The Sternum (Latin sternum) is the structure in the middle of the bony chest (thorax) and consists of 3 bone parts: 1. Handle (lat. Manubrium sterni), 2nd body (lat. Corpus sterni) and 3rd sword extension (lat. Xiphoid process).
The sternum is articulated with the Ribs (lat. Costae) and the left and right Collarbone (Latin clavicula) connected.
The joint names are named according to the structures that articulate with each other: Articulatio sternocostale connects sternum and ribs, Articulatio sternoclaviculare connects the sternum and collarbone.
The sternum itself is a relative flat bone and from the outside in its entire length well palpable. Together with the ribs, the sternum forms a protective bony cage for many vital organs (heart, lungs, etc.).
Also read our article: Sternum pain
Causes of pain
Pain in or on the sternum can have various causes and its characteristics can also vary.
Sternum pain is caused by problems with the heart (cardiac causes), with the muscles, with the bones themselves or with complaints in other organs.
Depending on what the reason for the pain is, one can differentiate between more harmless triggers and life-threatening causes.
The sternum, like any other bone, can break through the application of traumatic forces, so that the dull to stabbing pain is directly causally related to the fracture. If there is any suspicion, an imaging test such as an X-ray can help clarify the situation. Another bony structure that can break and cause similar pain are the ribs.
If a fracture is ruled out, a sternum contusion should still be considered, as this also manifests itself in severe pain.
In addition to the bony structures, sternum pain can also originate from the surrounding muscles. Muscle tension and sore muscles in the chest and back muscles provoke pain that is primarily dependent on movement or can be made worse by movement.
You can find more information on this topic on our website: Sternum pain
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Causes in the gastrointestinal tract
Heartburn is a harmless cause that is not considered by most. This is a burning and drawing pain behind the breastbone. The reason for this is the gastric acid, which flows unphysiologically from the stomach back into the esophagus (Latin: esophagus) and thereby irritates the wall of the esophagus due to its acidic properties (clinical picture: reflux esophagitis).
A change in eating and drinking habits and drug treatment can quickly lead to pain relief.
Other causes from the gastrointestinal tract are the diaphragmatic hernia, gall bladder and pancreatitis.
The diaphragm is a muscle that separates the organs in the chest from those in the abdomen. This boundary layer can be permeable due to holes or weak points, so that abdominal organs push themselves from below upwards into the chest cavity.
If the stomach is able to move into the chest cavity because of such a malformation, severe chest pain can occur: This is known as a diaphragmatic hernia.
Read more on the topic: Diaphragmatic hernia
Inflammations of abdominal organs such as the gallbladder or the pancreas (lat. Pancreas) trigger pain under the breastbone in addition to their classic symptoms.
An infection with the "varicella zoster virus" (VZV; or chickenpox virus infection) can also be a harmless trigger of sternum pain. Chickenpox is the result of an initial VZV infection. After a second infection with the virus, shingles (herpes zoster) can develop, which is a belt-shaped rash.
This rash often causes burning to pulling pain over a dermatome (= skin area supplied by a nerve branch) and in the sternum region.
Causes at heart
Cardiac causes are less harmless, but there is a clinical picture with reflex heart complaints, which is simply triggered by an accumulation of gases in the abdomen, the "Roemheld syndrome".
Excessive ingestion of food and gas that causes gas can put pressure on the heart. This leads to symptoms such as angina pectoris with a feeling of tightness in the chest, shortness of breath and chest pain.
Symptoms that can be confused with angina pectoris are sometimes psychological in origin. Fortunately, this factor is harmless, but not to be underestimated, as those affected feel severe pain and an oppressive feeling. Most of the time, stress, anxiety and stressful everyday problems are the triggers for the psychological sternum pain.
It is now important to consider the serious and life-threatening triggers. Cardiac (affecting the heart) and pulmonary (affecting the lungs) causes are the most common causes.
The "Marburg Heart Score" helps to assess the likelihood of coronary artery disease (CHD) in the case of sternum pain. This is a point system of 0-5 points with an increasing probability of CHD (0-1 points: <1%, 2 points: 5%, 3 points: 25%, 4-5 points: 65%).
Criteria are age and sex, known vascular diseases, stress dependence of the pain, provocation of pain through pressure and the patient's self-assessment.
The cardinal symptom of coronary heart disease is angina pectoris ("chest tightness"). Triggered by a reduced blood supply to the heart, pressing, constricting and burning pains develop on the sternum.
The pain usually only lasts a few minutes and can be triggered by increased exercise, cold weather, or stress.
Much more severe pain is caused by myocardial infarction, which is defined as the loss of muscle tissue (Latin: myocardium) due to reduced blood flow.
The characteristics of sternum pain are like angina pectoris with additional severe pain, which is also called "annihilation pain". This is accompanied by cold sweat, paleness, radiation of pain, nausea, dyspnea (subjectively felt shortness of breath) and dizziness.
If a myocardial infarction is suspected, emergency therapy must be initiated immediately, which includes the administration of morphine, oxygen, acetylsalicylic acid (ASA) and nitrates.
Another serious cause of sternum pain is inflammation of the pericardium (pericarditis). As is typical of inflammation, the pain is accompanied by fever.
The sternum pain in pericarditis is described as stabbing, sharp and cutting and usually lasts for several hours to days.
The large arterial vessel that transports the blood from the left heart into our body's circulation is the aorta. A pathological splitting of the aortic wall layers (mainly due to tearing of the innermost "tunica intima" layer) is called aortic dissection and leads to severe pain in addition to the previous cardiac causes.
The pain is mainly localized in the anterior rib cage on the sternum and can radiate into the back, as the aorta is also very far back as it runs through the body. The pain is excruciating, stabbing and tearing and usually occurs suddenly.
Read more on this topic: Aortic dissection
A dissection can also occur in the esophagus. One cause of esophageal dissection can be reflux esophagitis, mentioned among the harmless triggers. The characteristics and localization of the pain are similar to those of an aortic dissection.
Causes on the lungs
Finally, sternum pain due to pulmonary causes such as pulmonary embolism, pneumonia, spontaneous pneumothorax, bronchial asthma and pulmonary hypertension should be explained as serious triggers of sternum pain.
In the case of a pulmonary embolism, blood vessels in the lungs are blocked by an embolus (= vascular plug made from the body's own or foreign material). Such an event does not always lead to severe pain, which is comparable to that of angina pectoris, but can only trigger symptoms such as dizziness, tachycardia (= increased heart rate) and fever.
Serious pulmonary embolism, however, is usually accompanied by sharp pain behind the breastbone and in the affected lung for minutes to hours. In addition to the acute occlusion of a pulmonary artery, the pulmonary vessels can be continuously narrowed for various reasons.
Due to the increased vascular resistance, the blood pressure in the pulmonary circulation rises and one then speaks of "pulmonary hypertension". The pain is localized behind the breastbone and is described as an oppressive feeling of pressure. The pain is mostly persistent and can be aggravated by exertion.
The lungs are surrounded by a membrane called the pleura. In between there is the pleural gap, which is actually not a real space, as there is a negative pressure here and the pleura is directly adjacent to the lungs.
If the pleura ruptures as a result of a traumatic experience or spontaneously, air or blood penetrates into the gap and the negative pressure is lost. The affected side's lungs then collapse, i.e. that it contracts and shrinks. This causes sharp pain on the side of the pneumothorax, shortness of breath, and a stinging sensation in the chest.
Finally, pneumonia (inflammation of the lung tissue), triggered by a bacterial or viral infection, should be mentioned. The symptoms of typical pneumonia are cough, high fever, sputum, shortness of breath, and sharp pain in the sternum.
Please also read: Lung pain
Is Sternum Pain Dangerous?
So there are different triggers for pain in the sternum. Many are harmless, but there are also some life-threatening conditions that must be considered. The decisive factors are the characteristics of the pain, the accompanying symptoms, as well as the duration and time of occurrence.
Localization of pain in the sternum
Right side sternum pain
Sternal Bone Disorders (sternum) per se are very rare. In the case of pain in the area of the sternum, it is more on Diseases of the lungs and respiratory tract to think. Especially when the pain aggravated by coughing occur is one bronchitis the likely cause of the discomfort.
In the case of pain on the right side, this would correspond to an inflammation of the right afferent airway. Another indication of this can be green or yellow expectoration be. Likewise is one lung infection (pneumonia) conceivable.
Kick the pain very suddenly on, shine in the entire rib cage out and go with Shortness of breath hand in hand, should be on a Pulmonary embolism getting tested. This is a clinical picture that urgently needs treatment!
However, the pain is depending on the breathing movement of the rib cage is one Blockage of the rib-vertebral joints conceivable, as well as one Intercostal neuralgia. This assumption is confirmed by pain-sensitive pressure points on the chest wall.
Left side pain in the sternum
Chest pain on the left side is understandable for many sufferers with a fear of one Heart attack connected. However, the nature of the pain can quickly provide information about whether this fear is justified.
Pain in the context of a heart attack or a narrowing of the coronary arteries typically have a constricting, oppressive character on. It is not without good reason that these symptoms are called angina pectoris, "Chest tightness". Furthermore, the pain mainly occurs during physical exertion and regardless of breathing movements on.
Read more about the here Signs of a Heart attack.
Left-sided pain caused by inflammation of the airways, on the other hand, increases when coughing and is usually accompanied by slimy sputum and fever. If the pain occurs instead when breathing or moving the shoulder, a blockage of the rib and vertebral joints or a Intercostal neuralgia can be thought of. If pain-sensitive pressure points can be found on the chest wall, this supports the latter suspected diagnosis.
Central sternum pain
As well as for pain in the sternum located on the right or left side (sternum) a handful of underlying causes are likely to cause pain in the center of the sternum. One of these is the bronchitis, inflammation of the large supplying airways (Bronchi). If the pain occurs more intensely when coughing and mucous sputum is observed, this diagnosis is very likely. Also one lung infection (pneumonia) would be conceivable here.
If the pain occurs depending on movements of the chest, for example when breathing or moving the shoulder, is one musculoskeletal cause more likely. This includes above all Blockage of the rib-vertebral joints and the so-called Intercostal neuralgia.
Nonetheless, a cardiac cause should also be considered. However, associated pain is very different from the above. Pain associated with reduced blood flow to the heart muscle occurs particularly during physical exertion and is characterized by pressing, constricting pain. This is where the name of the symptoms angina pectoris, "chest tightness", comes from. Similar symptoms can, however, also trigger heartburn (reflux). With the appropriate severity, this often causes a feeling of pressure and burning pain behind the breastbone. In addition, heartburn is often associated with hoarseness as the stomach acid attacks the vocal cords. Increased pain after eating also indicates heartburn as the cause of the symptoms.
When does the sternum pain occur?
Sternum pain when breathing
Breathing-related pain in the sternum occurs primarily in two basic groups of diseases. This includes on the one hand musculoskeletal disordersto which especially the Blockage of the rib and vertebral joints and the Intercostal neuralgia belong. The latter represents a so-called neuralgiform syndrome This term describes pain caused by the Damage to nerves caused.
Intercostal neuralgia is characterized by persistent, pulling pain, which increases when the chest moves, for example when breathing.
A number of different diseases can be the cause here. The most common are Muscle hardening (Myellosis) of the intercostal muscles, which can lead to pinching of the nerves running here. However, as well as many others are also possible degenerative changes in the spine or the Herpes zoster (Shingles), which can also damage nerves. Precisely because the number of possible underlying diseases is so large, an exact diagnosis is often difficult here.
Another conceivable cause of breath-dependent pain in the sternum are diseases of the respiratory tract. Inflammation of the supplying airways (bronchitis) in particular play a role here, but pneumonia should not be disregarded. If the pain occurs very suddenly and intensely and is accompanied by shortness of breath, a pulmonary embolism can also trigger the symptoms be. This is a serious clinical picture that urgently needs treatment.
Sternum pain after heart surgery
In the case of open heart surgery, access must first be created to the organ, which is well protected in the center of the chest. To do this, the breastbone is usually sawed open lengthways and split so that the ribs can be moved to the sides and the heart can be exposed. After the operation on the heart, the two halves of the sternum are put back together and fixed with strong wires. In the weeks after the heart operation, the bone has to heal again. In the first few weeks after the operation, sternum pain can occur repeatedly. In rare cases, the wires themselves may be responsible for the pain and may need to be removed. Before a heart operation, you should ask your doctor about the pain to be expected and also ask for which complaints a re-presentation is indicated.
Sternum pain with back pain
Pain in the sternum and back can be caused by various clinical pictures. First and foremost, however, should be one musculoskeletal Cause to be thought. This includes various diseases of the musculoskeletal system, i.e. muscles, bones and joints. Belt-like pain around the chest is common Blockage of the rib-vertebral joints responsible.
However, there is also a so-called Intercostal neuralgia conceivable as a trigger of the complaints. This is pain caused by damage to nerves, which is classically a persistent, pulling character exhibit. However, the term intercostal neuralgia does not represent an exact diagnosis, but includes several independent clinical pictures.
These include, among others Indurations (Myellosis) the intervertebral muscles, which can entrap nerve tracts. Likewise, intercostal neuralgia can affect one degenerative change in the spine be due.
In this regard there may also be a Herniated disc of the thoracic spine cannot be excluded as the cause of the pain. Precisely because the complaints described are so unspecific, a doctor's clarification should be considered if the pain persists over a long period of time, is very severe, or increases in intensity.
Pain in the sternum and ribs / at the base of the ribs
If, in addition to pain in the sternum, there is pain in the base of the ribs, this clearly indicates a Blockage of the rib-vertebral joints down. Classically, this leads to a restricted freedom of movement in the thoracic spine or the thorax, which is from dull, pulling, frequent attacks of pain is accompanied. These typically radiate belt-shaped around the rib cage and intensify with movements such as breathing excursions of the rib cage.
Those affected often experience this Restrictions while breathing. In rare cases, abnormal sensations such as numbness in the rib area can occur when the intercostal nerves are pinched. They are also typical of rib blockages Pressure points over the affected joints at the sternum, through which the pain can be reproduced.
The cause of rib blocks are next accidental injuries mostly degenerative changes in the joints or one unfavorable posture in everyday life. The most common treatments for the ailments include drug pain therapy Ibuprofen or Diclofenac and physiotherapeutic as well as manual therapy procedures.
In order to avoid the recurrence of rib blocks, in addition to a consciously healthy posture, strengthening exercises for the spinal muscles as well as stretching exercises are recommended.
Sternum pain during pregnancy
Some complaints such as stomach pain or nausea hardly surprise anyone during pregnancy and are often even commonplace. But also pain behind the breastbone is not uncommon during this time and is usually considered harmless. They are due, at least in part, to the increasing size of the child in the womb. Since the space in the abdomen is rather limited, the remaining organs, above all the gastrointestinal tract, have to evade. This can lead to discomfort, especially when lying down, as a lot of pressure is exerted on the abdominal organs in this position. So it happens that previously unknown symptoms such as heartburn occur during pregnancy, especially when lying down. This is characterized by a burning and pressing pain behind the breastbone, if it is appropriate.
It is useful for those affected to know that the stomach is curved in the upper abdomen, with the bulge on the left side. For this reason, the contents of the stomach tend to shift towards the esophagus when lying on the left side, which is why lying on the right side often leads to an improvement in symptoms.
In addition, adjusting your eating habits can help minimize gastric acid production. It is important to know that foods containing protein and caffeine in particular promote the production of gastric acid. Drugs used to treat heartburn should be avoided during pregnancy. Drugs belonging to the group of proton pump inhibitors, such as pantoprazole, are known to pass into breast milk. Even if only a few study results are available, this suggests a potentially harmful effect on the child.
Antacids, on the other hand, seem to be much less problematic here. Nevertheless, you should always consult your gynecologist before taking any new medication during pregnancy.
Please also read our page Medication in Pregnancy.
Tietze syndrome is a swelling that is painful to pressure and usually occurs at the base of the ribs on the upper part of the sternum. The cause of this rare disease is unknown and it usually heals within a few months. In the case of sternum pain, the patient or the doctor often initially fears that the symptoms originate from the heart. Therefore, Tietze syndrome is often only diagnosed after a heart-related cause has been ruled out. Tietze syndrome is one of the usually harmless causes of sternum pain that originate in the muscular and skeletal system. In contrast to heart disease, it is typical for these complaints that the pain can be triggered by applying pressure to the affected area. In some cases, you can even see redness or swelling. In order to make the diagnosis, a medical consultation and a targeted physical examination are usually sufficient. As a rule, the patient does not experience any benefit from further diagnostic measures. If the doctor can reassure the patient that only a harmless Tietze syndrome and no serious illness is responsible for the sternum pain, this often contributes to a decrease in the pain symptoms. If necessary, a short-term treatment with an anti-inflammatory pain reliever can also take place. In the case of very pronounced symptoms, a single injection with a locally effective anesthetic can be considered.
Chest pain can be accompanied by various symptoms, which can often provide clues as to the cause of the symptoms. For example, the symptom fever suggests that there is inflammation. In this constellation, pleurisy could be present, for example.
In the case of a cold infection, if the trachea is involved, in addition to increased body temperature and sternum pain, coughing, runny nose and fatigue can occur. If the esophagus is inflamed by rising stomach acid, frequent belching and coughing may appear as accompanying symptoms in addition to the pain.
Breathlessness in connection with sternum pain is usually an alarming sign because these symptoms together can indicate an acute disease of the heart or lungs such as a heart attack or a collapsed lung (pneumothorax). In such an emergency situation, cold sweats and fear of death can also occur as additional symptoms. In the case of a heart attack, the pain often radiates, for example to the left arm or the jaw. Other unspecific accompanying symptoms can be nausea and vomiting.
Also read: heartburn