Sternum pain: 5 possible causes (and what to do?)

A breastbone pain can be indicative of a serious pathology in some cases, while it is benign in other cases. Pathologies heart, lung, digestive, cartilaginous, bone et muscle can cause pain in the sternum.

It is therefore important to know how to identify the characteristics of such pain in order to consult a specialist in time for proper management. It can be manifested by tightness, tightness or severe pain.

This article will discuss 5 possible causes (in the form of categories) of pain in the sternum after describing the anatomy of the bone called sternum. It will also provide effective means of dealing with such a situation.

What exactly is the sternum? (short anatomical reminder)

Le sternum is an odd, flat, median bone located anterior to the rib cage. It thus closes the thorax from the front. It consists of 3 parts. From top to bottom we find: manubrium, body of the sternum and the xiphoid process. The shape of this bone resembles a sword or even a tie.

The rib cage is formed by the vertebrae behind, the sternum forward and the ribs on either side. The sternum therefore accommodates all the ribs. Other elements such as muscles also fit on the sternum. Most of these muscles ensure the breathing, automatically or consciously (forced breathing).

The rib cage contains vital organs that can be affected if there is pain in the sternum. We have the heart and great vessels which constitute the mediastinum. The latter is located just behind the sternum. It is limited on the sides by the lungs (right and left).

At a distance from the sternum, we find:

• Bottom left, stomach
• Bottom right, the liver.

Several possible causes of sternum pain

Without further ado, here are various causes of sternum pain. It can manifest itself locally at the level of the bone of the sternum (at the front of the rib cage), or even appear as a chest pain.

It can even radiate to the side, the ribs, the back or the upper limb in some cases.

Sternum pain from heart causes

Pathologies of cardiac origin cause chest and sternum pain with characteristics to be identified. It is usually a feeling of pain inside the chest (intra-thoracic pain) that can spread to the left arm and jaw.

The main causes of heart pain in the sternum are:

• THEangina pectoris (1): In this case the pain is felt behind the sternum and manifests itself on exertion. The patient has a feeling of constriction in the chest (chest pain).

• THEmyocardial infarction (2): commonly called heart attack, it corresponds to the destruction of part of the heart muscle by obstruction of one of its arteries. It is manifested in particular by chest pain that radiates (arm, jaw, etc.).

• THEpulmonary embolism (3): It is defined as the obstruction of a pulmonary artery or one of its branches by a blood clot. It is characterized by pain on one side of the sternum. It is sudden onset with difficulty in breathing, chest pain, coughing and possible coughing up of blood.

• La pericarditis (4): It is an inflammation of the membrane that covers the heart (pericardium). This heart condition causes pain in the middle of the back and sternum. It is accompanied by fever, sweating, dyspnoea, permanent difficulty in breathing and a feeling of a vice-like chest pain.

Pulmonary causes

Pathologies affecting the lungs are sources of pain in the sternum with breathing difficulties. We mainly have:

• Le pneumothorax (5): It is the presence of air between the two layers of the pleura (membrane that covers the lungs), causing lung collapse (collapse) partial or complete. Pneumothorax is manifested by a sudden and violent pain on one side of the sternum or the rib cage. Chest pain is associated with a dry cough and difficulty in breathing.

• La pneumonia (6): This acute bacterial infection affecting the lungs also causes pain in the sternum. It is part of a context of impaired general condition with fever, dry cough and unilateral chest pain.

• La pleurisy (7): It is the presence of liquid between the two layers of the pleura.

• Viral infection linked to Covid-19 (8)

Digestive causes

Sternum pain from digestive causes is very common:

• Gastritis (9): It is the inflammation of the lining of thestomach by several factors. Reflux and their acidity induce pain in the lower part of the sternum. These pains are punctuated by meals and nocturnal cough.

• Gastric or duodenal ulcer (10): This is a deep sore that forms in the inner lining of the stomach or in the first part of the intestine called duodenum.

• Esophagitis (11): Inflammation of the mucous membrane of theesophagus generally caused by gastroesophageal reflux disease (GERD), it causes pain behind the sternum called heartburn.

• Attack of hepatic colic (12). We can think of an attack of the liver in case of very significant pain in the right and lower part of the sternum.

• Hernia hiatus (13): It is the rise of the upper part of the stomach in the thorax through an orifice called diaphragmatic hiatus.
• Roemheld syndrome

Muscle causes

The pectoral muscle is inserted along the sternum, in front of the rib cage. He may suffer a tear or stretch (14) during a sudden movement of the arm backwards, or a sudden effort (weight training, rugby, etc.).

This can cause sharp muscle pain in the sternum area.

Other muscles insert at the level of the sternum. We have the diaphragm which is the main muscle of respiration but also, the abs and muscles intercostal.

Abnormalities in the functioning of these muscles will therefore cause chest pain and pain in the areas of attachment to the sternum (between the shoulder blades, ribs, flank, breast, chest, etc.). These pains will manifest themselves mainly at the time of forced inspiration or coughing (15).

Bone and Joint Causes

• La sternoclavicular dislocation (16): She corresponds to a dislocation of the joint between the clavicle and the sternum, sometimes causing sternum crackles.
• La sternum fracture (17): It is rare and is linked to trauma or stress fracture (osteoporosis). For example, it can be caused by the seat belt during a car accident.
• Le Tietze syndrome (18): This is an inflammation of the cartilage at the junction of the sternum and one or more ribs (chondro costal or chondro sternal joint). It can occur following a trauma, but most often there is no obvious triggering factor. It is characterized by the sudden onset of acute chest pain that sits in the affected chondro-costal or chondro-sternal joints. The pains are sharp, increased on mobilization and on inspiration. They can worry and make fear a heart attack.
• La costochondritis,
• Mediafixer rib pain in general (fracture, sprain, Cyriax syndrome, intercostal neuralgia, etc),
• Deformities of the sternum: Like the sternum sticking out, lump in sternum, sunken breastbone (pectus excavatum), the supernumerary rating, etc.
• A non-cardiac chest pain.

What to do in front of a pain in the sternum? (and when to worry?)

Faced with pain in the sternum, the action to be taken as well as the treatment will depend on the suspected cause. A clinical and radiological examination will clarify the diagnosis and guide management.

If you experience chest pain with characteristics corresponding to the heart and lung pathologies listed above, you should immediately go to the emergency room or consult your doctor.

With regard to digestive pathologies, most are diagnosed by a radiography, a scan or an digestive fibroscopy (gastric and duodenal ulcer for example).

The treatment will be based on hygieno-dietary measures and medications. Antiacids, antispasmodics and antibiotics are the drugs most often used.

Visceral osteopathy, although it is not based on solid scientific foundations, can sometimes relieve functional digestive pathologies and gastric disorders in certain patients.

The hiatal hernia will definitely be treated with surgery to reposition the stomach in the abdomen and tighten the hiatal orifice.

THEosteopathy is strongly indicated in the case of pain in the sternum of muscular and articular origin. Some people observe an improvement in their condition by using postural correctors or postural t-shirts.

Note that it is best to use these accessories sparingly, and only for the purpose of correcting short-term pain.

If the cause is muscular, relaxing the muscles around the sternum can relieve symptoms, along with stretching or breathing. In addition to a qualified practitioner, it is possible to use a massage accessory independently: this is the mini massage gun which relaxes the muscles in a specific and localized way.

A massage roller can also relax the musculature around the sternum and thoracic spine and provide some relief.

Finally, it is important to optimize the quality of sleep to promote adequate healing. If the sleeping position is problematic, it may be worth investing in a suitable pillow.

What to do in front of a broken sternum?

In general, surgery is not offered for an isolated, benign fracture of the sternum. The pain generally decreases after 10 days to a few weeks or so. The consolidation of the bone occurs spontaneously in 4-6 weeks more or less.

The treatment of the fracture of the sternum will therefore be based on taking analgesics to relieve the pain.

Physical therapy (physiotherapy) sessions may be prescribed to speed healing following a broken breastbone. Analgesic methods associated with gentle mobilizations and therapeutic exercises will relieve pain, regain full movement and resume activities.

In the absence of complication or pathological context, these are fractures that heal very well, without there being any functional sequelae.

However, surgical treatment of sternal fractures may be considered in the event of displacement of bone fragments, comminuted fracture (bone broken into multiple bone fragments) or lack of union bone.

What to do in case of Tietze syndrome?

• Repos
• Analgesic drugs (paracetamol, non-steroidal anti-inflammatory drugs) for pain
• anti-inflammatory ointment
• Infiltration corticosteroids or local anesthetics in the painful area.

To prevent the occurrence of Tietze syndrome, a few simple steps can be taken:

• Warm up well before doing any physical activity
• Stay hydrated daily
• Avoid as much as possible movements that strain the spine in case of known herniated disc
• Do regular physical activity
• No smoking

To learn more about the management of Tietze syndrome, see the following article.

What about natural remedies?

Although they are not supported by solid scientific evidence, several natural products and home remedies are used to treat various body pains, especially for their anti-inflammatory power.

Here is a non-exhaustive list of plants and essential oils that are effective in controlling pain and inflammation:

• Turmeric : Thanks to its antioxidant and anti-inflammatory powers very powerful, turmeric is one of the most used plants in a culinary and therapeutic context. The composition of turmeric is essentially made of essential oils, vitamins (B1, B2, B6, C, E, K) and trace elements. But it is to its composition rich in curcumin and curcuminoids that we owe them and calm skin of this spice.

• Ginger : In addition to the special flavor it brings to the kitchen and its aphrodisiac properties, ginger is a root well known for its anti-inflammatory powers. THE gingerol gives it its anti-inflammatory action. It is an active component acting on the inflammatory pain related to chronic joint inflammatory diseases, including rheumatoid arthritis, lupus, rheumatic diseases, etc. It has been proven that this active element is also effective in acting on the inflammation linked to arthritis and sciatica. Ginger also has other benefits thanks to its high potassium content and its richness in trace elements (calcium, magnesium, phosphorus, sodium) and vitamins (provitamin and vitamin B9).

• Omega-3s : Omega-3 are polyunsaturated fatty acids that play a very important role in the functioning of our body. They are provided by food in three natural forms: docosahexaenoic acid (DHA), alpha linolenic acid (ALA) and eicosapentaenoic acid (EPA). Beyond their action on the brain and the cardiovascular system, omega-3s prove very effective against inflammation. Indeed, they have the ability to act on the inflammatory mechanisms in osteoarthritis by slowing down cartilage destruction, thus they reduce the intensity of osteoarthritis pain. Sciatica, being most often linked to an inflammation secondary to a herniated disc, it can also respond to omega-3 provided it is consumed regularly. 

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• Lemon eucalyptus: Eucalyptus is a plant most often used in the form of herbal tea or essential oil. She would have anti-inflammatory effects which give it the ability to act on the bone and joint pain in general and the pain of sciatica in particular.

• wintergreen : Wintergreen is a shrub from which a very interesting essential oil is extracted. It is one of the most used essential oils in aromatherapy. This oil extracted from the shrub bearing the same name, is used in massage to relieve sciatica and act like a analgesic. Indeed, it provides a heating effect thanks to its ability toactivate blood circulation locally.

References

1. https://www.osteopathes.paris/osteopathe-a-paris-specialiste/mal-de-dos/douleur-au-sternum/
2. https://www.reflexosteo.com/blog-sante-bien-etre/douleur-sternum-comprendre-stress-412
3. https://www.femmeactuelle.fr/sante/sante-pratique/douleur-au-sternum-les-differentes-causes-possibles-2081485
4. https://www.institut-kinesitherapie.paris/pathologies/douleurs-thorax-et-cotes/fracture-sternum/
5. https://douleurs-musculaires.ooreka.fr/astuce/voir/638975/syndrome-de-tietze