Pain in sternum is pain or discomfort felt in the area of breast bone (sternum). The sternum is present as a flat bone in the centre of the chest, to which the ribs are attached in the front. Pain in sternum can be of short term nature, called acute pain or may be present for long as in chronic pain. Pain may be felt in and around the sternal area or may be felt behind the bone.
Pain in sternum can occur due to various causes related to various body systems, hence evaluation of sternal pain is essential. The nature and duration of the pain may vary depending on the cause. It is important to understand that although pain in sternum is presented as chest pain, it need not create panic. Stress and anxiety often only adds to the existing problem. Hence, being aware of possible causes of pain in sternum and its management can help in dealing with such situations.
What Can Cause Pain in Sternum?
Some of the causes of pain in sternum include:
Musculoskeletal Causes of Pain in Sternum
Pain in sternum can be directly related to problem with the sternal bone, its surrounding structures, muscles and tissues.
- Injury to the sternum or nearby bones causing sternal fracture, clavicular fracture (fracture of the collarbone), rib fracture due to sports or falls. Such injuries are more common in children, young adults and sportspersons.
- Muscle strains around the sternal area can cause pain in sternum. Pectoral muscles, muscles of the chest, intercostal muscles, upper arm and even those coming from the neck, if strained or in spasm can cause pain in sternum. This can occur due to forceful activities, twisting movements, lifting of heavy weights and sports.
- Fibromyalgia, is a condition, which causes muscle and tissue pain in the body and can commonly affect the sternal area causing pain in sternum.
- Costochondritis, which is inflammation of the rib cartilage can cause sternal pain.
- Joint problems, arthritis of the nearby joints can cause joint inflammation and pain in and around the sternum. Joint between the sternum and the clavicle (sternoclavicular joint), joints of the ribs, shoulder blades, etc. can cause sternal pain.
- Other conditions like precordial catch syndrome in children and young adults, disorders of the ribs or infections of bone like osteomyelitis, tuberculosis, etc. can cause sternal pain.
Gastric Causes of Pain in Sternum
Gastric and abdominal causes can lead to pain in sternum, particularly burning type of pain behind the sternum. Conditions related to acid reflux, esophagitis, gastritis, peptic ulcers and inflammation of abdominal organs like pancreatitis, cholecystitis, etc. can cause sternal pain. Indigestion, bloating of abdomen and excessive accumulation of gases can cause pain in upper part of abdomen, often felt under the ribs and sternum.
Cardiac Causes of Pain in Sternum
Various conditions affecting the heart can cause chest pain, which is felt as pain in sternum. Heart conditions like coronary artery disease, cardiomyopathy, heart valve diseases, aortic disorders, pericarditis, myocarditis, etc. can cause pain in sternum.
Pulmonary Causes of Pain in Sternum
Lung related or respiratory disorders can cause pain in sternum, which include asthma, COPD (chronic obstructive pulmonary disease) and bronchitis. Infections like tuberculosis and pneumonia or inflammation of structures behind the sternum like tracheitis can cause sternal pain.
Other Causes of Pain in Sternum
Pain in sternum can mimic a heart attack with no underlying cardiac cause and is called as non-cardiac chest pain. Factors like anxiety and stress can contribute to the pain. Other causes like cancers of the lungs, breasts and bone can also cause pain in sternum.
Symptoms of Pain in Sternum
Pain in sternum can be experienced as a dull aching pain or severe sharp pain. Muscle spasm or tissue injury often results in pain proportionate to the severity of the injury and pain is often felt on movement and breathing. Any fall or sports injury may be obvious as symptoms may begin soon after the event or within few days.
When pain in sternum is due to cardiac or pulmonary causes, it may present with other associated symptoms like sweating, difficulty in breathing, cough, etc. With gastric causes, abdominal symptoms like nausea, vomiting, burning sensation in stomach, abdominal pain or bloating, etc.
Diagnosis of Pain in Sternum
Careful history taking and clinical examination can help to reveal the possible causes of pain in sternum. Arthritis and joint problems may show joint inflammation and pain on touch. Muscle injuries or fibromyalgia may reveal tender points.
Further investigations can be done based on existing associated symptoms. Blood investigations to detect presence of inflammation, infection, etc. may be performed. These may include X-rays, bone scans and MRI to rule out fractures of the bone and tissue injuries. Additional tests like electrocardiogram (ECG), gastroscopy may be considered, if required.
Treatment of Pain in Sternum
Treatment for pain in sternum usually depends on the underlying cause. For sternum pain caused due to injuries and muscle strains, ice packs or hot compresses may be applied. Rest is usually required to aid healing of the damaged tissues. Anti-inflammatory medicines are given. Physical therapy may be advised.
Gastric and acid reflux disease causing pain in sternum is treated with antacids and bland food is advised. Cardiac and pulmonary causes require specific treatment and some may need hospitalization, depending on the severity of the pain in sternum.