Causes and when to see a doctor

Many conditions can cause pain in the sternum, including injuries, pneumonia, bronchitis, and costochondritis. Gastrointestinal problems, such as acid reflux, can cause pain behind the sternum.

People may believe that their sternum pain is a heart attack symptom. However, it is possible to differentiate the two.

In this article, learn about the causes of sternum pain and the differences between sternum pain and heart problems.

The sternum is a flat T-shaped bone that sits at the front of the chest and connects to the ribs with cartilage. It forms part of the rib cage, a series of bones that protects the heart and lungs from injuries.

People often refer to the sternum as the breastbone.

Sternum pain can result from problems with muscles and bones near the sternum, as well as the sternum itself.

Substernal pain is discomfort occurring behind or below the sternum. It often results from gastrointestinal conditions.

Some of the most common causes of sternum and substernal pain are:

• costochondritis
• sternum fracture
• sternoclavicular joint injury
• collarbone injuries
• muscular strain or bruise
• hernia
• acid reflux
• pleurisy
• bronchitis
• pneumonia

Costochondritis is inflammation of the cartilage between the sternum and ribs. The medical term for this area is the costochondral joint.

The symptoms of costochondritis include:

• sharp pain on the side of the sternum area
• pain that worsens with a deep breath or a cough
• discomfort in the ribs

Inflammation in the costochondral joint may occur due to injury, infection, or irritation. A person may experience costochondritis due to:

• impact trauma
• respiratory tract infections
• severe coughing
• physical strains

Learn more about costochondritis here.

Like fractures in other parts of the body, sternum fractures can cause a lot of pain. Sternum fractures usually occur as a direct result of trauma, such as a car accident or sports injury.

People who believe they may have a sternum fracture should seek immediate medical attention in case of additional damage to the heart and lungs.

Symptoms of a sternum fracture include:

• pain during inhaling or coughing
• swelling over the sternum
• difficulty breathing

Learn more about fractures here.

The sternoclavicular joint connects the top of the sternum to the collarbone. Injuries to this joint generally cause pain and discomfort at the top of the sternum in the upper chest area.

People experiencing sternum pain due to a sternoclavicular joint injury will often experience the following:

• mild pain or swelling in the upper chest area
• difficulty or pain when moving the shoulder
• popping or clicking around the joint

The collarbone connects to the top corners of the sternum by cartilage. Due to the direct connection between the two structures, injuries to the collarbone may cause pain in the sternum area.

Collarbone trauma

Impact and stress trauma can damage, or even fracture, a person’s collarbone. Collarbone trauma may affect its connection to the sternum and the surrounding musculature. This may mean a person feels pain either in or around their sternum.

Depending on the location of collarbone trauma, other symptoms may include:

• severe pain when raising the arm
• bruising or swelling in the upper chest area
• abnormal positioning or sagging of the shoulder
• clicking and grinding in the shoulder joint

A great many muscles connect to the sternum and ribs. Injuries or trauma can result in bruising these muscles, which may cause them to ache. Strenuous or repetitive movements can also cause strains in these muscles.

Learn more about muscle strains here.

Most hernias occur in the abdomen. However, a hiatal hernia can affect the chest area and cause substernal pain.

A hiatal hernia occurs when the stomach moves past the diaphragm and into the chest. Symptoms of a hiatal hernia include:

• frequent burping
• heartburn
• vomiting blood
• a feeling of fullness
• trouble swallowing

People with substernal pain and symptoms of a hiatal hernia should see a doctor for prompt treatment.

Learn more about hernias here.

Acid reflux happens when stomach acid wears away the lining of the windpipe (esophagus). This happens primarily in people with gastroesophageal reflux disease (GERD).

Acid reflux may cause substernal pain and discomfort in the chest.

Pain in this region can also result from inflammation or a spasm of the windpipe. People with GERD should talk with their doctor about preventing further damage to this area.

Learn the difference between heartburn, acid reflux, and GERD here.

Pleura are sheets of tissue between the lungs and ribcage. Inflammation to these tissues is pleurisy.

Pleurisy can cause a sharp, stabbing pain at the site of irritation, which may worsen if a person breathes deeply, coughs, or wheezes.

If inflammation occurs toward the upper middle chest, pleurisy may cause substernal pain.

Learn more about pleurisy here.

Bronchitis is the inflammation of the primary airways of the lungs. The condition can cause:

• chest pain
• severe coughing spells
• shortness of breath
• wheezing

Inflammation of the primary airways may cause substernal pain.

Learn more about bronchitis here.

Pneumonia is a common lung infection that causes air sacs in the lungs to inflame and fill with fluid. The medical term for these air sacs is alveoli.

Pneumonia can cause sharp chest pains, which a person may feel behind their sternum.

Other symptoms of pneumonia include.

• severe coughing
• shortness of breath
• fever
• sweating
• nausea and vomiting
• loss of appetite
• confusion

Infectious bacteria, viruses and fungi can cause pneumonia.

Learn more about pneumonia here.

Symptoms of sternum pain vary depending on the cause. The most common symptom is discomfort and pain in the center of the chest, which is the location of the sternum.

Other associated symptoms may include:

• pain or discomfort in the ribs
• pain that worsens during deep breathing or coughing
• mild, aching pain in the upper chest
• swelling in the upper chest
• stiffness in the shoulder joints
• severe pain when raising the arms
• signs of collarbone trauma, such as bruising or swelling
• difficulty breathing
• grinding or popping sensation in joints near the sternum
• frequent belching
• heartburn
• feeling too full
• throwing up blood

People experiencing chest pain may worry they are having a heart attack. However, sternum pain differs from heart attack pain.

People who are having a heart attack experience specific signs before the heart attack itself, whereas most sternum pain starts suddenly.

A heart attack often occurs with the following symptoms:

• pressure, squeezing, or fullness in the center of the chest
• sweating
• nausea
• shortness of breath
• lightheadedness

However, anyone who thinks they are having a heart attack should seek immediate medical attention.

While sternum pain is not usually serious, there are some causes of sternum pain that require immediate medical attention.

A person should seek emergency medical attention if the pain:

• started as a result of direct trauma
• is accompanied by heart attack symptoms
• is persistent and does not improve over time
• is accompanied by intense vomiting or vomiting blood

A person should also speak to a doctor if the pain in their sternum gets worse or does not improve over time.

Physical trauma, costochondritis, and muscle strains are common causes of sternum pain.

Conditions such as pneumonia, pleurisy and GERD can also cause pain in nearby tissue that people may mistake for sternum pain.

Read the article in Spanish.

Sternal Injury | Rib Injury Clinic

A less common chest wall injury, it is usually caused by a direct blow, associated with an acceleration-deceleration injury or from a fall onto the front of the chest. The Sternum or breastbone is a strong bone and in otherwise fit and healthily patients’ significant injuries to the sternum usually suggest a fairly severe injury or blow. However, in frail patients particularly with associated osteopenia (weakness of bones) even an apparent minor injury can cause a sternal fracture.

Anatomy of the sternum. The sternum is made up of three parts (blue arrows) with two junctions (grey arrows)

Symptoms

Patients with a sternal or breastbone injury typically experience a sudden onset of chest pain at the time of injury. Pain is often sharp and intense and may increase during deep breathing, coughing, laughing or sneezing. Patients may also experience an ache in the front of the chest that is particularly prominent at night or first thing in the morning (particularly in the first few days following injury). Pain may increase when lying down in certain positions (such as face down or on your side) and on firmly touching the sternum at the site of injury. Swelling and / or bruising may also be evident. In severe sternal fractures with bony displacement, an obvious deformity may be present. Patients with this condition may also experience pain with certain movements of the upper back and chest (such as twisting, bending forwards or sideways, or arching backwards) and with certain movements of the upper limb (such as pushing, pulling, heavy lifting or with overhead activities).

Diagnosis

Sternal x-ray from the side showing significant sternal fracture.

As with rib injuries the diagnosis of a sternal injury is what doctors call a clinical one, that is taking a precise history of the injury coupled with a careful physical examination with a doctor familiar with chest wall injuries. Examination may demonstrate swelling, tenderness, occasionally crepitus (crunchy feeling under the skin) and if the sternum is badly broken a step. There is no specific blood test unless an associated chest infection or other internal complication is suspected. Radiological assessment with chest x-ray is not helpful as its very insensitive at picking up sternal injuries but may be helpful in identifying other associated problems such as fluid in the chest or a collapsed lung. More useful is a specific type of x-ray called a lateral sternal view.

If the injury is subtle occasionally a chest wall ultrasound may demonstrate a sternal fracture and associated bruising (haematoma) as well as identifying internal problems such as fluid around the heart (tamponade). The most sensitive radiological investigation is a Chest CT scan. This allows the severity of the sternal injury to be clearly seen as well as identifying any other chest related injuries such as haematoma behind the breastbone, fluid around the heart, lung bruising or contusions and other associated injuries.

Video of a Chest CT scan taken from the side (sagittal) demonstrating a displaced fracture through the body of the sternum.

Severity

Sternal injuries vary significantly from a minor injury with associated pain, tenderness and bruising to severe sternal fracture. The type of injury and what happened is often the most useful guide to severity of sternal injury. One specific type of sternal injury is an acceleration-deceleration type of car accident in a seat-belted occupant either directly from a direct blow to the sternum or indirectly.

As with the classification of rib fractures, sternal fractures are based on the appearance on Chest CT scan. They are described typically as:

Simple: Usually a single fracture either partially or completely through the sternum, which is not displaced (dislodged) or angulated.

Chest CT showing an un-displaced sternal fracture albeit in two places (blue ring)

Complex: Usually single occasionally multiple and displaced where the broken ends are misaligned or overlapping with an associated step (lump) on the front of the chest.

Chest CT showing a displaced sternal fracture. The fracture is through the Manubriosternal junction and area of nature weakness of the sternum.

Complications

Pain: Immediate (acute) and can be severe over the area and is sore to touch and worse on certain movements. In most the pain will settle, however occasionally it can persist and become chronic causing significant issues. The main reason for this is failure to manage appropriately after the initial injury (with painkillers, rest, restrictions of activity and tailored return to normal activities).

Sternal fractures do generally heal even if displaced but the patient may be left with a permanent lump and tenderness.

Deformity: Occasionally if the sternum is badly displaced a tender lump can develop over the fracture site.

Breathlessness: Shortness of breath acutely is usually caused by the chest wall pain not allowing deep breaths to be taken, occasionally it can be associated with the lung collapsing after the injury; a build-up of fluid in the chest cavity (effusion) or even a developing chest infection (pneumonia). Chronically, on-going breathlessness can be due to chronic pain but also occasionally to complications of retained blood or fluid in the chest cavity which can trap the lung.

Internal injuries: Very rarely, if the sternal injury is severe internal injuries can lead to sinister symptoms of severe breathlessness and even collapse due to blood building up around the heart (tamponade) or bruising (contusions) of the heart itself. Diagnosis requires an ultrasound scan of the heart or chest CT scan.

Xiphersternal injury: Pain at the bottom of the sternum in the area of the ‘solar plexus’ can occur following even minor injuries and may be caused by an injury to the xiphersternal junction or the xiphersternum itself. The xiphersternum is actually made of cartilage and is susceptible to injury and inflammation leading to long-term pain and discomfort. For more information see Complex chest wall injuries.

Treatment

Sternal injuries can usually be treated conservatively involving rest, restrictions of activities and painkillers, or occasionally through some form of intervention including targeted physical therapy or surgical options such Open Reduction Internal Fixation. See Treatments.

Why there are pains in the chest and chest

Enroll

August 24, 2022

read 5 minutes

“If we are discussing chest pain, then at a young age it is most often due to problems with the spine or intercostal muscles. Such pain is characterized by an increase in a certain posture or position of the body (for example, when bending to the side), there may be an increase in inhalation or exhalation, ”says Dr. Lummer.

As a rule, chest pain resolves on its own and does not require a serious examination.

Another option is pain behind the sternum, in the middle of the chest. Such pain may indicate a problem with the heart. A feature of heart pain is a compressive character. In addition, this pain often radiates to the left shoulder, left arm, left shoulder blade. If such pain occurs, you should immediately consult a doctor to exclude angina pectoris and myocardial infarction.

“Pain in the breast can also indicate a wide variety of different problems, from minimal to quite serious. Periodic discomfort associated with the menstrual cycle is quite common and does not indicate any serious pathology. As a rule, after pregnancy and childbirth, this disappears. But twitching pains, especially in combination with fever, reddening of the skin of the gland and a palpable volumetric formation, signal a serious inflammation – mastitis, ”explains Kirill Borisovich.

Moreover, mastitis can be both in nursing mothers and in women outside the period of breastfeeding. This is a reason to immediately consult a doctor. In addition, pain in the mammary gland can be caused by a disease such as fibrocystic mastopathy. This is a dyshormonal disease and, unfortunately, one cannot cope with it without qualified medical assistance.

“And, finally, the most frequent question, does pain in the mammary gland speak of a malignant formation? Unfortunately, this category of diseases is in no way characterized by pain, otherwise they would be much better detected, ”explains Dr. Lummer.

Therefore, it is correct for all women over 25 years old to have an ultrasound of the mammary glands once a year.

Ultrasound specialist
Surgeon

Source Rambler Doctor

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What to do if it hurts in the chest? article on the website of the Transfiguration Clinic

Any pain tells us that something is wrong with our body. Chest pain is one of the most common symptoms that lead to medical attention. Pain, discomfort in the chest area can be symptoms of damage to many organs and systems:

• cardiovascular;
• digestive;
• respiratory;
• musculoskeletal, etc.

To begin with, let’s figure out why such different diseases manifest themselves so similarly. All internal organs of a person are controlled by the autonomic nervous system, the nerve bundles of which depart from the brain, and then branch to all organs. Therefore, sometimes pains in the heart are similar to pains in the esophagus or stomach – they are transmitted to the common bundle, and from it to another organ. In addition, the nerves that control the musculoskeletal system pass there, so osteochondrosis can be manifested by pain behind the sternum.

So, the cause of chest pain can be both serious, for example, myocardial infarction, and quite banal, for example, heartburn. Therefore, you should not postpone visiting a doctor if you experience chest pain.

Angina – real pain in the heart

One of the most common and dangerous causes of chest pain is heart disease. In the first place due to the development of heart pain is angina pectoris. The cause of pain in angina pectoris is a lack of nutrition of the heart muscle, which occurs with a spasm of the heart vessels or an atherosclerotic plaque in them. The onset of pain is usually preceded by physical activity. The pain has a pressing, compressive character, is localized behind the sternum and disappears 5-15 minutes after the cessation of the load or the intake of nitroglycerin. Despite the restored physical well-being, do not forget about a visit to the doctor, because angina pectoris is a precursor of myocardial infarction. To establish the diagnosis of angina pectoris and prescribe appropriate treatment, it is necessary to conduct a complete blood count, a general urinalysis, a biochemical blood test, a lipid spectrum, an ECG, a Holter monitoring, an ultrasound of the heart and blood vessels, a treadmill test, as well as a daily self-monitoring of blood pressure twice a day. day.

A general blood and urine test, a biochemical blood test are prescribed to determine the general condition of the body in order to more accurately calculate the dosage of prescribed drugs. The content of blood lipids indicates the likelihood of developing atherosclerosis, allows you to accurately calculate the dosage of lipid-lowering drugs and further monitor their effectiveness. After an attack, it is imperative to do an ECG in order to immediately exclude myocardial infarction. But after the end of an angina attack, there may not be any changes in the ECG, so it is also necessary to conduct Holter monitoring to track the presence of attacks per day. Ultrasound of the heart and blood vessels will show the existing changes in the heart muscle, the patency of the vessels, which will determine the further tactics of treating the disease. The treadmill test is performed in remission of the disease to determine exercise tolerance.

We are always afraid of myocardial infarction

Pain in acute myocardial infarction is very strong, unbearable, sometimes even with the development of pain shock. Patients describe these pains as “like a horse has stepped on the chest”, “like a concrete slab on the chest”. This is often accompanied by a feeling of fear, panic, fear of death. The skin turns pale, intense sweating appears, blood pressure may fall. With the development of myocardial infarction, the pain does not stop as quickly as it happens with angina pectoris, since it is not just a lack of nutrition, but the death of a part of the muscle. The first thing to do is to call an ambulance, since myocardial infarction is an extremely dangerous disease that requires treatment in a hospital. Timely treatment will help reduce the affected area and keep a larger volume of the heart in a healthy state. Also, the development of myocardial infarction is dangerous for its complications: arrhythmias, expansion of the heart cavities, heart aneurysms, the formation of heart failure, and many others.

After discharge from the hospital, it is necessary to continue monitoring your health with a cardiologist. Regular monitoring of cardiac ultrasound, Holter monitoring, blood and urine tests, adherence to treatment recommendations is a guarantee of the absence of relapses.

Heartburn – a wolf in sheep’s clothing

Yes, often the cause of chest pain is diseases of the cardiovascular system, but do not forget about diseases of the gastrointestinal tract, for example, gastroesophageal reflux disease (GERD). The reason for the development of pain in GERD is the reflux of the contents of the stomach into the esophagus, that is, the effect of acid on the lining of the esophagus. Often this is combined with an inflammatory process due to the reproduction in the stomach of a specific bacterium – Helicobacter pylori. With GERD, pain can also be localized behind the sternum and have a burning character. In this case, the pain is not associated with the load, it can be provoked by the intake of certain products, it is aggravated in the supine position or during movements. Taking antacids, the vertical position of the body alleviate the condition. For the diagnosis of GERD, it is necessary to conduct a general blood and urine test, a biochemical blood test, a blood test for antibodies to toxocara, ascaris, giardia and opisthorchia, a stool test, FGS, an ultrasound of the abdominal cavity and kidneys. FGS will allow assessing the condition of the mucous membrane of the esophagus, stomach and duodenum, without which it is impossible to correctly establish the diagnosis and prescribe effective treatment. All discomfort during this unpleasant procedure can be minimized with the help of sedation (medicated sleep). Ultrasound of the abdominal cavity and kidneys will allow to exclude concomitant pathology, for example, varicose veins of the esophagus, chronic pancreatitis, cholelithiasis, and so on. Despite the seeming safety of heartburn, it is necessary to consult a doctor for treatment, as ulcers and cancer of the esophagus can become a consequence of GERD.

Osteochondrosis – upright posture

Also, pain in the chest can occur with osteochondrosis.