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Causes Behind Sternum Pain

Published on Dec 01, 2022 and last reviewed on Dec 02, 2022   -  6 min read

Abstract

The majority of occurrences of sternum discomfort are unrelated to the heart and are caused by abnormalities with the sternum or adjacent cartilage.

Introduction

Sternum pain usually occurs as a result of problems associated with sternal muscles and bones and is not due to the sternum itself. Because the sternum is so close to the heart, many persons who experience sternum discomfort mistake it for more general chest pain. Chest discomfort accounts for around one to three percent of annual visits to a primary care provider in the United States.

What Is the Anatomy of Sternum?

The sternum is a flat bone in the anterior thoracic wall that is placed in the center. It is divided into three sections:

  • The Manubrium: The manubrium is a quadrangular structure located between the third and fourth thoracic vertebrae. The thickest section of the manubrium is the jugular (suprasternal) notch, which is convex anteriorly and concaves posteriorly. The clavicles, first ribs, and the superior section of the second costal cartilage all articulate with the manubrium.

  • The Body: The sternum's body is longer and thinner than the manubrium. The lower section of the 2nd costal cartilage, the 3rd to 6th costal cartilage, and the superior portion of the 7th costal cartilage articulate with its edges.

  • The Xiphoid Process: The xiphoid process is the sternum's lowest and smallest component. It connects the rectus abdominis, transversus abdominis aponeurosis, and transversus thoracic to the inferior section of the 7th costal cartilage.

What Are the Causes Behind Sternal Pain?

Substernal discomfort is a type of pain that occurs right behind or below the sternum and is often caused by gastrointestinal issues. The following are a few of the most common reasons for sternum and substernal pain:

  • Collarbone injuries caused by costochondritis.

  • Damage to the sternoclavicular joint.

  • Hernia.

  • Acid reflux.

  • Sternum fracture.

  • Muscular strain.

  • Bruising.

What Are the Cardiovascular Causes Behind Sternum Pain?

Patients aged 20 to 39 years old account for 52 % of all cases. Chest pain, difficulty breathing, tiredness, and palpitations are all possible symptoms. The patient might have recently experienced flu-like symptoms. The cardiovascular causes behind sternal pain are enlisted as follows;

What Are the Respiratory Causes Behind Sternal Pain?

There are several respiratory causes behind sternal pain, which are enlisted as follows;

  • Asthma.

  • Exercise-induced.

  • Bronchoconstriction (a narrowing of the airways).

  • Bronchitis.

  • Bronchiectasis (a condition with damaged airways).

  • Chronic obstructive pulmonary disease.

  • Tracheitis (windpipe bacterial infection).

  • Tuberculosis.

  • Embolism of the lungs.

  • Pleurisy (inflammation of the tissues that line the lungs and chest cavity).

  • Pneumothorax.

  • Hypertension of the lungs.

  • Sarcoidosis of the lungs (growth of inflammatory cells in lungs).

  • Infections of the lower respiratory tract.

  • Overuse of chest muscles due to coughing or pleural irritation causes chest pain.

What Are the Abdominal and Gastrointestinal Causes?

The pain in the sternum may result from several ailments of the gastrointestinal tract, which have been enlisted as follows;

GERD (Gastroesophageal Reflux Disease): This is characterized by a burning discomfort behind the sternum, which may be accompanied by asthma-like symptoms such as a dry cough and a sore throat.

Pancreatitis:

  • Pain in the upper abdomen and the lower chest is a symptom of this illness.
  • Ulcers in the stomach.

  • Pain in the esophagus.

  • Anxiety or drinking cold water can also cause esophageal spasms.

Boerhaave's Syndrome: It is a condition in which an esophageal rupture induced by a sudden increase in intraluminal pressure is an uncommon occurrence. Although a report exists of one case resulting from spinal manipulation for back pain, such a surge in pressure may occur as a result of hard lifting. This illness is also linked to severe retching, which is associated with alcoholism. Pleuritic chest pain and painful swallowing are common symptoms.

Referred Pain:

  • Shoulders.

  • The cervical spine is the backbone of the neck.

  • The thoracic spine, including a herniated thoracic disk (which is rare given the relative immobility of this region).

  • Diskitis or a spinal cord or vertebral body lesion (e.g., neoplasm).

Cancer:

  • Breast cancer.

  • Lung cancer.

  • Lymphoma.

  • Bone cancer.

  • Skin cancer.

What Are the Diagnostic Tests for Sternal Pain?

Electrocardiography and potentially a chest X-ray should be performed on any patient over the age of 35 who has a history or risk of coronary artery disease or who comes with cardiovascular symptoms.

  • To thoroughly rule in or rule out a heart malfunction, cardiac stress testing may be required.

  • A chest X-ray should be performed on any patient who has a fever, cough, chest wall edema, or other respiratory abnormalities on history or examination.

  • X-rays and bone scans are also utilized to rule in or out fractures (since X-rays are negative in 60 percent of all stress fractures).

  • If more information is needed about suspected bone damage, Computed tomography (CT) scans and Magnetic resonance imaging (MRI) scans may be recommended.

  • When neoplasms are highly suspected, CT scans should be performed.

  • The use of nuclear scintigraphy (organ scanning) may be beneficial.

  • Chest discomfort that lasts more than 12 hours and sensitivity on examination of the anterior chest wall are both strong clinical markers of sternal pain caused by a musculoskeletal problem.

  • Deep breathing (to expand the thorax) and raising the upper extremities are examples of active movements that can help to confirm a musculoskeletal diagnosis.

  • Pain during inspiration, as well as painful chest and upper extremity motions and pain on palpation and/or light percussion, would be predicted in the presence of a rib or sternal fracture.

  • In the case of a stress fracture, the pain could be difficult to pinpoint at first, but over time it could become more noticeable and painful. It is possible that a bony callus exists.

How Is Sternal Pain Managed?

While sternal pain is not usually a serious condition but requires medical attention.

  • Trauma directly to the bone.

  • Heart attack-like symptoms may be seen.

  • The pain is persistent.

  • It does not improve over time.

The following conditions and their managements are enlisted as follows;

Rib Fracture:

  • Three weeks' rest is mandatory for post-injury.

  • Pain is managed with the help of medications.

  • Deep breathing exercises are recommended to maintain the appropriate function of the lungs.

  • In case of stress fractures, practicing proper sports techniques helps to prevent a recurrence.

Joint Subluxation:

  • Joint subluxation is usually treated conservatively.
  • Joint manipulation followed by the use of painkillers to alleviate the pain is recommended.
  • Surgical debridement is required if there is a failure in conservative treatment.

Costochondritis: Reassurance, pain management, mobilization or manipulation, and taping as appropriate. This condition typically resolves within one year.

Acute Myalgia: Relative rest.

Fibromyalgia: Graded exercise.

Muscle Strain:

  • Reassurance, pain control, and avoidance of aggressive activities, followed by strengthening exercises, help the individual to return to normal activity.
  • Injections like Lidocaine or Corticosteroids can be given if the conservative treatment fails.

Pectoralis Major Rupture:

  • A sling for comfort, and the use of painkillers, followed by adequate rest, is recommended initially.
  • After a few days, gentle stretching can be performed.
  • After six to eight weeks, the individual can start doing strengthening exercises.

Slipping Rib Syndrome:

  • Rest, physiotherapy, followed by intercostal nerve blocks, is the treatment of choice.
  • In severe cases, surgical intervention is recommended.

Conclusion

Sternal pain can range from innocuous conditions to several serious circumstances. Although it is not usually severe, extreme cases may require intervention at the right time to prevent complications. The physician's instructions should be strictly adhered to in this regard.

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Last reviewed at:
02 Dec 2022  -  6 min read

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