Sternum Pain? Let's Talk About Your Breastbone

It’s a scenario I see quite often in my clinic: someone comes in, a hand pressed to their chest, worried. “Doc, it’s right here,” they’ll say, pointing to the middle of their chest. That central spot, that’s where your sternum, or breastbone, lives. It’s more than just a bit of bone; it’s a crucial protector. And when it hurts, it’s natural to feel a bit uneasy. So, let’s talk about your sternum and what might be going on if it’s causing you discomfort.

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What is This Sternum, Anyway?

You probably know your sternum as your breastbone. It’s that flat, somewhat T-shaped bone sitting right at the front and center of your chest. Think of it as the main shield for some really important stuff inside you. It also acts as an anchor, connecting to your collarbones and many of your ribs with tough, flexible tissue called cartilage. This whole setup forms your ribcage, which is like a protective bony hug for your heart and lungs.

What’s Its Job?

Your sternum is a bit of an unsung hero. Its main jobs are:

Protection: It guards vital organs like your heart, lungs, esophagus (the tube that carries food to your stomach), and major blood vessels from bumps and injuries.
Support: It connects to your clavicles (collarbones) at the top and the first seven pairs of ribs, giving structure to your chest. Muscles in your chest and upper belly also attach here.
Breathing (indirectly): While the sternum itself doesn’t move much, the cartilage connecting it to your ribs allows for the slight movements of your ribcage every time you take a breath. Pretty neat, huh?

A Closer Look: The Anatomy of Your Sternum

Let’s get a bit more specific about this important bone.

Where Exactly Is It?

You can feel your sternum right in the middle of your chest, running downwards. It’s in front of a little gland called the thymus. This gland is part of your immune system, helping train special white blood cells. Above it, your collarbones connect to its top corners.

The Three Main Parts

Your sternum isn’t just one solid piece; it’s made of three parts that fuse together as you grow:

Manubrium: This is the wider, top part, almost like the handle of that upside-down sword I mentioned. Your collarbones and the first pair of ribs connect here.
Body: This is the longest, flat, central part. Ribs two through seven (mostly) attach along the sides of the body of the sternum.
Xiphoid Process: This is the small, pointy bit at the very bottom. It’s mostly cartilage when you’re younger and gradually turns to bone as you age. Its shape can vary a bit from person to person. Sometimes people notice it if they’re thin, and that’s usually perfectly normal.

It’s about 6 inches long, give or take, and often described as looking like an upside-down sword – broad at the top (the manubrium as the handle), long and flat in the middle (the body as the blade), and pointy at the bottom (the xiphoid process as the tip).

Why Your Sternum Might Be Hurting

Okay, so what happens when this central chest bone starts to ache? Pain around the sternum can come from a few different places. Sometimes the pain feels like it’s behind the sternum (we call this substernal pain), and that often points to issues with your digestive system. Let’s go through some common culprits:

Costochondritis: This is a really common one I see. It’s when the cartilage connecting your ribs to your sternum gets inflamed. It can be caused by an injury, an infection, or even something like arthritis. It often feels like a sharp, stabbing pain, and the area can be tender to touch.
Pectus Carinatum: You might know this as “pigeon chest.” It’s a condition where the sternum sticks out more than usual. Often, it doesn’t cause symptoms, but sometimes people feel chest pain with certain activities or positions.
Sternum (Sternal) Fracture: Yes, you can break your sternum. This usually happens from a direct blow to the chest, like in a car accident, a hard fall, or a sports injury. Ouch.
Sternoclavicular Joint Injury: This joint is where your collarbone (clavicle) meets your sternum. Injuries here aren’t super common, but they can happen due to trauma, infection, or arthritis, causing pain right at that junction.
Collarbone Injury: Since your collarbone connects directly to your sternum, an injury to the collarbone (like a fracture) can definitely cause pain that you feel in the sternum area.
Muscle Strain: You can pull or strain the muscles or tendons around your chest and sternum. This can happen from overuse, heavy lifting, sports, or even a really bad coughing fit.
Hiatal Hernia: This is when the top part of your stomach pushes up through your diaphragm (the big muscle under your lungs) and into your chest. It can cause that substernal pain or discomfort.
Acid Reflux (GERD): If stomach acid regularly flows back up into your esophagus, it can cause a burning pain behind your sternum – classic heartburn.
Pleurisy: This is when the thin tissues (pleura) lining your lungs and chest cavity get inflamed. It can cause sharp chest pain, especially when you breathe or cough.
Bronchitis: Inflammation of your main airways (trachea and bronchi) can lead to a deep cough and sometimes discomfort behind the sternum.
Pneumonia: An infection in your lungs can cause inflammation and fluid in the air sacs, leading to chest pain that might feel like it’s around or behind your sternum.

Spotting the Signs: What to Look Out For

The exact feeling can vary a lot depending on what’s going on. Of course, pain in the middle of your chest is the main one, but here are some other clues:

If it’s Costochondritis:
Sharp pain, often on the sides of your sternum.
Tenderness when you press on the area.
Pain might get worse with deep breaths, coughing, or stretching.
If it’s Pectus Carinatum:
Often no symptoms, but sometimes chest pain with certain activities.
If it’s a Sternum Fracture:
Pain that’s worse when you cough or breathe deeply.
Tenderness, bruising, or swelling over the sternum.
Maybe shortness of breath.
If it’s a Sternoclavicular Joint Injury:
Pain, tenderness, maybe bruising or warmth right where the collarbone meets the sternum.
Trouble moving your shoulder.
A clicking or popping sound with arm movement.
Fever or redness if there’s an infection.
If it’s a Collarbone Injury:
Pain along the collarbone, worse when you lift your arm.
Bruising, swelling, maybe a lump you can feel.
Your shoulder might look like it’s sagging a bit.
If it’s a Muscle Strain:
Chest pain or tenderness, especially with a deep breath.
Maybe some bruising or swelling.
Limited movement.
If it’s a Hiatal Hernia:
Frequent burping, heartburn, indigestion.
Trouble swallowing, or feeling like something’s stuck in your throat. Often worse when lying down.
If it’s Acid Reflux:
That burning feeling rising up your chest.
Sour taste in your mouth.
Sore throat. Often worse after eating.
If it’s Pleurisy:
Sharp, stabbing pain that worsens with breathing, coughing, or sneezing.
Shortness of breath, maybe fever or tiredness.
If it’s Bronchitis:
A nagging cough, maybe some chest discomfort.
Shortness of breath, wheezing, fatigue.
If it’s Pneumonia:
A bad cough, shortness of breath, fever, sweating.
Sometimes nausea or loss of appetite.

Figuring It Out & Getting You Better

So, if your sternum area is giving you grief, what do we do? First off, we’ll have a good chat about your symptoms, when they started, and what makes them better or worse. A physical exam is key too. Depending on what we suspect, treatment can vary quite a bit.

For costochondritis, rest is often the best medicine. We might suggest over-the-counter pain relievers like ibuprofen or naproxen. Rarely, a steroid injection might be needed.
Pectus carinatum treatment depends on severity. Sometimes a special brace is used, or a surgical procedure called the Ravitch procedure might be considered.
A sternum fracture might just need rest and pain meds if it’s mild. More serious breaks could need surgery.
Sternoclavicular joint injuries often respond to rest and pain relief. Surgery is less common but possible for severe cases.
Collarbone injuries might mean wearing a sling or a special brace, ice, and pain meds. Physical therapy can be really helpful too. Surgery is for more complex breaks.
Muscle strains usually get better with rest, ice, heat, and pain relievers. Sometimes, we might prescribe a muscle relaxant.
Hiatal hernias without symptoms might not need treatment. If they’re bothersome, medications to reduce acid or lifestyle changes (like smaller meals) can help. Surgery is an option for severe cases.
Acid reflux can often be managed with lifestyle tweaks and over-the-counter antacids. For more persistent GERD, we might prescribe stronger meds like proton pump inhibitors (PPIs).
Pleurisy treatment targets the underlying cause. Pain relievers help with symptoms. Sometimes, if there’s a lot of fluid, a procedure to drain it (thoracentesis) might be needed.
Bronchitis treatment depends on the cause (viral or bacterial). Antivirals might be used for flu. Sometimes bronchodilators (to open airways) or corticosteroids are prescribed.
Pneumonia treatment depends on the germ! Antibiotics for bacteria, antivirals for viruses, and antifungals for fungal infections.

We’ll always discuss the best options for you.

When to See Your Doctor (Please Do!)

It’s always best to get checked out if:

Your pain started after a direct injury or trauma.
The pain is lingering, not getting better, or getting worse.
You’re also having severe vomiting, especially if there’s blood.

We can help figure out what’s causing your sternum pain and get you on the right track.

Is It My Sternum or My Heart?

This is a big worry, and a very valid one. Chest pain always makes us think about the heart. Pain from most sternum-related issues often feels different from a heart attack. It might be sharper, more localized, or tender to the touch.

Heart attack symptoms can include:

A feeling of pressure, squeezing, fullness, or pain in the center of your chest that might spread to your arm, jaw, or teeth.
Sweating (especially cold sweats).
Nausea.
Shortness of breath.
Feeling lightheaded or dizzy.

If you have any of these symptoms or even a strong suspicion you might be having a heart attack, please don’t wait. Call for emergency medical help immediately. It’s always better to be safe.

Take-Home Message: Key Things About Your Sternum

Here’s a quick recap of what’s important to remember about your sternum:

Your sternum (breastbone) is a vital bone that protects your heart and lungs.
Pain in the sternum area can have many causes, from simple muscle strains or cartilage inflammation (costochondritis) to fractures or issues with nearby organs.
Pain behind the sternum often relates to digestive issues like acid reflux or a hiatal hernia.
While many causes of sternum pain aren’t life-threatening, it’s crucial to get checked out, especially if the pain is severe, persistent, follows an injury, or if you have any concerns about your heart.
Never ignore symptoms that could suggest a heart attack. Seek emergency care right away.

You’re Not Alone

Dealing with chest pain, even if it turns out to be “just” your sternum, can be scary. Remember, we’re here to listen, help figure things out, and get you feeling better. You don’t have to go through this worry by yourself.

Sternum Pain? Let’s Talk About Your Breastbone