and seven days.
Other exercises that can lead to such pain include push-ups or bench presses. If the sternum pain is not dependent on movement, a muscular cause and thus a connection to the dips is unlikely.

Sternum pain when moving

If sternum pain occurs when moving or the intensity of the pain is movement-dependent, the cause of the symptoms is very likely to be damage to the musculoskeletal system. The cause of the pain can lie in the bones, the joints or the muscles of the chest.
Due to the often not clearly assignable origin of the movement-dependent sternum pain, these are often summarized as chest wall syndrome. This classification is important to distinguish it from other causes of the symptoms that may require urgent treatment. Sternum pain caused by damage to internal organs such as the heart, lungs or esophagus typically occurs independently of movement, so that there is usually no dangerous disease present.

Sternum pain on pressure

Similar to movement-dependent complaints, sternum pain, which is triggered or exacerbated by pressure, also suggest a bony or muscular cause.
If a certain point on the sternum is sensitive to pressure, this can indicate, for example, tension in the muscles between the ribs or damage to a joint between the rib and the sternum. On the other hand, sternum pain in dangerous internal organs such as a heart attack cannot be triggered by pressure. Pressure-sensitive sternum pain therefore usually gives the all-clear and usually subsides on their own after a few days.

Sternum pain after a fall

After a fall on the chest, sternum pain is not uncommon.
Usually they are caused by a bruise. In addition to pain, a bruise can form if small blood vessels were destroyed in the fall and bleeding into the tissue occurs. A short-term use of painkillers and cooling the sternum can provide relief. In the event of a fall from a great height or another serious accident, a doctor should be consulted in order to rule out serious injuries. Indications for this can be severe pain when breathing and a feeling of instability in the chest.

Read more about this:

Treatment of a bruised rib
Bruised or broken rib?

Sternum pain from injuries to the spine

Musculoskeletal misalignments or injuries to the spine can lead to secondary pain in the area of the sternum.

The reason for this is the complex interplay between the spine, ribs and sternum in all movements, e.g. breathing or changes in the position of the upper body.
A transmission of pain stimuli originating in the spine via the intercostal nerves is also conceivable when sternum pain develops.

Sternum pain in pregnancy

Sternum pain occurring during pregnancy is not uncommon and usually has a harmless cause.
In addition to the general possible causes of pain, some special processes during pregnancy can trigger the symptoms. For example, it happens that the growing child pushes the abdominal organs upwards with increasing size. Especially when lying down, the pressure on the stomach can cause acid to enter the esophagus and trigger heartburn, which is perceived as burning or pressing pain in the sternum. This can be remedied if the pregnant woman sleeps with her upper body raised. The “acid blockers” often taken for heartburn should not be used during pregnancy and breastfeeding. In the case of frequent or very pronounced sternum pain, the gynecologist or family doctor should also be consulted.

Read more about this: Heartburn during pregnancy

Sternum pain in children

Basically, sternum pain in children can have different causes.
The cause is often found very quickly if you ask the child what it was doing the day before. Sternum pain can arise in children as well as in adults due to incorrect or overuse of muscles. If the child has been climbing around all day, it may well be that the muscles were overexerted, especially the pectoralis major muscle, which runs from the sternum to the humerus.
However, it is also possible that the child has an inflammation of the bronchi (bronchitis). In this case, the child suffers from sternum pain and has a slimy cough (in the later stages also dry cough), often combined with a slight fever.
Especially with growing children, one should always remember that the growth of the sternum can also cause pain that is caused by irritation of the intercostal nerves located there (intercostal neuralgia).
In addition, the joint cartilage of the ribs can become inflamed (costochondritis). In this case, the children also complain of sternum pain, often the sternum is slightly swollen and very tender. In this case, the parents should see a pediatrician the next day as the symptoms will not go away on their own.

therapy

If sternum pain occurs, a decision about how to proceed should first be made depending on whether there is a recognizable harmless cause of the symptoms, such as strength training on the previous day or a bruise.
A doctor should be consulted if sternum pain occurs for no apparent cause. Indications of a serious illness as the cause of the symptoms can be if the pain is independent of movement and occurs more intensely during exertion such as climbing stairs. In the case of sudden, severe sternum pain, possibly in connection with fear and shortness of breath, it is even important to notify an emergency doctor immediately, as these may be signs of a heart attack. If none of the alarming signs are present or if a harmless cause of the sternum pain is clear, one can wait and see.
Taking analgesic and anti-inflammatory drugs for a few days can often relieve the pain. If the sternum is bruised as the cause of the pain, it helps to cool the affected areas temporarily and to take it easy for a few days. However, low-intensity physical activity can also help alleviate the symptoms. If the sternum pain does not subside, is steadily increasing or is accompanied by other complaints such as shortness of breath, frequent belching or fever, an early presentation to the family doctor is indicated.

diagnosis

In the case of sternum pain, a medical consultation and physical examination are the first and most important measures to make the diagnosis.
The doctor asks the patient specific questions such as whether the pain is caused by stress or is dependent on movement or breathing. In addition, possible accompanying symptoms such as shortness of breath, fever or cold sweat are recorded. During the examination, the doctor tests, among other things, whether the sternum pain can be triggered by pressure. A diagnosis is not always possible on the basis of the measures mentioned, but it can usually be assessed with a high degree of probability whether or not there is a dangerous disease or disease that requires acute treatment. Depending on the findings, the doctor will also decide how to proceed.
If necessary, further examinations are indicated for the diagnosis, such as an EKG (electrocardiogram) or an X-ray of the chest.

forecast

The prognosis of sternum pain depends in principle on the underlying cause.

In many cases it is a harmless periostitis (inflammation of the bone skin) in the context of overload or injuries such as Bruises.
Due to the potentially life-threatening organic manifestation of retrosternal pain (located behind the breastbone), a diagnostic clarification of the cause must be followed in a particularly timely manner.

Duration

The duration of sternum pain can vary widely and depends largely on the cause.
If muscles or bones are damaged by overexertion or a bruise, the symptoms usually subside after a few days. If the airways or lungs are inflamed, the pain will subside as soon as the disease has cured. If the heart is causing the sternum pain, it can keep coming back. The symptoms are triggered by physical exertion, emotional stress or cold. With stable heart disease, the pain does not last more than 20 minutes.
If the pain persists with a known heart condition or occurs without a trigger, it may be a sign of a heart attack and an emergency doctor should be called immediately.