What does it mean when your sternum hurts?
Many issues with your sternum and its surrounding bones and muscles can cause sternum pain. In addition, you may experience substernal pain — discomfort that occurs below or behind your sternum. This type of pain is usually due to gastrointestinal conditions. Some common causes of sternum or substernal pain include:
- Costochondritis.
- Pectus carinatum.
- Sternum (sternal) fracture.
- Sternoclavicular joint injury.
- Collarbone injury.
- Muscle strain.
- Hiatal hernia.
- Acid reflux.
- Pleurisy.
- Bronchitis.
- Pneumonia.
Costochondritis
Costochondritis is a condition that causes inflammation in the cartilage that attaches your ribs to your sternum. An infection, injury or arthritis can cause the condition. Costochondritis causes sharp, stabbing rib pain and tenderness. You usually feel it in your sternal area and the first three sets of ribs, but it can spread to your arms and shoulders. You may also notice warmth and tenderness in the area.
Pectus carinatum
Pectus carinatum is a condition that causes your sternum to stick out more than it should. Other names for the condition include pigeon chest and keel chest because of how it makes your chest appear. Most people with pectus carinatum don’t have symptoms. But, you may experience chest pain when in specific positions or participating in certain activities.
Sternum (sternal) fracture
A sternal fracture occurs when you break your sternum bone, most often due to blunt force trauma. Sternum fractures commonly occur due to auto accidents. They also happen because of sports injuries and falls. There are two types of sternum fractures:
- Direct: When a direct blow to the front of your chest wall causes a break further back in your chest.
- Indirect: When your sternum is injured in such a way that a break occurs closer to the front of your chest.
Sternoclavicular joint injury
Your sternoclavicular joint is the area in your body where your clavicle connects to your sternum. Although rare, you can sometimes develop problems in this joint area due to infections, injuries or arthritis. You’ll experience pain and discomfort if you have an injury there.
Collarbone injury
Your collarbone (clavicle) connects to the top corners of your sternum. Since the two are closely connected, if you injure your collarbone, you’ll feel pain and discomfort in your sternum, as well. You can injure your collarbone through accidents, sports injuries and falls.
Muscle strain
A muscle strain, or a pulled muscle, can occur when you injure a tendon or muscle. Many tendons and muscles are connected to your sternum. Therefore, injuries to a muscle or tendon can also affect your sternum. Muscle strains occur due to overuse, playing sports and coughing too hard.
Hiatal hernia
A hiatal hernia happens when the top of your stomach moves past your diaphragm and into your chest. This affects the area behind your chest and can cause substernal pain (the area behind your sternum). Hiatal hernias are the most common type of hernia.
Acid reflux
Acid reflux occurs when stomach acid causes irritation and inflammation that wears away the lining of your esophagus. This can cause substernal pain. The condition most often affects people with gastroesophageal reflux disease (GERD).
Pleurisy
Pleurisy is a condition that causes inflammation in your pleurae — the sheets of tissue between your ribcage and lungs. Some autoimmune diseases, lung conditions, and bacterial or viral infections can cause pleurisy. This can also cause substernal pain.
Bronchitis
Bronchitis is a condition that causes inflammation in the primary airways leading to your lungs — your trachea (windpipe) and bronchi — causing substernal pain. This inflammation causes your lungs to fill with mucus, leaving you with a nagging cough that can last for weeks.
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Pneumonia
Pneumonia is a condition that causes inflammation in the air sacs (alveoli) in your lungs. After the alveoli inflame, they fill with fluid, which can cause sharp chest pains. You may feel this pain behind your sternum.
Common signs or symptoms of sternum conditions
The symptoms and signs of sternum pain will vary depending on the cause. The most common symptom you may experience is pain and discomfort in the center area of your chest. Other symptoms you may experience include:
Costochondritis
- Chest pain that gets worse with physical activity, stretching, breathing deeply or coughing.
- Tenderness.
- Discomfort in your ribs.
- Sharp pain on the sides of your sternum.
Pectus carinatum
You may not experience any symptoms, or you may have some chest pain while performing certain activities and being in certain positions.
Sternum (sternal) fracture
- Chest pain that gets worse when coughing or breathing deeply.
- Tenderness.
- Bruises.
- Swelling.
- Shortness of breath or difficulty breathing.
Sternoclavicular joint injury
- Pain or tenderness in the sternoclavicular joint area.
- Bruising.
- Mild swelling or heat in the joint area.
- Difficulty moving your shoulder.
- A clicking, popping or crunching sound when you try to move your arm.
- Fever, chills or redness if you have an infection.
Collarbone injury
- Pain or tenderness along the collar bone that gets worse when you raise your arm.
- Bruising.
- Swelling.
- A crackling, clicking or grinding sound when you move your shoulder.
- A lump or bump that you can feel.
- Atypical sagging of your shoulder.
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Muscle strain
- Chest pain or tenderness, which worsens especially with a deep breath.
- Bruises.
- Swelling.
- Limited or reduced range of motion.
Hiatal hernia
- Frequent burping.
- Heartburn.
- A feeling of fullness (indigestion).
- Difficulty swallowing.
- Feeling like there’s a lump in your throat.
These symptoms often worsen when lying down.
Acid reflux
- Backwash from your stomach into your throat.
- A burning feeling in your esophagus.
- Sore throat.
- Feeling like there’s a lump in your throat.
These symptoms often worsen with eating.
Pleurisy
- Sharp, stabbing pain that gets worse when you cough, breathe deeply or wheeze.
- Shortness of breath.
- Fever.
- Extreme fatigue (tiredness).
Bronchitis
- Chest pain.
- Severe coughing spells.
- Shortness of breath.
- Wheezing.
- Fever.
- Fatigue.
Pneumonia
- Severe coughing.
- Shortness of breath.
- Fever.
- Sweating.
- Nausea and vomiting.
- Loss of appetite.
- Confusion.
Common treatments for sternum pain
Treatment of sternum pain will vary depending on the cause.
Costochondritis
The most common treatment option for costochondritis is rest. You need to give your chest and ribcage time to heal. Your healthcare provider may also recommend over-the-counter (OTC) pain medications like nonsteroidal anti-inflammatory drugs (NSAIDs). Rarely, your provider will inject you with a corticosteroid to reduce the inflammation.
Pectus carinatum
The most common treatment options for pectus carinatum are bracing and surgery. With bracing, you wear a brace around your chest 24 hours a day for a long time (months to years). This provides pressure from the back and the front to move your sternum back to its usual position.
Surgery for pectus carinatum involves a procedure called the Ravitch procedure. A surgeon will make a cut (incision) into your chest to remove the cartilage in the front of your chest. Then, they’ll make a small cut in the front of your breastbone, press it into its usual position and anchor it in place.
Sternum (sternal) fracture
Treatment for a sternal fracture depends on the type and severity of your injury. You may only need rest and pain medication for mild cases. In more severe cases, you may require surgery to put your sternum back into its proper position.
Sternoclavicular joint injury
Treatment for a sternoclavicular joint injury also depends on the severity of your condition. For mild cases, your healthcare provider may recommend rest, avoiding activities that trigger pain and pain relievers. More severe cases may require surgery.
Collarbone injury
Treatment for a collarbone (clavicle) injury depends on the severity. For mild cases, your healthcare provider may recommend putting your arm in a sling to keep it from moving, or a collar bone fracture brace. They may also recommend icing it to reduce swelling and pain relievers to help with the pain. You may need to see a physical therapist to help improve your arm motion and strengthen your shoulder. In severe cases, you may require surgery.
Muscle strain
You can treat most muscle strains using OTC pain relievers, ice and heat, massage and rest. Sometimes, prescription muscle relaxants can be prescribed.
More severe injuries may require surgery.
Hiatal hernia
If a hiatal hernia doesn’t cause any symptoms, you don’t necessarily need treatment. But if you have symptoms, they won’t get better without treatment. You can manage mild cases of hiatal hernias with acid reflux medication or lifestyle changes such as small meals, avoiding lying down after eating and weight loss. You may need surgical care for more severe cases.
Acid reflux
You may be able to treat acid reflux with lifestyle changes, including eating well-balanced meals, avoiding certain trigger foods, quitting smoking and reducing your alcohol and caffeine intake. If you have chronic acid reflux or GERD, you may need medication to reduce the amount of acid in your stomach. You can get some medications over the counter (like antacids). Other medications, like proton pump inhibitors (PPIs), may require a prescription.
Pleurisy
Treatment for pleurisy depends on the cause. Your healthcare provider may recommend pain relievers for symptom relief. You may need a medication to treat an infection. In severe cases, you may need a procedure called a thoracentesis, where your provider removes fluid from your lungs.
Bronchitis
Treating this depends upon the cause. Certain viruses like flu or COVID can be treated with antiviral medication. In some cases, if you’re having trouble breathing, your provider may prescribe a drug that helps open your airways (bronchodilator) or corticosteroids for the inflammation.
Pneumonia
Treatment for pneumonia depends on whether a bacterial, viral or fungal infection caused your condition. If a bacterial infection caused your condition, your healthcare provider may prescribe an antibiotic. They may prescribe an antiviral if you have a viral infection, and they may recommend an antifungal if you have a fungal infection.