Sternum pain - Causes, Treatment & When to See a Doctor

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What is Sternum Pain?

The sternum, or breastbone, is the flat, vertical bone that sits in the center of the chest and connects the rib cage to the clavicles (collarbones). Sternum pain refers to any discomfort, ache, sharp stabbing, burning, or pressure felt over this bone or the surrounding cartilage and soft tissue. The pain can be localized to a single spot or spread across a larger portion of the chest wall.

Because the chest houses the heart, lungs, and major blood vessels, any new or worsening chest pain is often evaluated for serious cardiac or pulmonary causes. However, many cases of sternum pain are musculoskeletal, post‑traumatic, or related to gastrointestinal or inflammatory conditions.

Common Causes

• Costochondritis – inflammation of the cartilage that connects the ribs to the sternum.
• Chest Wall Trauma – bruises, fractures, or contusions from blunt force (e.g., car accidents, sports injuries).
• Costosternal Sprain – overstretching or tearing of the ligaments that attach the ribs to the sternum.
• Gastro‑esophageal Reflux Disease (GERD) – acid reflux can cause a burning sensation that mimics sternum pain.
• Peptic Ulcer Disease – ulceration in the upper stomach or duodenum can radiate to the sternum.
• Myocardial Ischemia (Angina) or Heart Attack – reduced blood flow to the heart may manifest as central chest pain.
• Pericarditis – inflammation of the lining around the heart that often presents as sharp central chest pain that worsens when lying down.
• Pulmonary Embolism – a blood clot in the lungs can create sudden, pleuritic chest pain.
• Thoracic Outlet Syndrome – compression of nerves or blood vessels between the clavicle and first rib causing referred chest pain.
• Fibromyalgia or Central Sensitization Disorders – widespread pain syndromes can include chest wall discomfort.

Associated Symptoms

Depending on the underlying cause, sternum pain may be accompanied by:

• Shortness of breath or difficulty breathing
• Palpitations or irregular heartbeat
• Fever, chills, or night sweats (suggesting infection or inflammation)
• Nausea, vomiting, or a sour taste in the mouth (common with GERD)
• Swelling, bruising, or tenderness over the chest wall
• Radiating pain to the neck, jaw, shoulders, back, or arms
• Cough, wheezing, or hemoptysis (coughing up blood) – red flags for pulmonary causes
• Muscle spasms or stiffness in the upper back or shoulders

When to See a Doctor

Most sternum pain resolves with simple self‑care, but you should schedule a medical evaluation if you notice:

• Chest pain that is sudden, severe, or worsening over minutes to hours
• Pain accompanied by shortness of breath, fainting, or dizziness
• Radiating pain to the left arm, jaw, or back
• Chest pain that occurs at rest, during sleep, or without an obvious trigger
• Fever >100.4°F (38°C) or signs of infection (redness, warmth, drainage)
• Recent chest trauma with persistent pain beyond a few days
• Persistent GERD symptoms despite over‑the‑counter treatment
• History of heart disease, clotting disorders, or recent surgery

When in doubt, contact your primary care provider or seek urgent care. If any “red‑flag” symptoms appear (see below), call 911.

Diagnosis

Evaluation begins with a thorough history and physical exam. The physician will try to differentiate between cardiac, pulmonary, gastrointestinal, and musculoskeletal origins.

Key Steps

1. History taking – onset, character (sharp vs. dull), aggravating/relieving factors, recent injuries, associated symptoms, and risk factors (smoking, hypertension, reflux, trauma).
2. Physical examination – palpation of the sternum and costochondral joints, listening to heart and lung sounds, assessing for tenderness, swelling, or crepitus.
3. Electrocardiogram (ECG) – to rule out myocardial ischemia or arrhythmia.
4. Chest X‑ray – evaluates ribs, sternum fracture, lung fields, and cardiac silhouette.
5. Blood tests – cardiac enzymes (troponin), complete blood count (CBC), inflammatory markers (CRP, ESR), and metabolic panel if needed.
6. Advanced imaging (CT or MRI) – reserved for suspected pulmonary embolism, aortic dissection, or complex chest wall injuries.
7. Endoscopy or esophageal pH monitoring – when GERD or ulcer disease is strongly suspected.
8. Ultrasound of the heart (echocardiogram) – if pericarditis or structural heart disease is a concern.

Treatment Options

Treatment is directed at the underlying cause. Below are common medical and self‑care approaches.

1. Musculoskeletal Causes (e.g., costochondritis, sprain)

• Non‑steroidal anti‑inflammatory drugs (NSAIDs) – ibuprofen 400‑600 mg every 6–8 hours (unless contraindicated) for 1–2 weeks.
• Heat or cold therapy – 15‑20 minutes, several times a day, to reduce inflammation or muscle spasm.
• Physical therapy – gentle stretching, postural training, and strengthening of the upper back and thoracic muscles.
• Local corticosteroid injection – for persistent pain not responding to NSAIDs (performed by a specialist).

2. Gastro‑esophageal Reflux / Ulcer Disease

• Proton‑pump inhibitors (PPIs) such as omeprazole 20 mg daily for 4–8 weeks.
• H2‑blockers (ranitidine, famotidine) as alternative or adjunct therapy.
• Lifestyle modifications – weight loss, elevate head of bed, avoid meals 2‑3 hours before lying down.
• Avoid trigger foods (caffeine, chocolate, spicy, fatty meals, alcohol).

3. Cardiac Causes (Angina, MI)

• Immediate emergency care if myocardial infarction is suspected (aspirin 325 mg chewable, call EMS).
• Anti‑ischemic medications – nitroglycerin, beta‑blockers, calcium channel blockers as prescribed.
• Long‑term risk‑factor management – statins, blood pressure control, smoking cessation, diabetes management.

4. Pulmonary Embolism / Pulmonary Causes

• Anticoagulation (heparin, low‑molecular‑weight heparin, direct oral anticoagulants) under specialist guidance.
• Oxygen therapy and supportive care in a monitored setting.

5. Pericarditis

• High‑dose NSAIDs (ibuprofen 600‑800 mg every 6 hours) for 1–2 weeks.
• Colchicine 0.6 mg twice daily (if tolerated) to reduce recurrence.
• In select cases, short courses of oral steroids.

6. General Home Care Measures

• Maintain good posture – especially when sitting at a desk; use ergonomic chairs and lumbar supports.
• Gentle stretching of the chest, shoulders, and upper back 2–3 times daily.
• Stay hydrated and avoid excessive caffeine or nicotine, which can exacerbate reflux.
• Apply a supportive chest brace only under medical advice (rarely needed).

Prevention Tips

While some causes (e.g., traumatic injury) are unpredictable, many instances of sternum pain can be reduced by adopting healthy habits.

• Exercise regularly – strengthen core and thoracic muscles to protect the chest wall.
• Practice safe sports techniques – wear protective gear in contact sports, use proper tackling form, and warm‑up before activity.
• Maintain a healthy weight – excess abdominal pressure worsens GERD and puts strain on the chest wall.
• Manage reflux – eat smaller meals, avoid lying down after eating, and limit trigger foods.
• Quit smoking – reduces risk of heart disease, pulmonary embolism, and chronic cough that can irritate the sternum.
• Monitor cardiovascular risk factors – control blood pressure, cholesterol, and diabetes.
• Ergonomic workstations – keep monitor at eye level, shoulders relaxed, and avoid prolonged hunching.
• Promptly treat infections – upper respiratory infections can spread to costal cartilage; seek care if symptoms persist beyond a week.

Emergency Warning Signs

Key Take‑Home Points

• Sternum pain is most often musculoskeletal, but cardiac, pulmonary, and gastrointestinal causes must be ruled out.
• Seek prompt medical care for pain that is severe, sudden, or accompanied by breathing or circulatory symptoms.
• Diagnosis involves history, physical exam, ECG, imaging, and targeted labs.
• Treatment ranges from NSAIDs and lifestyle changes to urgent interventions like anticoagulation or cardiac reperfusion.
• Prevention focuses on posture, core strength, reflux control, and cardiovascular health.

For more detailed guidance, consult reputable sources such as the Mayo Clinic, the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the Cleveland Clinic.

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