When does the pain in the sternum occur?

Respiratory pain in the sternum occurs primarily in two basic groups of conditions. On the one hand, there are musculoskeletal diseases, which include in particular the blockage of rib-vertebral joints and intercostal neuralgia. The latter represents a so-called neuralgiform syndrome.This term describes pain caused by damage to nerves.

Intercostal neuralgia is characterized by persistent, pulling pain, which increases when the chest is moved, for example when breathing. The cause can be a number of different diseases. One of the most common are hardened muscles (myelgeloses) of the intercostal muscles, which can lead to constriction of the nerves running through the intercostal space.

Degenerative changes of the spine or herpes zoster (shingles) are also possible, which can also lead to nerve damage. Precisely because the number of possible underlying diseases is so large, an exact diagnosis is often difficult. A further conceivable cause of breath-dependent pain in the area of the sternum is diseases of the airways.

Inflammation of the supplying airways (bronchitis) plays a particularly important role here, but pneumonia should not be ignored either. If the pain occurs very suddenly and intensively and is accompanied by shortness of breath, however, a pulmonary embolism can also be the trigger of the symptoms. This is a serious clinical picture that requires urgent treatment.

In the case of open heart surgery, access must first be gained to the organ that is well protected and located in the center of the chest. For this purpose, the sternum is usually sawed open lengthwise and split so that the ribs can be moved to the sides and the heart exposed. After the intervention on the heart, the two halves of the sternum are rejoined and fixed by strong wires.

In the weeks following heart surgery, the bone must heal again. In the first weeks after the operation, sternum pain may occur again and again. In rare cases, the wires themselves may be responsible for the pain and may have to be removed.

Before heart surgery, the physician should inform the patient about the expected pain and also ask for information about the symptoms for which recurrence is indicated. Pain in the sternum and back can have various clinical pictures as a background. First and foremost, however, a musculoskeletal cause should be considered.

This includes various diseases of the musculoskeletal system, i.e. the muscles, bones and joints. Pain running around the chest in the form of a belt is often caused by blockages in the rib-vertebral joints. However, a so-called intercostal neuralgia is also conceivable as a trigger for the complaints.

This is pain caused by damage to nerves, which classically have a persistent, pulling character. However, the term intercostal neuralgia does not represent an exact diagnosis, but encompasses several independent clinical pictures. These include hardening (myelgelosis) of the intervertebral muscles, which can lead to constriction of nerve tracts.

Likewise, intercostal neuralgia can be due to a degenerative change in the spinal column. In this respect, a herniated disc of the thoracic spine cannot be ruled out as the cause of the pain. Precisely because the described complaints are so unspecific, a medical clarification should be considered if the pain persists over a longer period of time, is very strong, or increases in intensity.

If there is pain in the rib roots in addition to pain in the sternum, this indicates quite clearly that the rib-vertebral joints are blocked. This is classically associated with limited freedom of movement in the thoracic spine or rib cage, which is accompanied by dull, pulling, often seizure-like pain. These typically radiate in a belt-like manner around the thorax and increase during movements such as breathing excursions of the thorax.

As a result, affected persons often experience restrictions during breathing. In rare cases, sensations such as numbness in the area of the ribs can occur when the intercostal nerves become trapped. Pressure points above the affected joints at the sternum attachment are also typical for rib blockages, through which the pain can be reproduced.

In addition to injuries caused by accidents, rib blockages are usually caused by degenerative changes in the joints or an unfavorable posture in everyday life.The most common treatments for the complaints include drug-based pain therapy with ibuprofen or diclofenac and physiotherapeutic as well as manual therapy procedures. In order to avoid the recurrence of rib blockages, it is recommended that, in addition to a consciously healthy posture, strengthening exercises for the spinal column muscles and stretching exercises are performed. Some complaints such as abdominal pain or nausea hardly surprise anyone during pregnancy and are often even commonplace.

But also pain behind the breastbone is not unusual during this time and is usually considered harmless. They are at least partly due to the increasing size of the child in the womb. Since the space in the abdominal cavity is rather limited, the remaining organs, especially the gastrointestinal tract, have to make way.

This can lead to discomfort, especially when lying down, since in this position there is a lot of pressure on the abdominal organs. This is why, especially when lying down, previously unknown complaints such as heartburn can occur during pregnancy. This is characterized by a burning and pressing pain behind the sternum.

It is useful for the patient to know that the stomach is curved in the upper abdomen, with the bulge on the left side. For this reason, when lying on the left side, the stomach contents tend to shift towards the esophagus, which is why lying on the right side often leads to an improvement in symptoms. In addition, an adjustment in eating habits can help to minimize the production of gastric acid.

It is important to know that protein-containing foods and caffeine in particular promote the production of gastric acid. However, drugs to treat heartburn should not be taken during pregnancy. Drugs from the group of proton pump inhibitors, such as pantoprazole, are known to pass into breast milk.

Even if only few study results are available, this suggests a potentially harmful effect on the child. Antacids, on the other hand, seem to be much less problematic. Nevertheless, the gynaecologist should always be consulted before taking new medicines during pregnancy.