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Sternal Pain: What It Is, Why It Happens, and When to Seek Help

What is Sternal Pain?

Sternal pain refers to discomfort, aching, sharp stabbing, or pressure felt in the sternum—the flat bone that forms the center of the chest wall, commonly called the breastbone. The pain may be superficial (felt on the skin or muscle covering the sternum) or deep (originating from the bone, cartilage, or structures behind it such as the heart, lungs, or esophagus). Because the sternum sits near many vital organs, any pain in this area often raises concern, but the underlying cause can range from harmless musculoskeletal strain to life‑threatening cardiac disease.

Common Causes

Below are the most frequently encountered conditions that can produce sternal pain. They are grouped by system for easier reference.

• Costochondritis – Inflammation of the cartilage that connects the ribs to the sternum (the “costosternal joints”). It typically causes a sharp, localized ache that worsens with deep breaths or chest wall movement.
• Muscle strain or overuse – Heavy lifting, vigorous exercise, or sudden twisting can strain the pectoral muscles or intercostal muscles attached to the sternum.
• Thoracic spine disorders – Degenerative disc disease, facet joint arthritis, or vertebral fractures can refer pain to the front of the chest.
• Gastroesophageal reflux disease (GERD) & esophageal spasm – Acid reflux can cause a burning sensation behind the sternum (heartburn) that may be mistaken for chest pain.
• Myocardial ischemia (angina) or heart attack – Reduced blood flow to the heart often presents as pressure or crushing pain behind the sternum that may radiate to the neck, jaw, or arms.
• Pericarditis – Inflammation of the pericardial sac surrounding the heart causes sharp, pleuritic pain that is often relieved by sitting up and leaning forward.
• Pulmonary embolism (PE) – A clot in the lung arteries can cause sudden, sharp chest pain that worsens with breathing.
• Pneumothorax – Collapsed lung leads to sudden, one‑sided chest pain and shortness of breath.
• Chest wall tumors or cysts – Benign or malignant growths on the sternum can cause persistent pain, especially if they erode bone.
• Post‑cardiac surgery or radiation therapy – Scar tissue (fibrosis) and changes in the chest wall after surgery or radiation can create chronic sternal discomfort.

Associated Symptoms

Because the sternum is near many structures, additional symptoms often accompany the pain and can help narrow the cause.

• Shortness of breath or difficulty breathing
• Palpitations, irregular heartbeat, or feeling of fluttering
• Radiating pain to the neck, jaw, left arm, or back
• Fever, chills, or night sweats (suggesting infection or inflammation)
• Swelling, redness, or warmth over the sternum (possible cellulitis or abscess)
• Heartburn, sour taste, or regurgitation (typical of GERD)
• Cough, wheeze, or hemoptysis (coughing up blood) – red flags for pulmonary causes
• Recent trauma, heavy lifting, or intense coughing episodes

When to See a Doctor

Not every case of sternal pain requires an emergency visit, but you should schedule a medical evaluation promptly if any of the following are present:

• Pain that lasts more than a few days without improvement.
• Chest pain that feels crushing, pressure‑like, or is triggered by exertion.
• Associated shortness of breath, dizziness, or fainting.
• New or worsening pain after a recent injury, surgery, or vaccination.
• Fever, chills, or a painful, swollen area over the sternum.
• Persistent heartburn that does not respond to over‑the‑counter medication.
• Any concern that the pain might be heart‑related, especially in people with known cardiovascular disease, high blood pressure, diabetes, or a family history of heart disease.

Diagnosis

Evaluating sternal pain involves a systematic approach to rule out serious conditions while identifying less risky causes.

1. Detailed History

The clinician will ask about:

• Onset, duration, and character of the pain (sharp, dull, burning, pressure).
• Triggers (exercise, deep breathing, meals, position changes).
• Relieving factors (rest, leaning forward, antacids).
• Associated symptoms (mentioned above).
• Medical history (heart disease, GERD, lung disease, recent trauma).
• Medication and substance use (including nicotine and stimulants).

2. Physical Examination

• Inspection for swelling, bruising, or deformity of the chest wall.
• Palpation of the sternum and costosternal joints to reproduce tenderness.
• Auscultation of heart and lungs to detect murmurs, rubs, or abnormal breath sounds.
• Assessment of peripheral pulses, blood pressure, and signs of heart failure.

3. Diagnostic Tests

• Electrocardiogram (ECG) – First‑line test to identify ischemia, arrhythmias, or pericarditis.
• Chest X‑ray – Evaluates lungs, ribs, and the sternum for fractures, pneumothorax, or masses.
• Blood work – Cardiac enzymes (troponin), CBC, inflammatory markers (CRP, ESR), and D‑dimer if PE is suspected.
• CT or MRI of the chest – Detailed imaging for pulmonary embolism, aortic dissection, or thoracic tumors.
• Echocardiogram – Assesses pericardial effusion, wall motion abnormalities, or valvular disease.
• Upper endoscopy or barium swallow – Considered when GERD or esophageal disorder is a leading possibility.
• Bone scan or biopsy – Rarely needed, reserved for suspected bone infection or malignancy.

Treatment Options

Treatment is directed at the underlying cause. Below are typical interventions for the most common etiologies.

1. Musculoskeletal Causes (Costochondritis, Strain)

• Non‑steroidal anti‑inflammatory drugs (NSAIDs) such as ibuprofen 400‑600 mg every 6‑8 hours.
• Heat or cold packs applied 15‑20 minutes several times a day.
• Gentle stretching and strengthening of chest wall muscles.
• Physical therapy for chronic cases.
• Short course of oral steroids may be prescribed if NSAIDs are ineffective (under physician supervision).

2. Gastroesophageal Reflux Disease

• Lifestyle modifications – weight loss, elevate head of bed, avoid large meals, caffeine, alcohol, and spicy foods.
• Over‑the‑counter antacids or H₂ blockers (ranitidine, famotidine).
• Proton‑pump inhibitors (omeprazole, esomeprazole) for 4‑8 weeks if symptoms persist.
• Referral to gastroenterology for refractory cases.

3. Cardiac Causes (Angina, Myocardial Infarction, Pericarditis)

• Immediate emergency care for suspected heart attack – aspirin 325 mg chewed, nitroglycerin if prescribed, and rapid transport.
• Anti‑ischemic medications: beta‑blockers, nitrates, calcium‑channel blockers.
• For pericarditis: high‑dose NSAIDs (e.g., ibuprofen 600‑800 mg TID) +/- colchicine; steroids reserved for refractory cases.
• Long‑term risk‑factor management – control hypertension, diabetes, cholesterol, and smoking cessation.

4. Pulmonary Causes (PE, Pneumothorax)

• PE: Anticoagulation (heparin → warfarin or direct oral anticoagulants) and, in severe cases, thrombolysis.
• Pneumothorax: Supplemental oxygen, needle decompression if tension pneumothorax, or chest tube placement.

5. Infections or Tumors

• Antibiotics for bacterial sternal infections or osteomyelitis, often requiring IV therapy.
• Surgical drainage or debridement when abscesses are present.
• Oncologic referral for biopsy and appropriate cancer treatment (surgery, radiation, chemotherapy).

Prevention Tips

While some causes (like trauma) cannot be fully prevented, many strategies lower the risk of developing sternal pain.

• Maintain good posture—avoid prolonged slouching which can strain chest wall muscles.
• Exercise regularly—strengthen pectoral and back muscles; include flexibility work for the thoracic spine.
• Use proper lifting techniques—bend at the knees, keep the load close to the body.
• Control heart disease risk factors—healthy diet, regular aerobic activity, blood pressure and cholesterol monitoring.
• Limit reflux triggers—avoid late‑night meals, wear loose clothing, and maintain a healthy weight.
• Avoid smoking and excessive alcohol—both increase the risk of cardiovascular and pulmonary events.
• Vaccinate against respiratory infections (influenza, COVID‑19, pneumococcal) to reduce cough‑related strain.
• Promptly treat infections—especially skin or respiratory infections that could spread to the chest wall.

Emergency Warning Signs

Key Takeaways

Sternal pain is a symptom, not a disease. Its wide range of causes—from benign muscle strain to life‑threatening heart attacks—means a careful assessment is essential. Most cases are musculoskeletal or reflux‑related and respond well to conservative treatment, but red‑flag features demand urgent medical attention. If you’re ever unsure, err on the side of safety and seek professional evaluation.

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Sources: Mayo Clinic, Cleveland Clinic, American Heart Association, CDC, National Institute of Health (NIH), World Health Organization (WHO), peer‑reviewed articles from Journal of the American College of Cardiology and Chest journal.

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