Sternum Pain

By Senior Editor
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Sternum pain or breastbone pain can be caused due to a variety of reasons. Sternum, commonly known as breastbone is a flat bone that is located in the centre of your chest directly below the collar bone. You can easily locate whether the breastbone pain is indeed in the region of the sternum, by tracing the sternum in the centre as it is connected to your ribs with cartilage. Sternum pain can be caused by a variety of reasons and you should consult a physician if you suspect that you are feeling pain around the region of the sternum.

Why Does My Sternum Hurt?
Causes of Sternum Pain
Diagnosis of Sternum Pain
When to see a Doctor

Why Does My Sternum Hurt?

Before your doctor looks into the real cause for your sternum pain, you might want to be aware of some of the common causes for breastbone pain. Pain under the breastbone or pain in the chest bone can be caused by multiple causes like esophagitis, acute pancreatitis, muscle strain or indigestion therefore the treatment for sternum pain should be carefully addressed to the cause which is producing it.

The location of the pain also gives a clue about its cause. Pain in the sternum area may present as upper or lower sternum pain or pain behind the sternum. When you feel pain below the breastbone region, it could be due to some disorder in the abdominal region. However abdominal pain may also manifest higher up as a feeling of discomfort or pain behind the sternum.

Other than this, the nature of pain can also lead to diagnosing the exact cause of sternum pain. Whether it is a mild pain which feels like a sore sternum or an excruciating sharp pain, they can have widely different causes and treatment modalities.

Image showing the location of the Sternum area

If you are experiencing breastbone pain, the problem can be of an acute nature and may not last for long or it may be of a chronic nature which means it will be long lasting.

Causes of Sternum Pain

Although the most common symptom of angina or heart attack is also chest pain, it is markedly different from pain behind the sternum. A physician can easily differentiate other sternum pain causes from cardiac pain. So pain in or around the sternal region is not always a cause of concern but it is always advised to consult your physician before reaching a conclusion.

Here are a few causes for breastbone pain:

1. Costochondritis
This is a condition of inflammation that occurs at the junction of the upper ribs and the cartilage resulting in sternum pain. This pain can sometimes mimic that of a heart attack so here are a few symptoms that can help you differentiate between the two:

Tenderness or discomfort that can be reproduced every time you press on the joint between the ribs and the cartilage
The breastbone pain is aggravated upon movement especially of the affected joint.
Pain that worsens every time you cough or take in a deep breath
The nature of the sternum pain is sharp and localized to the joint between the ribs and the cartilage.

Treatment: Pain due to costochondritis can be treated by the help of a conservative approach or using medication prescribed by your doctor. When using a conservative approach, you can use ice packs or heat locally to relieve the pain. However using a painkiller like naproxen or ibuprofen after advice from your physician can also help reduce the inflammation and help relieve the soreness and discomfort of sternum pain. As a precaution, you should tend to avoid unnecessary activities or exercises that tend to aggravate the breastbone pain.

2. Pleurisy
Sternum pain due to pleurisy is caused by the inflammation of the pleura surrounding the lungs. So pleurisy causes the inner walls of the chest to inflame due to many chest or lung condition resulting in breastbone pain. Here are a few symptoms that can help you recognize that the pain is indeed due to pleurisy only:

Severe sternum pain or chest pain when you inhale but there is no pain in between breaths
The pain is accompanied by dry cough
You will experience shortness of breath along with the symptom of breastbone pain
The pain in this condition is also accompanied with chills, fever and sore sternum area.
Other minor symptoms include nausea and appetite loss.

Treatment: Pleurisy can be caused due to different reasons therefore the treatment strategy also depends on the underlying cause. For example if sternum ache due to pleurisy is caused by pneumonia then antibiotics may be able to treat the underlying problem effectively. Some over the counter anti-inflammatory medication may also help relieve the symptoms of sternum pain. Taking rest and lying down on the painful side of the body can also reduce the intensity of breastbone pain.

3. Sternoclavicular joint pain

Sternoclavicular joint is present at the top of the chest where the collar bones are connected to the sternum on both sides. Sternum pain caused by problems in the sternoclavicular joint are usually a result of trauma. The severity of the breastbone pain may vary from mild to severe depending on the intensity of the injury that caused it. A serious case of chest bone pain may occur if your sternoclavicular joints are dislocated either anteriorly or posteriorly. Here are a few symptoms that you may experience other that severe chest bone pain if you have suffered a sternoclavicular joint injury:

Severe pain localized to the point where the sternoclavicular joint is situated along with breastbone pain at the time of injury.
Other than the symptom of pain, the displaced clavicle or collar bone may result in symptoms like hoarseness, swallowing difficulty, breathing difficulty or a choking sensation.
More chronically you may experience a swollen sternum at the top or crepitus while movement.
The pain felt in the chest may be aggravated in a position when you try to reach across your body.

Treatment: As a form of temporary conservative management icing around the region of sternum pain may help relieve the inflammation. But use of a sling for immobilization and pain medications are required as advised by your physician as a form of treatment. Some operative measures are also available although they are not usually preferred to treat this form of breastbone pain.

4. Collarbone trauma

Your collar bone is also located at the top of your chest in the reason between the shoulder girdle and the sternum and is connected to the arm. Trauma to the collarbone can be a common cause of sternum pain. This kind of pain is usually caused by trauma to the collar bone as a result of an injury or fall in early childhood. Here are a few signs and symptoms of breastbone pain due to collarbone trauma:

Shoulder sags down and forward
Severe pain in the arm along with pain in the sternum leads to an inability to raise the shoulder
When you attempt to raise the shoulder, you will feel a grinding sensation along with the sternum pain
Bruising, swelling, soreness and discomfort may occur around the area where your sternum hurts

Treatment: You should immediately consult your physician if you experience sternum pain or any of these symptoms. Your physician will offer you a correct diagnosis and sternum pain treatment to help alleviate the pain in your breat and correctly get the collarbone fixed.

5. Sternum fractures

This kind of sore breastbone trauma is usually caused by a direct hit to the sternum using a lot of force. The sternum may be in a lot of pieces as a result of the fracture so this may be a cause of extreme pain in the chest bone. Here are a few symptoms that are specific to pain caused by a fracture:

Severe sternum pain in the centre of the chest
Pain that worsens on breathing
Pain that worsens on movement
Chest bruise at the site of the sternum pain due to the trauma
Difficulty breathing due to the severity of the breastbone pain and trauma

Treatment: Analgesics and anti-inflammatory medication provided by your doctor may help alleviate the symptoms of the sternum pain. You should also refrain from strenuous physical activity and preferably restrict all forms of physical activity till the fracture heals and the sternum pain subsides.

6. Heartburn or indigestion

Heart burn can be a very important cause of lower sternum pain or pain under sternum after eating. This may be a result of GERD, helicobacter pylori infection or gastroeosophageal reflux disease. Moreover sternum pain during pregnancy is also due to heartburn caused by the pressure from the enlarging uterus. Here are a few symptoms that may help you differentiate sternum pain due to indigestion from other causes:

The pain is episodic in nature and situated in the upper abdominal or lower sterna region
The pain is usually described as being burning in character
The pain behind the breastbone occurs after taking a heavy spicy meal or may occur on an empty stomach during the night
Pain worsens upon lying down or bending over
This type of pain is relieved by taking medication to reduce stomach acidity or by eating food

Treatment: Over the counter medication like antacids, proton pump inhibitors to reduce acid production can provide relief to the sternum pain caused in this condition. In case of infection caused by a bacteria caused helicobacter pylori, your doctor may be able prescribe medications to help the infection and your stomach heal.

7. Esophagitis

Pain due to esophagitis can be caused by irritation or inflammation to the esophagus. This is usually caused by stomach acids flowing back into the esophagus due to reflux disease. Factors that increase a likelihood of esophagitis include smoking, alcohol, vomiting and as a side effect of some medication. If you suspect that you are experiencing stomach pain due to esophagitis then you must look for the following symptoms:

Upper abdominal pain or pain under the sternum
Pain under the sternum that may cause difficulty swallowing
Acid brash or a bitter taste in your mouth along with the breastbone pain in the chest
Hoarseness in voice and cough

Treatment: A diagnosis of esophagitis can be confirmed with the help of endoscopic examination. Treatment for pain due to esophagitis would include antacids or other medications that help lower stomach acid levels. Antibiotics can be prescribed to treat infection causing the breastbone pain due to esophagitis. As a precaution and to prevent aggravation of sternum pain, smoking and alcohol intake should be avoided.

8. Respiratory Disorders

Sternum pain can also be caused because of various respiratory disorders like pneumonia, lung abscess, asthma and bronchitis causing severe pain. The symptoms that can help you link your sternum pain to respiratory disorders include:

Severe pain under the sternum or pain behind the sternum
The pain will be accompanied by cough and difficulty in breathing
In case of breastbone pain due to pneumonia, sternum pain will also be accompanied with a fever

Treatment: Treatment for respiratory causes of sternum pain will depend on appropriate physical examination by your doctor and laboratory results of tests like a chest x-ray and pulmonary function tests pointing out the underlying cause. Treatment will be catered the diagnosis obtained by your physician and can include antibiotic therapy, bronchodilators and deep breathing exercises.

9. Other causes of sternum pain

Other factors that may contribute to breastbone pain include excessive belching, a hiatus hernia, acute pancreatitis and stomach ulcers. Other causes may be pain due to injured ribs excessive exercising, overstraining of the abdominal or chest musculature and osteomyelitis. Cancer of the breast, lung and bone may present in the form of sternum pain. Especially if you observe a mass around the region of an aching sternum or a swollen sternum, your physician might want to consider the possibility of a severe condition called chondrosarcoma. It is always advised that you consult a physician if you suspect that you are suffering from symptoms of sternum pain that may point towards any serious conditions mentioned above.

Diagnosis of Sternum Pain

There are many possible causes of sternum pain and a physician may obtain several differential diagnosis based on your history and his examination findings. But in order to confirm the findings, a few laboratory tests are very helpful to single out the most appropriate cause of your pain. These diagnostic tests for sternum pain include:

Blood tests
Pulmonary function tests
Chest X-ray
Magnetic resonance imaging (MRI)
Computed tomography scan (CT)
ECG and stress testing

When to see a Doctor?

Although conservative pain management by icing the region or over the counter pain medication may provide relief for the less serious causes of sternum pain, it is strongly advised that you consult a doctor if you experience any one of the following symptoms:

Sternum pain accompanied by difficulty in breathing
Breastbone pain that is accompanied by pain radiating to the arm or jaw
Sternum pain aggravated by activity like running or walking up a flight of stairs
Experiencing sternum pain with other symptoms like difficulty breathing, high fever or signs of infection like pus, redness or swelling.

References:
http://www.wosm.com/index.php/health-library/orthopaedic-conditions-and-treatments/145-sternoclavicular-joint-injury
http://orthoinfo.aaos.org/topic.cfm?topic=a00072
http://ubbmc.buffalo.edu/bmc_pain_treatments/noncardiac_chest_pain.php
http://umm.edu/health/medical/reports/articles/peptic-ulcers
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1398648/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1346531/

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