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.

Chest Pain in Children: Is It a Heart Condition?

Featured Expert:

Chest pain tends to be associated with heart attack or other acute heart conditions in adults. But what about chest pain in children? Parents should know that childhood chest pain is actually a fairly common complaint and it’s rarely an indication of a heart condition.

“Only about 1% to 4% of chest pain in children will be cardiac. The vast majority—95% or more—isn’t related to a heart issue,” explains William Ravekes, M.D., Medical Director of Pediatric Heart Transplant at Johns Hopkins Children’s Center.

Causes of Chest Pain in Children

Some of the most common causes of chest pain in children include:

• Acid reflux (heartburn)
• Anxiety
• Asthma
• Costochondritis (inflammation of joints between ribs and breastbone)
• Muscle strain
• Respiratory infection

What Should I Do About My Child’s Chest Pain?

As a parent, you want to know when you should talk to a doctor about your child’s chest pain and when the chest pain could be a medical emergency.

Seeking Emergency Care for Chest Pain in Children

Ravekes recommends going to the emergency department or calling 911 if your child’s chest pain:

• Gets worse over the course of a few hours
• Happens during exercise or physical activity
• Is accompanied by breathing problems
• Is followed by fainting

It’s also important to know your family’s health history. If congenital heart conditions run in your family, or family members have died suddenly at a young age, monitor your child’s heart health closely.

Mild Chest Pain in Children

Mild chest pain that comes and goes usually isn’t cause for alarm, but may warrant a conversation with your child’s doctor. “Start with your pediatrician,” says Ravekes. “They’ll evaluate the possibility of cardiac and non-cardiac chest pain causes.”

Your child’s pediatrician may refer them to a pediatric cardiologist if they find:

• A heart murmur (abnormal sounds of blood flow between heartbeats)
• Abnormal vital signs, including heart rate, blood pressure, breathing or temperature
• An arrhythmia (abnormal heartbeat)
• Irregularities on an electrocardiogram (ECG), a noninvasive test that measures the electrical activity of the heart

Diagnosing Chest Pain in Children: How does a pediatric cardiologist evaluate my child?

“The first thing I do as a pediatric cardiologist is get a good, careful history. We spend a lot of time talking about when the chest pain happens and the quality of the chest pain, as well as its locations and duration,” explains Ravekes. He encourages children to describe the chest pain as accurately as possible, including:

• What triggers the chest pain?
• Does it happen during activity or rest?
• Is it a sharp, stabbing chest pain or is it dull?
• Is it always in one spot or does it move around?
• Is it accompanied by other symptoms?

The doctor will gather information from parents that could help determine the underlying cause of chest pain. It’s important to evaluate physical and psychological signs to get a full picture of your child’s health. The doctor may ask about your child’s energy and anxiety levels, or if they noticed any changes in skin color during episodes of chest pain. 

After a thorough physical, the doctor will typically perform diagnostic tests. “Any kid that comes to a cardiologist will get an ECG. That looks at heart rhythm and signs of ongoing or prior heart muscle damage,” says Ravekes. Other diagnostic tests may include:

• Echocardiogram, (an ultrasound of the heart), which looks for structural defects
• Chest X-ray to look for a chest wall fracture or abnormalities in the shape or size of the heart
• Holter monitor, which uses electrodes to track the heart’s rhythm for 24 to 48 hours
• Exercise stress test to see how the heart works during physical activity

Heart Conditions That Cause Chest Pain in Children

While it’s rare for a heart condition to be the cause of chest pain in children, it does happen. Heart conditions that can cause chest pain include:

• Congenital cardiomyopathies, which describe an enlarged heart muscle (hypertrophic) or a heart muscle that is too thin (dilated) and are usually present at birth
• Coronary artery anomalies, which are usually congenital issues
• Myocarditis, or infection of the heart muscle
• Pericarditis, or infection of tissue around the heart 

Treatment for these heart conditions depends entirely on the condition and its severity. There are a range of treatment options available, from medication and monitoring to open-heart surgery.

How Can I Help Monitor My Child’s Chest Pain?

There are a variety of ways that parents can help monitor their child’s chest pain. Most importantly, encourage your child to be honest about their symptoms. Tips include:

• Ask your child to report specific details about chest pain, including the severity of the pain on a scale of 1 to 10.
• Check your child’s pulse regularly. If it’s over 180, notify your child’s cardiologist right away.
• Encourage your child to tell you about stressors at home, at school or among friends that could be contributing to health issues like chest pain. 

Ravekes tells his pediatric patients, “Whenever you see any doctor, there is no right or wrong answer to what you’re feeling. Just be open and honest. We want to get you back on your sports team, dance team or whatever activities you like to do. We can make things better. It’s very rare that we can’t do anything. Either surgery will fix it, or we have medicines to make you happier and healthier.”

Chest Pain Treatment at The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center

Our pediatric heart specialists provide the most advanced diagnosis and treatment of chest pain for your child and other conditions through adulthood in one place.

Learn more about the Pediatric and Congenital Heart Center

Chest pain: causes, prevention, treatment

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Chest pain

Chest pain (thoracalgia) may come from simple fatigue or overexertion, or be precipitated by serious illness. Its severity does not depend on the severity of the disease with which it is caused. Yes, it’s a pretty scary symptom.

We are sure that there is a heart in the chest, which means it hurts, and this is very dangerous. But we forget that other organs are located in the chest: the aorta, lungs, esophagus, diaphragm. In addition, the chest is the bones, muscles, ligaments, and in women – the mammary glands. All of them can get sick.

Types and localization of pain

To determine the “significance” of pain, you first need to understand exactly where it hurts and how, and then associate it with other symptoms.

Chest pain differs in character and localization:

• Right. Such pains are associated with liver diseases and biliary tract problems. They do not increase with movement, just aching or grabbing from time to time pain that radiates to the shoulder blade or arm. In addition, gastritis, an esophageal ulcer, and even intestinal colic sometimes manifest themselves this way. Intercostal neuralgia, myositis, scoliosis – are manifested by acute pain during movements, bending over, coughing. With inflammation of the right lung it is difficult to breathe. It is impossible to write off mental disorders when the patient “winds” himself, exaggerating the severity of the symptoms, and independently makes the most terrible diagnosis.
• Left and middle. This pain syndrome in the presence of coughing and burning may appear due to pneumonia, pleurisy, bronchitis or influenza. Pain that occurs after physical exertion behind the sternum and on the left side is a sign of heart disease – myocardial infarction, myocarditis, cardiomyopathy. If these symptoms are accompanied by difficulty breathing, coughing, inability to take a deep breath, then most likely it is pericarditis. In the case when the pain is not so pronounced and does not have additional symptoms (lack of connection with the position of the body, movement, breathing, eating) and is localized behind the sternum, then we can talk about aortic diseases, the presence of arrhythmia, oncology of the chest organs.

In any case, you should not take any medications, but immediately go first to the therapist, who will prescribe an examination, as a result of which a referral to a narrow specialist will be issued – cardiologist,
phthisiatrician, gastroenterologist, neurologist.

You can sign up for a consultation with a cardiologist at our consultants by phone +7 (495) 125-49-50

Prices for cardiologist services Addresses of clinics ECHO of the heart Cardiologist in Moscow ECG Calling a cardiologist at home

General diagnostics

At home, the amount of help is very limited, so you should immediately consult a doctor. The survey algorithm is based on the following methods:

• Questioning the patient about the nature, duration, location of pain, connection with other factors (food intake, physical activity, stress, etc.).
• External inspection. Listening, measuring pressure and temperature.
• X-ray examination of the chest.
• Electrocardiogram.
• Computed tomography.
• Magnetic resonance imaging.
• FEGDS (in a simple way, a probe).
• Mammography.
• Complete blood count.

Based on a comprehensive examination of the causes that provoke pain in the chest, a treatment regimen is built – it is clarified whether conservative therapy can be dispensed with or surgical intervention should be resorted to.

An unhealthy lifestyle increases the risk

So that chest pain does not bother,
you should eat right, observe the correct mode of activity and rest,
go in for sports, give up bad habits, maintain a constant
normal weight. It is useful to engage in auto-training so as not to succumb
stress. Always keep chronic diseases under control.

This article is not medical advice and should not be used as a substitute for consultation with a physician.

Thoracalgia, chest pain, causes of girdle chest pain

Intercostal neuralgia

Intercostal neuralgia is also called thoracic sciatica. This disease is characterized by intense pain in the chest on the left and right along the intercostal nerves. They are aggravated by deep breaths, coughing, sneezing, and also by movement. They may be non-passing or intermittent, unilateral or bilateral, and have an aching, stabbing, burning character.

Although this disease mainly hurts the chest, radiating pain can also be felt under the shoulder blade, in the back and in the region of the heart.

Treatment of intercostal neuralgia in Tibetan medicine eliminates the cause of chest pain. One of the main such causes is pinched nerve roots in the thoracic spine. This is due to osteochondrosis and its complications – disc protrusion and intervertebral hernia.

Other causes of intercostal neuralgia may be endocrine disorders (in particular, in women in menopause), vascular atherosclerosis, herpes and a number of other diseases.

The complex application of Tibetan medicine methods, aimed at the root cause of neuralgia, allows not only to reliably and effectively eliminate chest pains, but also to prevent their recurrence.

Thoracic osteochondrosis

Thoracic osteochondrosis is a disease of the intervertebral discs, as a result of which they become thinner, dry out, and lose their shock-absorbing properties. As a result, the height of the gaps between adjacent vertebrae decreases, their processes approach each other, which can lead to pinching of the intercostal nerves extending from the spinal cord in the thoracic region. As a result, there are pains in the chest by the type of intercostal neuralgia.

At the same time, pain in the left chest with intercostal neuralgia is often mistaken for angina pectoris, while spinal problems are their cause. If adequate treatment is not carried out at this stage, the disease will continue to develop.

As the discs become more and more flattened, they bulge (protrusion). This may be followed by the destruction of the annulus fibrosus and prolapse of the disc core outside the spinal column – a hernia. The consequence of this, as a rule, is the pinching of the nerve roots of the intercostal nerves and the occurrence of pain in the chest and in the region of the heart.

For the effective treatment of osteochondrosis and its complications in Tibetan medicine, complex therapy is used. It is based on the use of acupressure, acupuncture, vacuum therapy, moxibustion and a number of other methods. These medical procedures relieve muscle spasms of the back (the main factor in the development of osteochondrosis and its complications), increase the gaps between the vertebrae. At the same time, they help to release pinched nerve roots and blood vessels, improve blood supply and nutrition to the discs, and stimulate their natural recovery processes. Thanks to this, pain in the chest on the right and left, as well as girdle pain and other symptoms of osteochondrosis disappear.

Kyphosis

The cause of chest pain in kyphotic curvature of the spine is persistent muscle spasms. Therefore, pain is felt mainly in muscle tissues, which is manifested by its intensification with pressure.

Tibetan acupressure, combined with acupuncture, manual therapy, osteopathy and other Tibetan medicine methods, helps relieve muscle spasms and tension. These methods significantly alleviate chest pain in kyphosis. At the same time, they reduce the degree of curvature of the spine and increase the physical activity and mobility of the back.

Ankylosing spondylitis

Bechterew’s disease, or deforming spondylarthrosis, is a chronic inflammation of the sacroiliac joints of the spine. In this disease, the intercostal joints and transverse processes of the vertebrae in the thoracic region are affected.

The development of the disease over time leads to immobilization, or ankylosis, of the spine and a decrease in the mobility of the chest. The result of this is chest pain when breathing deeply.

As with other diseases of the spine, chest pain on the left in Bechterew’s disease can be mistaken for angina pectoris.

Methods of Tibetan medicine can effectively treat Bechterew’s disease. As a result, pain in the chest disappears, the mobility of the spine increases significantly. Muscle spasms are removed, and the development of the disease stops or slows down significantly. This achieves sustainable relief for all symptoms of the disease.

Schmorl’s hernias

Multiple hernias of Schmorl in the thoracic region in Scheuermann-Mau disease cause deformity of the spine and pinching of the nerve roots. As a result, there are pains in the chest and other symptoms – aching pain in the back, a feeling of muscle fatigue in the sitting position and when walking.

Tibetan medicine methods – acupressure, acupuncture and others – eliminate muscle spasms, reduce the degree of curvature of the spine and eliminate chest pain. They affect the cause of the disease – degenerative-dystrophic processes in the spine. Thanks to this, stable and long-term results of treatment are achieved.

Neurosis, cardioneurosis

A disorder of the central nervous system can also cause chest pain associated with nervous stress and psycho-emotional overload. In this case, treatment with Tibetan medicine methods will be aimed at restoring the balance of the nervous system, increasing resistance to stress and strengthening emotional stability. In terms of Tibetan medicine, this means restoring the balance of the Rlung, or Wind, regulatory system.

This result is achieved with the help of acupuncture, various massage techniques, stone therapy, vacuum therapy, moxotherapy, as well as the use of herbal remedies that have a beneficial effect on the nervous system and emotional state. As a result, pain in the chest and other symptoms of neurosis disappear.

Ischemic heart disease

Symptoms of coronary heart disease are felt as pain in the chest on the left. Treatment with Tibetan medicine methods in this case includes two components – herbal medicine and medical procedures (acupuncture, acupressure). These methods are aimed at the treatment of atherosclerosis. With their help, the tone of the vascular walls increases. Achieved cleansing of blood vessels from plaques and an increase in the lumen of blood vessels, improving the quality (lowering cholesterol levels, viscosity) of blood and restoring the balance of the nervous system. The latter serves as a prevention of vasospasm and complications of coronary disease in the form of heart attacks and strokes.

Gastric ulcer

Peptic ulcer of the stomach and 12 duodenal ulcer can cause pain in the middle of the chest, which is also often mistaken for heart disease. Unlike angina pectoris, chest pain associated with stomach disease is dependent on food. With a duodenal ulcer, they occur on an empty stomach (often at night), and with a stomach ulcer – after eating.

The methods of Tibetan medicine act simultaneously on the disease itself and its causes – they improve the innervation of the stomach and local immunity, eliminate the disorder and restore the balance of the nervous system. Along with acupuncture and acupressure, herbal remedies are used for peptic ulcer disease, which have a targeted anti-inflammatory and immunomodulatory effect. They allow you to eliminate pain in the middle of the chest and other symptoms of peptic ulcer.

Diseases of the biliary tract

Gallbladder spasms, or biliary dyskinesia, can also cause chest pain. Since the liver, gallbladder and bile ducts are located in the right hypochondrium, it would seem that they should cause pain in the chest on the right. However, pain in the disease of these organs is felt, on the contrary, in the left side of the chest and behind the sternum.