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The sternum, also known as the breastbone, is the long, flat bone in the middle of your chest. You can have pain in this area because of infection, inflammation, injury, or the breakdown of cartilage affecting the sternum itself.
Problems with nearby organs like the heart, lungs, and esophagus can also cause pain in this area. This includes a heart attack, pleurisy (a lung inflammation), and acid reflux.
Usually, if the pain is in the actual sternum, you’ll have sharp pain when you push in the middle of your chest. But because the symptoms of chest bone pain are so similar to other causes of chest pain, you might need to have tests to check for heart attack and other serious conditions.
If your problem is just with your actual sternum, you may feel better with rest, gentle stretching, and anti-inflammatory medications. But if there are other issues, you might need prescription medications, joint injections, or surgery.
Causes of sternum pain
- Pain in the sternum, usually sharp
- Worsening pain with deep breathing or movement
- Pushing or pressure on the sternum is painful.
Costochondritis is inflammation of the cartilage that links your ribs to your sternum. It’s the most common cause of chest bone pain. Usually you feel pain when you push on the sides of your sternum. In many cases, the cause is unknown, but it is sometimes related to exercise or a recent illness.
Because costochondritis feels so much like more serious causes of sternum pain, you should see a doctor. They will probably do a chest X-ray and an electrocardiogram (EKG) to make a diagnosis.
Usually, costochondritis gets better with rest and gentle stretching. But if you are very uncomfortable, ice and anti-inflammatory medication can help. If the pain is severe, you may need a steroid injection.
If you have costochondritis or a muscle strain, ask your doctor how long your symptoms might last, and how you can manage your symptoms. It’s a relief to be diagnosed with a non-life-threatening condition, but it doesn’t mean that your pain goes away immediately! There are things you can do to control the pain. —Dr. Anne Jacobsen
2. Sternoclavicular arthritis
- Pain at the top of the sternum
- Worsening pain with activity
- Swelling and tenderness
- Pain radiating into the arms
Osteoarthritis is a breakdown of joint cartilage over time. The sternoclavicular joint is where the top of the sternum (breastbone) meets the clavicle (collarbone).
Osteoarthritis in this area can cause pain in the sternum, especially near the top part. It happens as you age, but it might occur earlier if you had a previous injury in that area. Because this is the area where your torso connects to your arms, this joint works hard. A study in the Journal of Clinical Rheumatology found that 90% of people over the age of 60 have osteoarthritis in this joint, but not all have symptoms.
Your doctor may order X-rays, a CT scan, or an MRI to diagnose sternoclavicular arthritis. Rest and anti-inflammatory medication may help you feel better. Some people may need joint injections with steroid medications. When sternum pain is severe, you may need surgery.
3. Muscle strain
- Sharp or achy pain in the sternum
- Worsening pain with movement
- Muscle spasm
- Bruising or tenderness of a chest wall muscle
A strained or pulled muscle in the chest wall can cause chest bone pain. This injury is caused by overuse or repetitive movement, an increase in activity level, or a sudden improper movement. Pulled muscles can also happen during an illness that causes coughing or vomiting.
Rest, ice, and over-the-counter pain medications can relieve muscle strain. But in more severe cases, you may need physical therapy or surgery.
4. Heartburn and acid reflux
- Burning pain in the chest, abdomen, or throat after eating
- Pain in the sternum
- Bad breath or bad taste in your mouth
Heartburn is a brief burning pain in your throat, chest, or abdomen that is caused by stomach acid. When it happens frequently, it can be a sign of acid reflux.
Both heartburn and reflux are caused by a problem with the sphincter (ring of muscles) that separates the esophagus from the stomach. When the sphincter doesn’t close tightly or opens too frequently, stomach acid or food can travel out of the stomach back into the esophagus.
Heartburn can also be caused by a hiatal hernia, which happens when part of the stomach slips through a hole in the diaphragm (the muscle that separates the chest from the abdomen).
Certain foods and drinks, including spicy or fatty foods, alcohol, and coffee, can trigger heartburn. Overweight people and pregnant women have a higher risk for reflux.
Your doctor may prescribe changes to your lifestyle and diet, medications, and sometimes surgery.
- Sharp sternum pain
- Worsening pain with breathing and coughing
- Pain may go away when you hold your breath
- Cough and fever
The lungs and the inside of the chest are covered with a thin protective tissue called the pleura. Pleurisy is inflammation and swelling of this tissue. A viral or bacterial lung infection, autoimmune disease, or other conditions in the lungs or chest can cause pleurisy.
Rest, over-the-counter anti-inflammatory medications (ibuprofen), and sometimes antibiotics can help you get better.
6. Heart attack
- Pain or pressure under the sternum
- Pain radiating to the arm or jaw
- Shortness of breath
Some people having a heart attack experience chest pain in or under the sternum. A heart attack is a blockage in an artery of the heart, which prevents blood and oxygen from reaching that area. It is caused by a blood clot that travels from a fatty buildup (plaque), inside the artery.
Heart attack can be life-threatening and requires immediate treatment. When you go to the ER for sternum pain, you’ll likely have tests like an EKG, blood tests, and a chest X-ray.
Treatment should begin as soon as possible after symptoms start, so call 9-1-1, if your pain could be heart related. You may get medications or have a procedure like a heart catheterization with balloon or stent treatments to open up your arteries. Severe cases may need surgery to create a bypass around the blocked artery.
7. Sternum fracture
- Pain in the sternum
- Worsening pain when breathing, coughing, or moving
- Swelling and tenderness of the sternum
Sternum fracture is a break in the sternum bone. This usually only happens in a serious trauma, like a car accident or falls from a high height. Seatbelts save lives in car accidents, but they cross over the sternum, which can fracture it in a high-impact crash.
Because breaking the bone requires such force, doctors will order additional CT scans to check for injuries to the vital organs behind the sternum, including the heart, lungs, and major blood vessels.
Ice, over-the-counter pain medications, and, sometimes, prescription pain medications may relieve your sternum pain. You may need surgery to fix the break or to treat other injuries inside the chest.
A number of the conditions mentioned here (for instance, costochondritis, muscle strain, and pleurisy) are what doctors refer to as a “diagnosis of exclusion.” This means that there’s not one specific test to make the diagnosis and that the symptoms can mimic the symptoms of other serious conditions. Once we rule out anything serious, we treat the non-serious problem that is most likely. —Dr. Jacobsen
Other possible causes
Other conditions that may cause pain near the sternum include:
- Pneumonia or bronchitis
- A blood clot in the lung (pulmonary embolism)
- Patients who have had open heart surgery may have chronic pain in the sternum because doctors have to split this bone in half to perform the procedure.
- Some people have genetic conditions that cause the sternum to sink into the chest or to jut forward, and this may cause pain.
When to call the doctor
- Pain in the sternum from a minor injury
- Pain is not controlled with rest, ice, and over-the-counter medications.
Should I go to the ER for sternum pain?
Because these conditions may have overlapping symptoms, many people with pain in the sternum will need to be tested for a heart attack. You should go to the ER immediately if you have any of the following:
- Sternum or chest bone pain that isn’t from a minor injury
- Pain radiating to your arms, jaw, or back
- Shortness of breath, nausea, sweating, or dizziness
- Pain related to a car accident or other traumatic injury
If you had a minor injury or if your doctor has ruled out serious causes of your pain, try the following:
- Over-the-counter anti-inflammatory or pain medications
Pain in the sternum is a complaint where we really need to consider every piece of evidence to feel confident making the right diagnosis. Bloodwork shows if there is injury to the heart muscle or an infection. An EKG shows if there are electrical changes from a heart attack. A chest x-ray or CT scan can show some infections. —Dr. Jacobsen
Other treatment options
- Prescription medications like antibiotics or heart medications
- Joint injection
- Physical therapy
Dr. Jacobsen is a board-certified Emergency Medicine physician and writer for Buoy Health. She received her undergraduate degrees in Chemistry and Biology from Macalester College (2006) and graduated from the University of Kansas School of Medicine (2010). She completed an Emergency Medicine residency program at the University of Missouri-Kansas City (2013). She practices community Emergency Medicine in Kansas City and is also engaged in urgent care telemedicine. She joined Buoy Health in 2021. She is passionate about explaining medicine in terms that patients can understand. She hopes to empower her patients with great educational resources so they can understand their current medical concerns and improve their health for the future.