Pain Below Sternum When Pressed – What Could It Be?

Pain Below Sternum When Pressed – What Could It Be?

Sternum or the breast-bone is a flat, T-shaped bone which sits exactly in the middle of the chest. Shape of sternum resembles to that of a neck-tie. It connects to the ribs by cartilages called sternocostal ligaments forming a rib cage which protects our vital organs of the chest like the lungs and heart.

What is Pain Below Sternum?

Since the sternum lies quite close to the heart, pain below the sternum is often mistaken as cardiac chest pain.

Pain below sternum when pressed is related to conditions of the sternum itself, the ribs or cartilages which attach ribs to the sternum. Some serious conditions of the lungs and heart circulation can mimic a sterna chest pain.

Causes for Pain Below Sternum When Pressed

There can be multiple causes for pain below sternum when pressed. These causes can be differentiated with the help of each of their presenting signs and symptoms.

           Cause                                           Description
Costochondritis It is the commonest cause for non-cardiac chest pain, seen commonly in females.

Costochondritis is inflammation of the cartilages which attach your ribs to the sternum or breast-bone. The cause is unknown and the condition usually resolves by itself within a few days.

Costochondritis may be secondary to bacterial or viral infections elsewhere in the body or may be precipitated by trauma to the sternum.

Signs and symptoms include:

  • Pain or soreness of sternum when pressed.
  • Pain could be present due to or may become worse from injury or exercise.
Tietze syndrome This is a rare condition which results in localized musculo-skeletal pain but it can be differentiated from costochondritis by presence of swelling over the affected junction between ribs and sternum.
Rib fracture It is associated with a recent history of trauma or blunt injury over the ribs resulting in localized pain, soreness, tenderness and formation of contusion over the fractured rib.
Sternum or clavicle fracture Fractures of the breast bone or the collar bone are seen commonly as a result of vehicular injuries or falls.

  • Sternum fracture can cause difficulty and pain during breathing.
  • There is visible swelling, contusion and pain on being pressed.
  • A major sternum fracture can also cause injury to the lungs.
  • With clavicle fracture, there is pain and inability to move the arm of affected side.
Fibromyalgia It is a chronic condition characterized by pain in various parts of the body. There is increased pain sensitivity and fatigue.

There are up to 10-11 tender points elicited by the patient, one out of which is located at the sternum.

Gastro-esophageal reflux disease

(GERD)

GERD comes under the term lifestyle disorders, that is, conditions arising out of faulty habits and food and lifestyle choices.

It is a chronic gastric condition characterized by:

  • Regurgitation of stomach contents including acid back into the esophagus.
  • Heartburn
  • Chest pain beneath the sternum and in upper part of the abdomen overlying the stomach
  • Bad breath
  • Nausea and vomiting
  • Chronic cough due to acid reflux.
Pulmonary embolism

(PE)

In this condition, there is blockage of arteries of the lungs.

Signs and symptoms include:

  • Difficulty in breathing
  • Chest pain on breathing
  • Rapid heart rate

PE can lead to sudden death and therefore it is important to diagnose and treat it at the earliest.

Acute coronary syndrome

(ACS)

This syndrome occurs due to reduced blood supply to arteries of the heart (coronary arteries).

Signs and symptoms include:

  • Severe chest pain on left side or in the middle of the chest near the sternum radiating to the left arm, shoulder, jaw or back
  • Difficulty in breathing
  • Chest pain may be intermittent and worse from activities or exercise.
  • Profuse sweating
  • Nausea and vomiting may be present
Psychological conditions Psychological conditions like anxiety disorder, panic disorder or depression can present with a variety of vague signs and symptoms; body ache and joint tenderness being some of the common complaints.
Malignancy Tumors within the chest or near the sternum can cause pain below sternum when pressed. Malignancy can also develop due to metastasis of cancer cells from other sites in the body.

Diagnosis of Pain Below Sternum

Conditions causing pain below the sternum when pressed can be diagnosed by the presenting signs and symptoms. Your doctor may advise you an x-ray of the chest or set of blood tests to rule out other possible causes for pain below sternum.

  1. Costochondritis – It is diagnosed by eliciting tenderness of affected ribs with no significant swelling.
  2. Rib fractures – It can be diagnosed based on history of trauma elicited by the patient and can also be viewed directly on a chest x-ray.
  3. Sternum and clavicle fracture –  It can be diagnosed with the help of history given by the patient and appearance of broken bone with pain, swelling and tenderness. X-ray of the chest can visualize a broken clavicle or sternum.
  4. Fibromyalgia – It can be diagnosed when patient elicits tender points along with patients’ history of dealing with psychological stress.
  5. Gastro-esophageal reflux disease –  It is diagnosed based on signs and symptoms alone. An endoscopic examination of the stomach and esophagus may be required in case the sign and symptoms are severe and relapsing.
  6. Pulmonary embolism It is a critical condition which can be diagnosed by an electrocardiogram (ECG) and by presenting signs and symptoms. Elevated D-dimer levels in blood are diagnostic of PE. The diagnosis can additionally be supported with the help of a CT-angiogram.
  7. Acute coronary syndrome – It can be diagnosed by presenting sign and symptoms. An ECG and elevated levels of cardiac enzymes in blood support the diagnosis.
  8. Psychological conditions require appropriate assessment by a qualified psychiatrist.

How to Relieve Pain Below Sternum When Pressed?

For conditions like pulmonary embolism and acute coronary syndrome, immediate treatment under intensive care is required as these can be life-threatening.

Psychological conditions like panic disorders, anxiety and depression need appropriate assessment, counseling and behavior therapy along with medications if required. Your doctor may prescribe anti-inflammatory medicines or antibiotics to manage pain, swelling and infection.

You can Additionally Resort to Home Remedies for Symptomatic Relief, Such as

  • Hot and cold packs for relief from pain and inflammation.
  • Avoid activities, exercises or contact sports which may worsen your condition.
  • Natural anti-infective and anti-inflammatory agents can be included in diet and consumed 2-3 times in a day to avoid and also treat infections. These include garlic, turmeric, ginger and apple cider vinegar.

When to See A Doctor?

If you have been experiencing pain below sternum when pressed, you need to contact your doctor immediately if you notice any of the alarming signs and symptoms mentioned below:

  • High grade fever not responding to medicines.
  • Difficulty in breathing
  • Coughing up of blood-tinged expectoration
  • Increased swelling, pain or pus formation at the sternum (signs of infection)
  • Chest pain radiating to left arm, left shoulder or jaw.
  • Palpitations and profuse sweating
  • Worsening of signs and symptoms in spite of taking medications.