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.

Upper Back Pain – Upper East Side New York, NY

UPPER BACK PAIN

Costochondritis

What is Costochondritis?

Costochondritis is an inflammation of the cartilage in the chest area.  Your upper ribs are connected to the sternum or breastbone by soft tissue known as cartilage. When this cartilage becomes irritated it can cause chest pain that may radiate to the back or stabbing pain when taking deep breaths.  There is no definitive cause but it may be the result of a trauma to the chest, bacterial, fungal or viral infections in the chest or osteoarthritis between the ribs.

Seek Treatment for these Symptoms:

• Tenderness when ribs pressed
• Pain when coughing or taking deep breaths
• Sharp pain that may radiate to back
• Pain typically felt on upper left side of chest

Next Steps

Consult the Center for a diagnosis and for treatment options.  Non-steroidal pain medication, ultrasound-guided nerve block or corticosteroid injections may be indicated.

Intercostal Neuralgia

What is Intercostal Neuralgia?

You may experience sudden pain to the chest, a band of stabbing pain wraps around your ribcage and numbness may radiate to the back.  However, in this instance it is a chronic condition called Intercostal Neuralgia and is the result of nerve inflammation in the chest. Your rib cage is composed of twelve ribs and between each are the intercostal nerves. When the nerves become irritated it is called neuralgia. This painful condition may be the result of nerve compression by the surrounding muscles and ligaments or may occur because of a trauma to the area, previous thoracic surgery, a shingles outbreak or even pregnancy.

Seek Treatment for these Symptoms:

• An ongoing  band of pain around the chest area
• Pain radiates from the back to the front of the chest
• Continuous stabbing, burning or dull aching pain in the chest area
• Pain increases when you laugh, cough, breathe or sneeze
• Shortness of breath because of pain

Next Steps

Consult the Center for a diagnosis and for treatment options.  If there is a nerve entrapment then a hydrodissection to relieve nerve compression or a series of ultrasound-guided nerve block injections or corticosteroid injections may be indicated. Anti- inflammatory medication may be recommended.

To learn more about the treatment and of Intercostal Neuralgia please call our office at 212-867-1777.

Degenerative Disc Disease

What is Degenerative Disc Disease?

The spinal column is made up of bones (vertebrae) between which are jelly-like cushions called discs. These rubbery discs act as shock absorbers between the vertebrae. The spine allows you to twist and bend. These discs may degenerate as a result of aging, back injuries and daily wear and tear. In addition, the outer wall of the disc may sustain minute tears that are replaced with scar tissue. Even so, the disc wall can become progressively weaker and the jelly-like center of the disc containing water and proteins may begin to dry out.  If the disc completely ruptures or cracks it is called a herniated disc. As the disc loses water it compresses and the joints in the vertebrae begin to rub against each other causing osteoarthritis pain and stiffness. The compressed disc may also put pressure on nerves as they exit the spine through its openings and cause further pain, numbness or tingling. You may endure pain in the upper back or neck while others may experience no pain.

Seek Treatment for these Upper Back Symptoms:

• Pain in the upper back
• Pain that may worsen when sitting or bending
• Pain may lessen when walking or lying down
• Numbness and tingling in the legs
• Weakness in the leg muscles

Next Steps

Consult the Center for a diagnosis and for treatment options.  Depending upon the diagnosis, treatment options may include ultrasound-guided corticosteroid injections, ultrasound guided injections of platelet rich plasma (PRP), ultrasound guided prolotherapy injections, stem cell therapy, physical therapy and anti-inflammatory medication. If nerve entrapment is indicated then a steroid-free hydrodissection to release the nerve or ultrasound-guided nerve block injections may be recommended.  To learn more about the treatment and relief of Degenerative Disc Disease please call our office at 212-867-1777.

Facet Joint Syndrome

What Is Facet Joint Syndrome?

Facet Joint Syndrome is pain in the joints of the vertebrae, the bones that comprise the spine. Each vertebra has 2 facet joints that connect it to the next vertebra. The joints both stabilize the spine so that it does not move too far forwards or backwards and they allow you to bend and twist.  Soft tissue called cartilage, as well as a lubricating fluid, cushion the joints. An injury to the back or neck, daily wear and tear or osteoarthritis can cause the cartilage to deteriorate and the joints to rub against each other causing stiffness and pain. This may in turn cause bone spurs or an overgrowth of bone that results in increased inflammation. If the joints swell too much then the openings in the spine through which nerves travel may narrow and cause nerve compression and even greater discomfort.

Seek Treatment for these Symptoms:

• Need to turn entire body to look left or right
• Unable to bend or twist body
• Trouble standing up straight or getting out of a chair
• Back or neck pain
• Pain that extends into your buttocks and upper thighs
• Muscle weakness in the arm, shoulder, or leg

Next Steps

Consult the Center for a diagnosis and for treatment choices.  Depending upon the diagnosis, treatment options may include ultrasound-guided corticosteroid injections, physical therapy, ultrasound guided injections of platelet rich plasma (PRP), ultrasound-guided prolotherapy injections, stem cell therapy, physical therapy and anti-inflammatory medication. If nerve entrapment is indicated then a steroid-free hydrodissection to release the nerve or ultrasound-guided nerve block injections may be recommended.

To learn more about the treatment and relief of Facet Joint Syndrome please call our office at 212-867-1777.

Failed Back Surgery Syndrome

What is Failed Back Surgery Syndrome?

Failed back surgery syndrome is a general term for chronic pain that does not dissipate following spine surgery.  The surgery may not have been effective or may have resulted in scar tissue that compressed a nerve. The cause of the initial back pain may have been misdiagnosed so that the the procedure did not address the correct root of the back pain. Regardless, the result is continued pain, stiffness and discomfort.

Seek Treatment for these Symptoms:

• Dull aching pain in the back or neck
• Pain radiating to the legs or arms
• Sharp or burning pain in the legs or arms
• Limited ability to walk and move

Next Steps

Depending upon the reason for the pain, treatment options will vary. These may include ultrasound-guided corticosteroid injections, ultrasound-guided injections of platelet rich plasma (PRP), ultrasound-guided prolotherapy injections, stem cell therapy, physical therapy and anti-inflammatory medication. If nerve entrapment is indicated then a steroid-free hydrodissection to release the nerve or ultrasound-guided nerve block injections will be recommended.

To learn more about the treatment and relief of Failed Back Surgery Syndrome please call our office at 212-867-1777.

Upper Back Spinal Osteoarthritis

What Is Spinal Osteoarthritis?

Osteoarthritis can affect any joint in the body, including joints in the spine. It causes the gradual weakening of the cartilage. Cartilage is connective tissue that protects the ends of the bones and allows the bones to glide smoothly in the joint. In the spine, the facet joints of the vertebrae are lined with cartilage. These joints allow the spine to bend forward, extend backwards and to twist. When the cartilage deteriorates, bones rub against one another creating inflammation, stiffness and pain. Bone spurs, are an overgrowth of the bone, and they often develop and may place pressure on the nerves further intensifying the pain. Aging and daily wear and tear increase the degeneration of the joint.  Other risk factors include excess weight, family history and gender. Osteoarthritis is more common in postmenopausal women than in men in the same age range.

Seek Treatment for these Symptoms:

• Back stiffness when awake in the morning or after periods of inactivity
• Intermittent back pain
• Back pain that radiates into the buttocks, thighs, pelvis, or down the back of the leg
• Grinding or popping noise when you turn your neck
• Weakness or numbness in the legs or arms
• Neck pain, tenderness, or numbness

Next Steps

Seek a diagnosis and treatment options. Dr. Kulick will design a customized treatment plan designed to alleviate the symptoms suffered.  Options include anti-inflammatory medication, ultrasound-guided corticosteroid injections, ultrasound-guided injections of a hyaluronic injection acid such as Synvisc or Supartz to help cushion the joints, ultrasound-guided prolotherapy injections and physical therapy.  Cutting edge therapy such as, ultrasound guided injections of platelet rich plasma (PRP) or ultrasound-guided stem cell injections that may stimulate the growth of new cartilage and ultrasound- guided nerve hydrodissections are other options. 

To learn more about the treatment of Osteoarthritis please contact our office at 212-867-1777.

Upper Back Spinal Stenosis

What is Spinal Stenosis? 

The vertebrae of the spine encase the spinal cord which is made up of nerves and bundles of nerves in an open space called the spinal canal. These nerves branch out from the spinal cord through openings in the vertebrae in order to allow the brain to send nerve signals throughout the body. When the canal narrows, it places pressure on the nerves, causing numbness, pain and/or tingling.  This typically occurs in the cervical spine (neck), upper-back and the lumbar spine (lower back). It is a degenerative process and is often associated with aging. Ligaments surrounding the spine may thicken and bulge into the open spaces of the vertebrae, osteoarthritis may cause bone spurs to jut into the spinal canal, herniated discs or tumors can narrow the canal and spinal injuries or post spinal surgery swelling can cause stenosis. These conditions all result in compression of the nerve root.

Seek Treatment for these Symptoms:

• Persistent stiffness, numbness or pain in back, legs, neck or arms
• Sciatica with pain radiating down the leg
• Difficulty walking
• Cramps in legs or arms

Next Steps

Consult the Center for a diagnosis and for treatment options.  A steroid-free hydrodissection will release the nerve and ultrasound-guided nerve block injections will provide relief.  Depending upon the cause of the stenosis, additional treatment options may include ultrasound-guided corticosteroid injections, ultrasound-guided injections of platelet rich plasma (PRP), ultrasound- guided prolotherapy injections, stem cell therapy, physical therapy and anti-inflammatory medication.  And, only after complete treatment failure will Dr. Kulick refer you to a neurosurgeon for surgery.

To learn more about the treatment and relief of Spinal Stenosis please call our office at 212-867-1777.

Upper Back Spondylolisthesis

What is Spondylolisthesis?

Spondylolisthesis is a condition in which one of the vertebra of the upper back, slips forward over another vertebra, pushing the spine out of alignment. This can place pressure on the spinal cord or one of the nerve roots inducing severe pain. Spondylolisthesis may be caused by a traumatic injury, a fracture or the degeneration of bones, ligaments or discs due to aging. Some people have no symptoms as a result of  Spondylolisthesis while others suffer pain from nerve compression.

Seek Treatment for these Symptoms

• Upper/lower back or leg pain
• Muscle weakness in the legs
• Sciatica

Next Steps

Consult the Center for a diagnosis and for treatment options.  A steroid-free hydrodissection will release the nerve and ultrasound-guided nerve block injections will provide relief if there is nerve compression.  Depending upon the cause of the spondylolisthesis, additional treatment options may include ultrasound-guided corticosteroid injections, ultrasound-guided injections of platelet rich plasma (PRP), ultrasound-guided prolotherapy injections, stem cell therapy, physical therapy and anti-inflammatory medication.

To learn more about the treatment and of Spondylolisthesis please call our office at 212-867-1777.

Muscle Spasms

What Are Muscle Spasms?

Muscle spasms are very common and can happen without warning. Perhaps you pick up a heavy box, reach for an item or even sleep in an awkward position. This suddenly triggers a muscle spasm in your upper back that makes you incapable of movement or straightening. Muscle spasms are the involuntary contraction or tensing of one or more muscles. They commonly occur in the neck, upper or lower back and legs.  Muscle spasms may be caused by heavy lifting, muscle overuse, weak muscles, nerve compression, spinal conditions such as degenerative disc disease (link to degenerative disc disease) or a herniated disc, and many sports injuries. Some sports including golf, football, weightlifting and basketball that require the constant twisting of the spine may lead to back spasms. Spasms may seem to appear out of nowhere however; typically small tears in the muscle may have developed over time. These tears may lead to swelling that compresses the nerves surrounding the muscle. This in turn sparks a muscle spasm that can cause pain, cramping or twitching.

Seek Treatment for these Symptoms:

• Muscle pain that does not dissipate on its own
• Constant muscle cramps
• Difficulty walking or moving
• Muscle appears hard or distorted

Next Steps

If the muscle spasm does not resolve by itself after a few days of rest, icing the area for short periods of 10 to 20 minutes every two hours or using a heated pad, and taking non-steroidal anti-inflammatory medication, then seek treatment. Consult the Center for a diagnosis and for options.  The spasm may be the result of an underlying condition that can be treated. Once identified, treatment options may include ultrasound-guided corticosteroid injections, trigger point therapy, ultrasound guided prolotherapy injections or anti-inflammatory or muscle relaxant medication. Ultrasound guided injections of platelet rich plasma (PRP), or stem cell therapy may be advised. If nerve entrapment is indicated then a steroid-free hydrodissection to release the nerve or ultrasound-guided nerve block injections will be recommended.  It is also important to note that trigger points can cause radiating pain and frequently the underlying cause of migraine headaches can be mistaken for sinusitis and can cause knee and hip pain unrelated to any underlying pathology in the knee or hip.

To learn more about the treatment and relief of Muscle Spasms please call our office at 212-867-1777.

why coughing can hurt the chest and lungs

Published: March 16

Updated: May 03

Reading time: 3 minutes

Cough is a protective mechanism aimed at clearing the airways of foreign bodies, mucus, sputum. Cough movements are provided by contraction of the diaphragmatic and intercostal muscles, so a prolonged cough is accompanied by chest pain.

Why does the chest hurt when coughing

Pain is a reaction of the nervous system to a stimulus. When coughing, such irritants are swelling and inflammation of the mucous membrane, muscle strain. There are many diseases accompanied by cough and chest pain in an adult.

Seek medical attention immediately if you develop a cough or fever. Initially, you can contact a therapist, after the examination, he, if necessary, will refer you to a pulmonologist, cardiologist, phthisiatrician or traumatologist.

Chest pain in a child when coughing

Causes of chest pain when coughing in children are the same as in adults. More often it hurts a child to cough for the following reasons:

• acute bronchitis;
• community-acquired pneumonia;
• foreign body in respiratory tract;
• chest contusions;
• muscle tension during a long course of a respiratory infection.

Chest pain is usually aggravated by coughing, the child feels relatively normal at rest. Typical localization of pain is behind the sternum, in the lateral and lower parts of the chest.

Seek medical attention as soon as the child complains that his chest hurts when he coughs. In childhood, the disease progresses faster, the likelihood of complications is higher. Primarily, you need to contact a pediatrician, the doctor will examine the baby and, if necessary, refer him to narrow specialists.

Chest pain when coughing – how to treat

Chest pain is a secondary symptom in respiratory diseases. The root cause of pain is a cough, so you need to act on it. Antitussive drugs are needed to relieve the pain that occurs due to coughing.

Rengalin helps to cope with dry and wet cough. The oral solution is more convenient to use for the treatment of children from the age of three, lozenges can be taken by both children and adults. Doctors prescribe an antitussive 3-6 times a day for a tablet or a teaspoon of solution. Rengalin can be combined with other medicines.

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Chest pain due to these 10 causes

What does chest pain mean (photo: freepik)

Author:
Svetlana Mashchenko

Chest pain may indicate heart problems, or may indicate other problems with the body. In any case, such a symptom should not be ignored, thinking that it will pass by itself.

Cardiologist Natalya Ivanyuk told about the top 10 causes of chest pain on Instagram.

When chest pain is the heart

• Aortic aneurysm

Pain in the area of ​​the heart, abdomen (abdominal aneurysm), back, sometimes radiating to the left arm. May be accompanied by tachycardia, shortness of breath, decrease / increase in heart rate. An aneurysm develops gradually and can lead to rupture of the aorta, this is very dangerous! Therefore, do not ignore the symptoms and do not forget about routine checks!

• Myocarditis

Burning, constrictive pain behind the sternum or under the left shoulder blade. At the onset of the disease, it occurs periodically, shortness of breath, weakness, especially after any exertion, may also appear.

• Pericarditis

Sharp, stabbing pain behind the sternum, in the left shoulder/arm, usually aggravated by movement, deep breathing, and relieved by sitting forward. Like myocarditis, it often occurs as a complication of infection. Both diseases can lead to heart failure, so it is important to diagnose them in a timely manner and start treatment.

• Angina

This is a burning, pressing, squeezing pain behind the sternum, often accompanied by shortness of breath. May radiate (“give”) to the left shoulder, shoulder blade, back or jaw.

Often appears after intense physical activity and disappears after 5-20 minutes or after taking nitroglycerin. It is a symptom of coronary heart disease, so if you recognize yourself, do not delay a visit to a cardiologist.

“If you have similar symptoms, but the pain is very strong, does not disappear within 20 minutes even after nitroglycerin – immediately call an ambulance! It could be a myocardial infarction!” warns the cardiologist.

Chest pain as a symptom of another disease

• Herpes zoster

Acute chest pain, accompanied by skin rash, headache, fever. The disease is caused by the herpes virus. If you notice these symptoms – contact a dermatologist as soon as possible!

• Pancreatitis

Most often it is pain in the upper abdomen, but it may radiate to the area under the left shoulder blade or behind the sternum. It usually appears after eating fatty foods or alcohol. This is a disease of the pancreas, so if you feel similar symptoms, you should consult a gastroenterologist.

• Intercostal neuralgia

Severe constrictive chest pain may radiate to the left arm/scapula. Symptoms are similar to angina pectoris, but are aggravated by movements of the arms, back, head. Cause of pain: pinching of nerves by intervertebral discs. Needs a consultation with a neurologist or vertebrologist.