Introduction
The sternum is a flat bone which, together with the ribs, forms part of the skeleton of the thorax. The sternum has an important stabilizing function in the bony ribcage. Due to its functional integration into a complex system of muscles, joints, vision and bones in the thorax, the sternum is exposed to strong forces and movements (e.g. during breathing).
Possible causes of sternum pain
The most common causes of pain in the sternum are listed below: Temporary pain in the sternum can be caused by various events. Temporary sternum pain can be purely localised to the sternum (then often local conditions such as fractures or inflammatory processes) or can be part of radiating chest pain (then often organic causes such as acute myocardial infarction or angina pectoris). Congenital malformations of the sternum can also theoretically lead to complaints in the area of the sternum (e.g. funnel chest, pigeon chest, Harrenstein deformity).
- Diseases of the lungs e.g. bronchitis or pneumonia
- Sore muscles
- Sternum fracture
- Scoliosis
- Funnel chest
- Pigeon breast
If a patient complains of sternum pain and coughing, acute bronchitis may be present, i.e. an inflammation of the bronchi of the lungs, usually caused by a virus. In addition to the sternum pain and the mucusy cough, there is often a rise in temperature and hoarseness.
As the cough progresses, it can become drier and drier, and the pain in the sternum, but also any pain behind the sternum, becomes increasingly intense. After about 2 weeks, however, the cough and sternum pain should subside. If the pain occurs suddenly and there is pain in the entire thorax area in addition to the sternum pain, together with coughing and shortness of breath, one should think of a pulmonary embolism (especially if the patient is elderly or has just undergone surgery) and call an emergency doctor immediately!
If the symptoms are rather insidious and there is a high fever and tight breathing in addition to the cough and pain in and around the sternum, one should think of pneumonia. If, however, in addition to the cough, the pain occurs in isolation in the sternum and not in the entire thorax region, it is also possible that the increased coughing irritates and overexerts the muscles that attach to the sternum, resulting in “sore muscles” which lead to sternum pain. Many patients come to the gym with sternum pain after the gym training.
Various exercises, such as dips, can be to blame for this. With dips, the major pectoralis muscle, a muscle that extends from the sternum to the humerus, is the most common. If the muscle is overstressed, this can easily lead to complaints in the area of the sternum.
In addition, dips put additional strain on the abdominal muscles, which also start at the lower part of the sternum. If you have made a wrong movement or overstrained yourself, it is possible that the dips cause sternum pain because the muscles pull too much on the sternum or are easily inflamed. It is important to have the exercises shown to you by an experienced trainer in order to avoid renewed sternum pain.
Acute sternum pain caused by dips should be treated by trying to relax the muscles by placing a warming pillow on the sternum or taking a hot bath. If the sternum pain does not improve, a physiotherapist or osteopath should also be consulted. Diseases of the sternum (sternum fracture/star fracture) and thus sternum pain are rare.
Due to an accident, a direct impact can lead to a fracture of the sternum and thus to sternum pain. In most cases, no therapy is necessary, as the sternum heals even under the constant breathing movements. The sternum is located in the thorax and can be palpated from the front along its entire length.
Via the first to the tenth rib, the sternum is connected to the thoracic spine in the back. Therefore, especially when sitting in the wrong position, back pain can occur in addition to sternum pain. Patients who sit a lot at their desk and have acquired relieving postures, such as supporting themselves with their elbows or a hump, are particularly affected by combined sternum and back pain.
This is caused by tension in the musculature, which ultimately puts strain on the joints. Especially the joints that connect the ribs to the sternum (sternocostal joints) are misloaded and can then cause sternum pain. However, since the spinal column is also incorrectly loaded, back pain is also caused.
It is therefore always a matter of incorrect loading, and congenital malpositions such as scoliosis, a bending of the spine, are rarely to blame for combined sternum and back pain. In any case, it is important to consult a physiotherapist or an osteopath so that they can help to remedy the malposition and thus also prevent sternal pain and back pain. The most common and in most cases harmless norm variant is so-called funnel chest (pectus excavatum).
This is a funnel-shaped retraction of the front wall of the ribcage. The cause is an abnormal growth of the sternum and the ribcage. However, sternum pain is hardly noticed.
In most cases it is only a cosmetic problem. Only in very severe cases with impairment of the heart and lungs is surgical correction necessary. The pigeon breast (pectus carinatum), which occurs about 10 times less frequently, is the counterpart to the funnel chest.
This causes the sternum and ribcage to bulge forward. Pigeon breasts also usually only present a cosmetic – psychological problem without a disease component such as sternum pain. The Tietze syndrome (Chondroosteopathia costalis) is a possible cause of sternum pain.
In this clinical picture, the cause is still unknown, but there is painful swelling in the area of the joint transition from the 2nd and 3rd ribs to the sternum (costosternal joint). Systemic signs of inflammation cannot usually be found diagnostically. However, since Tietze syndrome heals spontaneously within a few months, it is a temporarily painful disease with a favourable prognostic outlook.
Tietze syndrome occurs more frequently in older people. They usually present themselves in emergency departments with the fear of a cardiovascular event. Ultimately, however, this is not an organic but a musculoskeletal thoracic pain. The Tietze syndrome can be clearly distinguished diagnostically from other causes (such as organic causes without swelling in the sternum area) by the swelling caused by pressure pain without the presence of radiation.