Associated symptoms | Breastbone pain

Associated symptoms

Depending on the underlying cause, sternal pain can occur as a single symptom or together with other accompanying symptoms. The upper ribs of the rib cage attach to the sternum in the form of a cartilaginous connection. This joint (Articulationes sternocostales) is a predilection site for inflammatory processes that can cause localised pain in the sternum (costochondritis).

In general, however, this clinical picture occurs rather rarely. Costochondritis is usually caused by a systemic disease (e.g. Reiter’s disease). Due to the tripartite structure of the sternum with an additional very flat bone structure, the sternum is also susceptible to fractures.

The sternum can be fractured, for example, during cardiopulmonary resuscitation (CPR) or postoperatively after a bypass operation. If, however, additional complaints occur, such as pain radiating to the area behind the sternum (retrosternal pressure pain), into the armpit, the left arm or down to the neck, an organic initial manifestation is often the cause. This radiating symptomatology is typical for a myocardial infarction as well as for angina pectoris.

Common accompanying symptoms are shortness of breath, increased respiratory rate, increased sweating, anxiety and anxiety. The occurrence of retrosternal pain in particular indicates an organic cause, which can also be a disease of the oesophagus (inflammation, reflux in the form of heartburn or tumours). Ulcerations in the area of the stomach can also be accompanied by pain in the area of the sternum.

In the context of traumatic injuries (sports injuries or accidents with contusions, bruises, etc.) may also be associated with sternum pain. In this case there are usually accompanying traumatic injuries elsewhere. Periostitis (non-specific, aseptic periosteitis) is usually the trigger for sternal pain in the context of injuries. The periosteum is the periosteum, which is very well supplied with blood and is also very sensitive to pain.

When can sternum pain occur?

The sternum is located in the thorax above the lungs. It is also connected to 10 of the 12 ribs via cartilaginous joints (sternocostal joints) and various respiratory muscles such as the pectoralis muscle. As a result, with each inhalation (inspiration) and thus also with each exhalation (expiration) the sternum is stretched a little bit and also loaded.

Breastbone pain during breathing is particularly frequent in the case of inflammation of the bronchi, which is usually caused by a virus (bronchitis). This lasts for about 2 weeks and is accompanied by a slimy and then dry cough. Pneumonia, which is usually caused by bacteria, can also lead to sternum pain when breathing or breathing in (pain when breathing in).

In addition, there is a rapid rise in temperature and shortness of breath. Pulmonary embolism is also characterized by sternal pain and general pain when breathing, but here there is also a bloody cough. This is always an emergency indication and the patient should be taken to hospital as soon as possible.

In some cases the sternum pain when breathing is also psychologically caused and is usually accompanied by extreme anxiety and very rapid, increased breathing (hyperventilation). Postoperatively, sternum pain is not an isolated case after heart or chest surgery. In bypass operations, for example, the anatomical position of the breastbone (Latin sternum) is used to gain access to the operating area.

The sternum is deliberately fractured by the surgeon and stabilised with metal spirals after the operation. Especially during bypass operations, numbness in the area of the ribcage can occur in addition to the typically pressing pain in the sternum. This is due to the fact that in most cases a section of the internal thoracic artery is used as a vascular replacement during a bypass, which supplies the thorax with arterial blood.

If the pain persists for more than six months after a sternotomy, it may be advisable to remove the metal spirals from the sternum. The numbness due to the removal of the internal thoracic artery in sections should disappear after a few weeks. If there is pain in the breastbone after heart surgery, there are various options for the patient.

In the vast majority of cases, the bypass was placed because of arteriosclerotic vascular diseases of the coronary arteries. Therefore, in the postoperative course, explicit attention should be paid to keeping the predisposing factors of elevated blood lipid values (especially cholesterol) and elevated blood sugar within the normal range. A possible cause of sternal pain is heartburn.

This occurs when acid flows from the stomach back into the esophagus. This triggers an inflammatory reaction in the mucous membrane of the oesophagus (medically known as reflux esophagitis). It usually causes a burning or pulling pain behind the breastbone.

An irritation of the throat can also trigger a dry cough. The symptoms can be alleviated by a change in eating and drinking habits and other measures such as sleeping with a raised upper body. Spicy food, alcohol and sweets should only be consumed in small quantities.

It is also advisable not to eat your last meal too late but to take it a few hours before going to bed. If the above measures are not sufficient, medication can be used. An active substance that reduces the production of stomach acid can often relieve heartburn and the associated sternum pain.

This topic might be of interest to you: Nutrition for heartburnThe diaphragm is a flat muscle that separates the thoracic cavity internally from the abdominal cavity. When you breathe in, the diaphragm contracts and sinks on both sides of the body and when you breathe out, it rises again in a dome-shaped form. Under certain circumstances, sternal pain can be caused by damage to the diaphragm.

Holes or weak points in the muscle layer can push abdominal organs into the chest. In most cases the stomach is affected by a so-called internal hernia. Here, sternum pain can be directly caused by the misaligned parts of the organs.

The hernia also promotes the occurrence of heartburn, which can also be a cause of the pain behind the sternum. If it is suspected that pain in the sternum originates from the diaphragm, it may be necessary to clarify the situation by means of imaging. Pain in the sternum after a training session is in most cases a harmless side effect.

Especially when exercising muscles which have their base in the area of the sternum, pain can occur afterwards. This is mainly the M. pectoralis major and minor. Theoretically, muscle pain is also possible after specific training of the anterior serratus muscle.

Since the pain is usually caused by a sore muscle, the pain usually improves within a week. After a strength training session with dips, sternum pain is not unusual. During the exercise, especially the large chest muscle (Musculus pectorales major) is trained, because with each repetition the entire body weight is pushed up.

The muscle originates from the chest wall, with some fibres also starting from the sternum and running up to its muscle attachment on the upper arm. Training can cause tiny tears in the muscle fibres, into which tissue water penetrates. This results in the pain known as muscle ache.

This usually occurs at the earliest twelve hours after training, but sometimes not until the day after next. When training the chest muscles, for example with dips, sternum pain can therefore also occur. These are motion-dependent and are intensified when the arm is moved.

The sore muscles occur especially when no other strength training of the chest muscles has been carried out and can last between two and seven days. Other exercises that can lead to such pain are for example push-ups or bench presses. If the sternum pain is not dependent on movement, a muscular cause and thus a connection to dips is unlikely.

If sternum pain occurs during movement or its intensity is dependent on movement, the cause of the pain is most likely damage to the musculoskeletal system. The cause of the pain may be in the bones, joints or muscles of the ribcage. Because the origin of movement-dependent sternum pain is often not clearly identifiable, it is often summarised as a chest wall syndrome.

This classification is important to distinguish it from other, possibly urgent causes of the symptoms. Breastbone pain resulting from damage to internal organs such as the heart, lungs or oesophagus typically occurs independently of movement, so that there is usually no dangerous disease. Similar to movement-related complaints, sternum pain that is triggered or intensified by pressure also indicates a bony or muscular cause.

If a certain area of the sternum is sensitive to pressure, this can indicate, for example, tension in the muscles between the ribs or damage to a joint between the rib and the sternum. By contrast, sternal pain in dangerous diseases of internal organs such as a heart attack cannot be triggered by pressure. Pressure-sensitive sternum pain therefore usually gives the all-clear and usually subsides of its own accord after a few days.

After a fall on the thorax, sternum pain is not unusual. They are usually caused by a contusion. In addition to pain, a bruise can form if small blood vessels have been destroyed during the fall and there is bleeding into the tissue.

Relief can be provided by taking painkillers for a short time and cooling the sternum. In the event of a fall from a great height or any other violent accident, a doctor should be consulted to rule out serious injuries. Indications for this can be strong pain when breathing as well as a feeling of instability of the chest.

Musculoskeletal deformities or injuries to the spinal column can lead to secondary pain in the area of the sternum. This is caused by the complex interaction of the spine, ribs and sternum during all movements such as breathing or changes in the position of the upper body. The transmission of pain stimuli originating in the spinal column via the intercostal nerves is also conceivable in the development of sternum pain.

Breastbone pain occurring during pregnancy is not unusual and usually has a harmless cause. In addition to the generally possible causes of pain, some specific processes during pregnancy can trigger the pain. For example, the growing child pushes the abdominal organs upwards with increasing size.

Especially when lying down, the pressure on the stomach can cause acid to enter the oesophagus and trigger heartburn, which is perceived as burning or pressing sternum pain. This can be remedied if the pregnant woman sleeps with her upper body elevated. The “acid blockers” frequently taken for heartburn must not be used during pregnancy or while breastfeeding.

In the case of frequent or very pronounced sternum pain, the gynaecologist or family doctor should also be consulted. Basically, sternum pain in children can have various causes. Often the cause can be found very quickly by asking the child what it was doing the day before.

Breastbone pain in children, as well as in adults, can be caused by incorrect or excessive strain on muscles. If the child has been climbing around all day, it is quite possible that the muscles have been overstrained, especially the major pectoralis muscle, which runs from the sternum to the humerus. However, it is also possible that the child suffers from inflammation of the bronchi (bronchitis).

In this case, the child suffers from sternum pain and has a mucusy cough (in the later stages also a dry cough), often combined with a slight fever. Especially with growing children, one should always remember that the growth of the sternum can also cause pain due to the irritation of the intercostal nerves located there (intercostal neuralgia). In addition, an inflammation of the joint cartilage of the ribs can occur (costochondritis). In this case the children also complain of sternum pain, often the sternum is slightly swollen and very sensitive to pressure. In this case, parents should consult a pediatrician the next day as the symptoms do not disappear on their own.