The breastbone (sternum) is the central elongated bone that lies at the center of the chest. It is the bone to which all the ribs connect usually through cartilaginous extensions. Despite its rigidity the sternum along with the ribs allow for the chest cavity to expand and contract as is quire for breathing. Behind the sternum lies the heart and great blood vessels. Sternum pain may therefore not always be a problem with the breastbone.
The sternum is composed of 3 parts – the manubrium at the top, the body of the sternum in the middle and the xiphoid process at the bottom.It lies between the breasts in the area commonly referred to as the cleavage. The sternum lies very superficially, immediately under the skin. The costal cartilages connect the sternum to the ribs. The muscles on the chest wall also play a role in arm movement apart from breathing. Therefore strain on the arms can sometimes strain the chest wall muscles and lead to breastbone pain.
Causes of Breast Bone Pain
It is often difficult to isolate the cause of breastbone pain as there are so many possible factors. The accompanying symptoms may provide some indicate to the cause. For example, breastbone pain with popping in the chest is more likely related to the bones, cartilages and joints. However, these additional symptoms can be confusing. Nausea may be seen with acid reflux, heart disease and anxiety. Breastbone pain should always be investigated by a medical professional especially in people with pre-existing diseases like coronary artery disease which may eventually progress to a heart attack.
A fracture of the breastbone is not uncommon. It can occur with blunt force or penetrating injuries to the chest. Most cases occur with motor vehicle accidents where the chest hits against a steering wheel. However, it can also occur with a hard blow to the chest as is seen during an assault or even with certain contact sports. A fractured sternum arises with a traumatic event, is very painful and may affect the normal breathing pattern due to the pain while inhaling and exhaling.
The costal cartilages that connect the end of the ribs to the sternum can become inflamed. This is known as costochondritis. It is actually the joints between the cartilages and the bones where the inflammation may arise. Costochondritis is a painful chest wall condition and the cause is largely unknown. However, repeated injury to the chest wall and stress to these joints may be one possible cause. Force placed on the arms are transmitted to the chest wall and this can possible cause strain of the joints.
Tietze syndrome is a similar condition to costochondritis. However, despite these similarities Tietze syndrome and costochrondritis are separate problems. In Tietze syndrome there is inflammation of the joints like with costochondritis but there is also extensive swelling. Pain is also present. Often it is difficult to differentiate between costochondritis and Tietze syndrome, however, the treatment may not be significantly different.
Chest Wall Problems
The chest wall is composed of skin, subcutaneous (under the skin) fat, fasica and muscles that lie over the breastbone. Therefore a host of problems can arise with the chest wall structures and pain may be felt in the area despite the sternum being unaffected. This includes skin diseases, superficial infections, muscle strain and even superficial nerve disorders. However, it is difficult for most people to differentiate between a superficial problem from a breastbone condition.
As with any trauma to the chest wall, surgery causes extreme pain that can persist for long periods of time. Sometimes this pain can continue for months or even years after the surgical procedure. It is further complicated if keloid scars form at the site of the surgical wound. This is more commonly seen in people who have open chest surgery as may be necessary with a coronary bypass procedure. Any penetrating chest wound may also present with long term pain even if the injury has adequately healed.
With the heart lying just behind the breastbone, many cardiac conditions are mistaken for breastbone pain. Coronary artery disease is where the blood flow to the muscle is impaired due to narrowing of these arteries. Initially it may be asymptomatic until the increased demand cannot be provided for thereby triggering pain referred to as angina pectoris. The breastbone pain may also be due to a heart attack. Other heart conditions where pain in the breastbone area is prominent is pericarditis, inflammation of the lining around the heart.
Acid reflux is where the acidic stomach contents rise up into the esophagus. It typically causes heartburn. Sometimes the pain associated with acid reflux may be mistaken for breastbone pain. Similarly heartburn may be mistaken for cardiac pain. It is often confusing and depends on the other symptoms. Burning chest pain that eases with antacids is usually acid reflux while no response to antacids may be cardiac pain. Furthermore acid reflux ix more common at night, after eating large meals, spicy foods and with drinking alcohol.
Chest pain is a common symptom in anxiety. It is not usually due to any physical abnormality except in people with pre-existing cardiac conditions. Many people confuse the chest pain in anxiety as being a heart attack. Sometimes anxiety is not as obvious and the chest or breastbone pain is one of the only symptoms that arises, especially in stressful situations. However, the other symptoms like palpitations and difficulty breathing which may accompany anxiety breastbone pain could be due to heart disease.
A number of respiratory diseases may also present with central chest pain that may be mistaken for breastbone pain. Bronchitis, tracheitis, pneumonia and pleuritis are some of the respiratory conditions that can cause chest pain. It is usually a deeper pain than breastbone pain. A cough, difficulty breathing and abnormal breathing sounds like a wheeze are some of the symptoms that may be present. These symptoms obviously point towards a respiratory disease rather than just a bone problem.