What causes pain in the sternum?

Sternum pain is pain or discomfort in the area of the chest that contains the sternum and the cartilage connecting it to the ribs. The sternum is located near the heart, so many people experiencing sternum pain may confuse it with more general chest pain.

Some people experiencing sternum pain worry they may be having a heart attack. However, in most cases, sternum pain is unrelated to the heart and caused primarily due to problems with the sternum itself or the nearby cartilage.
In this article, learn about the causes of sternum pain and the differences between sternum pain and heart problems.

Contents of this article:

1. What is the sternum?
2. Causes of sternum and substernal pain
3. Symptoms of sternum pain
4. When to see a doctor

What is the sternum?

The sternum is sometimes known as the breastbone. This flat bone sits at the front of the chest and connects to the ribs with cartilage.
The sternum is part of the rib cage, a series of bones that protects the heart and lungs from injuries.

Causes of sternum and substernal pain

The sternum is located at the front of the chest and is connected to the ribs.

Sternum pain is usually caused by problems with the muscles and bones near the sternum and not the sternum itself.
Pain felt just behind or below the sternum is called substernal pain and is sometimes caused by gastrointestinal problems.
Some of the most common causes of sternum and substernal pain are:

• costochondritis
• collarbone injuries
• sternoclavicular joint injury
• hernia
• sternum fracture
• acid reflux
• muscular strain or bruise

Costochondritis

Costochondritis is the most common cause of sternum pain and occurs when the cartilage between the sternum and ribs becomes inflamed and irritated.
Costochondritis can sometimes occur as the result of osteoarthritis but may also happen for no apparent reason.
The symptoms of costochondritis include:

• sharp pain on the side of the sternum area
• pain that worsens with a deep breath or a cough
• discomfort in the ribs

Costochondritis is usually not a cause for concern. However, people experiencing symptoms of costochondritis may want to consult a doctor if their symptoms worsen or do not go away.

Sternoclavicular joint injury

The sternoclavicular joint connects the top of the sternum to the collarbone. Injuries to this joint generally cause pain and discomfort at the top of the sternum in the upper chest area.
People experiencing sternum pain due to a sternoclavicular joint injury will often experience the following:

• mild pain or swelling in the upper chest area
• difficulty or pain when moving the shoulder
• popping or clicking around the joint

Collarbone injuries

Collarbone injuries may lead to long-lasting pain or limited movement in the shoulder and upper chest.

While the collarbone itself is not part of the sternum, it is connected to the sternum by cartilage. Injuries to the collarbone may cause pain in the sternum area.
Collarbone injuries are often the result of trauma, such as a car accident or sports injury, although infections or arthritis can also cause them.
Symptoms of a collarbone injury include:

• severe pain when raising the arm
• bruising or swelling in the upper chest area
• abnormal positioning or sagging of the shoulder
• clicking and grinding in the shoulder joint

Hernia

Hernias may not be an obvious cause of pain near the chest. However, a hiatal hernia may cause substernal pain.
A hiatal hernia happens when the stomach moves out of its normal position up past the diaphragm and into the chest. Symptoms of a hiatal hernia include:

• frequent burping
• heartburn
• vomiting blood
• a feeling of fullness
• trouble swallowing

People with substernal pain and symptoms of a hiatal hernia should see a doctor for prompt treatment.

Sternum fracture

Like a fracture in other parts of the body, sternum fractures can cause a lot of pain. Sternum fractures usually occur as a direct result of trauma, such as a car accident or sports injury.
People who believe they may have a sternum fracture should seek immediate medical attention, as the heart and lungs may also be injured.
Symptoms of a sternum fracture include:

• pain during inhaling or coughing
• swelling over the sternum
• difficulty breathing

Acid reflux or GERD

Acid reflux happens when stomach acid wears away the lining of the windpipe (esophagus). This happens primarily in people with gastroesophageal reflux disease (GERD).
Acid reflux may cause substernal pain and discomfort in the chest and is generally accompanied by a burning feeling.
Pain in this region can also be caused by inflammation or a spasm of the windpipe. People with GERD should talk to their doctor about how to prevent further damage to this area.

Muscular strain or bruise

The sternum and ribs have many muscles attached to them. These muscles can be pulled or strained by severe coughing or strenuous activity involving the arms or torso.
Injuries or trauma can result in bruising to these muscles, which may cause them to ache.

Symptoms of sternum pain

Sternum pain is usually caused by muscles or bones surrounding the sternum.

Symptoms of sternum pain vary depending on the cause. The most common symptom is discomfort and pain in the center of the chest, which is the location of the sternum.
Other associated symptoms may include:

• pain or discomfort in the ribs
• pain that worsens during deep breathing or coughing
• mild, aching pain in the upper chest
• swelling in the upper chest
• stiffness in the shoulder joints
• severe pain when raising the arms
• signs of collarbone trauma, such as bruising or swelling
• difficulty breathing
• grinding or popping sensation in joints near the sternum
• frequent belching
• heartburn
• feeling too full
• throwing up blood

Sternum pain vs. heart attack

People experiencing any kind of chest pain may worry they are having a heart attack. However, sternum pain differs from heart attack pain.
People who are having a heart attack experience specific signs before the heart attack itself, whereas most sternum pain starts suddenly.
A heart attack also occurs with the following symptoms:

• pressure, squeezing, or fullness in the center of the chest
• sweating
• nausea
• shortness of breath
• lightheadedness

However, anyone who thinks they are having a heart attack should seek immediate medical attention.

When to see a doctor

While sternum pain is not usually serious, there are some causes of sternum pain that require immediate medical attention.
A person should seek emergency medical attention if the pain:

• started as a result of direct trauma
• is accompanied by heart attack symptoms
• is persistent and does not improve over time
• is accompanied by intense vomiting or vomiting blood

A person should also speak to a doctor if the pain in their sternum gets worse or does not improve over time.