Your sternum is a bone that is located in the middle of your chest. It is also oftentimes referred to as the breastbone. Your sternum protects the organs of your torso from injury and also serves as a connection point for other bones and muscles. Your sternum is a flat bone that is located in the middle of your torso. If you place your fingers at the center of your chest, you can feel it.
The sternum has three parts:
- Manubrium – The manubrium is the top part of your sternum. Your collarbone and your first set of ribs connect here. The bottom of the manubrium shares a border with the body of the sternum. Your second set of ribs connects at this point.
- Body – The body is the middle part of the sternum and is also the longest part. Your third through the seventh set of ribs are connected to the body of the sternum through cartilage.
- Xiphoid process – This is the lowest part of the sternum. Its shape can vary. The xiphoid process is composed mostly of cartilage, and it slowly begins to calcify as you age.
In addition, your sternum also serves two important functions within your body:
- Protection – Your sternum, along with your ribs, works to protect the organs of your torso, such as your heart, lungs, and chest blood vessels.
- Added support – Your sternum also provides a connection point for other parts of your skeletal system, including your collarbone and most of your ribs. Some muscles of your chest and upper abdomen also connect to the sternum.
Sternum fractures can occur whenever a person experiences blunt force pressure or trauma to the chest. In a car accident, you can sustain an injury if your chest impacts the steering wheel or panel or, for a passenger, the dashboard or seat in front of you. Additionally, elderly people with fragile bodies are more susceptible since less force could result in a fractured sternum injury just by a sudden flexing of the chest. Otherwise, it generally takes an impact of considerable force to cause such injuries in healthy patients.
Causes & Symptoms
A fractured sternum is most often caused by an accident where something hits your chest with a giant amount of force. Some examples include:
- Car crashes.
- Falling from a great height.
- Physical assault or attack.
- Cardiopulmonary resuscitation (CPR).
- Sports injuries (from high-impact sports like football).
You may have a higher chance of a stress fracture of the sternum if you have:
Kyphosis is a spinal condition. In people with kyphosis, the spine curves outward more than it should. As a result, the upper back looks overly rounded. The curvature can make people look hunched or slouching. People sometimes call it hunchback or round back.
Osteopenia is a loss of bone mineral density (also known as BMD) that weakens bones. It is more common in people older than the age of 50, especially women. Osteopenia has no signs or symptoms, but a painless screening test can measure bone strength. Therefore, osteopenia isn’t as severe as osteoporosis, a disease that weakens bones so much that they can break more easily.
Osteoporosis weakens bones, making them more susceptible to sudden and unexpected fractures. The disease often progresses without any symptoms or pain, and is not found until bones fracture. Most of these fractures associated with osteoporosis include the hip, wrist, and spine.
Also, older adults and people who must take steroids for long periods of time are at an increased risk of a sternal stress fracture.
Patients with a sternal fracture will typically experience a sudden onset of chest pain at the time of injury. Pain is often sharp and intense and may increase during deep breathing, coughing, laughing, or sneezing. Patients may also experience an ache in the front of the chest that is particularly prominent at night or first thing in the morning.
Pain may increase when lying down in certain positions (such as face down or on your side) and on firmly touching the sternum at the site of injury. Swelling and / or bruising may also be evident. In several sternal fractures with bony displacement, an obvious deformity may be present. Patients with this condition may also experience pain with certain movements of the upper back and chest (such as twisting, bending forwards or sideways, or arching backward) and with certain movements of the upper limb, such as pushing, pulling, heavy lifting, or with overhead activities).
Who gets a Fractured Sternum?
The following risk factors can increase your risk of fracturing your sternum:
- Sports participation – Playing contact sports, such as hockey, football, or baseball, increases your risk of trauma to your chest.
- Osteoporosis – Having osteoporosis in which your bones lose their density makes you more susceptible to a sternum fracture.
- Age – Older adults ages 50 and up are more prone to fracturing their sternum due to general wear and tear.
How Does it Affect You? How Serious is it?
There are several types of complications that can affect the ways you live after experiencing severe fractures of the sternum. Some of these complications include:
- Deformity – Occasionally if the sternum is badly displaced, a tender lump can develop over the fracture site.
- Breathlessness – Shortness of breath acutely is typically caused by the chest wall pain not allowing deep breaths to be taken, occasionally it can be associated with the lung collapsing after the injury; a build-up of fluid in the chest cavity (effusion), or even a developing chest infection (pneumonia). Chronically, ongoing breathlessness can be due to chronic pain but also occasionally to complications of retained blood or fluid in the chest cavity which can trap the lung.
- Internal injuries – If the sternal fracture is severe, internal injuries can lead to sinister symptoms of severe breathlessness and even collapse due to blood building up around the heart (also known as tamponade) or bruising of the heart itself.
- Xiphersternal injury – Pain at the bottom of the sternum in the area of the solar plexus can occur following even minor injuries and may be caused by an injury to the xiphersternal junction or the xiphersternum itself. The xiphersternum is made of cartilage and is susceptible to injury and inflammation leading to long-term pain and discomfort.
Recommended Treatment & Rehabilitation
It is important to seek a diagnosis if you suspect you have a sternal fracture to determine if you need surgery and rule out other injuries. Therefore, your doctor will take an X-ray called a lateral radiograph to detect a sternal fracture.
Although most sternal fractures are treated with pain management and bracing, some patients could benefit from surgical stabilization. In particular, repair to the sternum may become necessary in patients who have undergone open-chest surgery (sternotomy). A sternotomy is a surgical incision made through the breastbone to access the thoracic cavity.
A median sternotomy is a primary approach used for major surgeries in the thoracic region, as it offers a wide view. You may need hospitalization of 7-10 days depending on the kind of surgery required with sternotomy. In addition, a thoracic surgeon may need to perform a sternotomy by first applying general anesthesia. Generally, it takes the sternum about six weeks to heal after a sternotomy. You must follow certain sternal precautions such as avoiding:
- Pushing or pulling with the arms.
- Lifting more than five to eight pounds.
- Reaching both arms overhead, behind your back, and to the side.
Surgeries requiring a sternotomy are major procedures. Therefore, apart from the risks of the surgery involved, sternotomy may have complications. The complications of a sternotomy include the following:
- Blood clots
- Sternal wound infection
Additional treatments can be done at home by following certain steps given by a physiotherapist. These treatments include:
Rest from your physical activities. Additionally, limit the use of your chest and shoulder muscles. No pulling, pushing, lifting, or activity requiring heavy breathing. To initiate the pain relief, hold crushed ice in a plastic bag against the breastbone without adding pressure to the fractured sternum. Hold the ice, cycling 20-30 minutes on and off, for the first 24-72 hours.
Range of motion
To help combat chest stiffness and re-instate proper respiratory function, practice slow and controlled breathing. This will expand the chest, stretch the tissue surrounding the sternum, and re-establish the range of motion. Complete 8-10 slow, deep breaths. To stretch the muscles of the chest, begin a comfortable standing position with your arms by your sides. Raise both arms in front of you, at 90 degrees. Move one arm at a time out to the side and as far back as you can without pain. Hold for 30 seconds, then complete 3-5 repetitions for each arm.
Even though rest is necessary initially for the chest muscles, they need to be strengthened later in the rehabilitation process. Begin by standing facing a wall. Then, plant your hands on the wall, directly in front of your shoulders, and perform small push-up movements against the wall. Progress doing push-ups on the floor, but from your knees. Progress further to a regular push-up from your feet. Repeat this training 10-12 repetitions for 3 sets a day.
Other exercises can help you boost your recovery from a sternum fracture after recovery has been done. Some exercise examples are targeted directly to your chest, such as:
Wrap the band around your feet, then hold the band with your thumbs facing upwards. Next, keep your arms at your side with your shoulders down and relaxed. Pull your elbows back squeezing the shoulder blades together toward the back. Perform this stretch 10 times a day with 25 repetitions.
- Foam roller – Foam rollers are light foam tubes that can be used to improve flexibility as well as for self-massage. They can be used to roll out thighs muscles, which relieves tension and speeds up muscle recovery.
- Doorway pectoral stretch – To perform this stretch, stand facing an open doorway. Then, raise your arm with your elbow bent 90 degrees. Rest your forearm against the wall with your elbows at shoulder height. Lastly, lean forward to gently stretch your chest muscles. Perform this stretch 2-3 times a day.
Alternative & Homeopathic Treatment
While your sternum is healing, there’s a lot you can do to help prevent a chest infection and ease your pain. Most homeopathic treatments include:
- Rest – Avoidance of activity or activities that increase pain may boost your sternum recovery. Deep breathing or coughing may exacerbate the pain but need to continue to avoid developing lung issues.
- Ice – Apply an ice pack to your injured area immediately and regularly for several days to reduce pain and local inflammation.
- Compression – A contentious issue in the early treatment of a sternum fracture due to concerns that by wrapping the chest in a bandage, corset, or rib strap may exacerbate breathing issues. There is still a role for rib strapping following sternum pain but only with specialist supervision.
- Pain medications – Taking non-steroidal anti-inflammatory drugs (NSAIDs) may help reduce further swelling and inflammation.