The breast bone, also known as the sternum, is a flat bone located in the middle of the thorax (chest) and serves two important functions in the body. Firstly, the breast bone protects the vital organs lying behind it, primarily the heart and airways, and secondly, it serves as a central point where the ribs and shoulder bones (clavicle) connect and articulate. The breast bone can be divided into three distinct parts :

  1. Manubrium
  2. Body
  3. Xiphoid process

Breast bone pain is a common symptom that is experienced at frequent intervals in life and may be harmless in most cases. However, persistent pain or pain that is increasing in intensity or frequency, should be investigated by a medical doctor. Breast bone pain is usually experienced and described as pain in the bone, under the breast bone or to the side of the bone.  Pain may range from sharp and stabbing sensations to mild soreness or a bruised feeling. In some cases there are reports of a popping sternum which is a clicking or cracking noise from the breastbone  joints that may be present along with pain, tenderness and swelling. Although referred to as the breast bone, the sternum does not lie under the breast but rather in between the breast, extending above (manubrium) and through the cleavage in women.


Causes of Breast Bone Pain

  • Heartburn or reflux is the most common cause of a burning pain along and under the breast bone as a result of esophagitis. Gastroesophageal reflux (GERD) may also result in episodes of severe sharp pains in the chest and is often mistaken for a myocardial infarction (heart attack) during these episodes. Other types of esophagitis may also cause breastbone pain.
  • Fractures of the sternum is rare but may occur in car accident injuries due to the impact with the steering wheel.
  • Joint pain at the points where the shoulder bone (1) and ribs (2) articulate with the breast bone can be due to inflammatory joint disorders like arthritis although this is uncommon. More commonly, joint pain may be due to strain during impact or when exercising, specifically weight lifting. Joint pain is usually felt on either side of the breast bone. Costochondritis and Tietze’s syndrome are two common causes of breastbone pain due to the inflammation of the costal cartilage and joint.
  • Muscle pain, specifically of the pectoral muscles, may cause breast bone pain as they attach at this site. Muscle strain is the most common cause and results typically in a bruised or sore pain, often described as an ache. The intercostal muscles, which lie between the ribs, may also cause breast bone pain and these muscles may get strained during constant deep and forced breathing, particularly in respiratory disorders like emphysema and asthma.
  • Cardiac conditions like coronary artery disease, angina, myocardial infarction (heart attack), myocarditis and pericarditis are serious causes of pain under the breast bone.
  • Respiratory causes of breast bone pain include bronchitis, bronchiectasis and tracheitis. Tuberculosis and pneumonia may also cause pain under the breast bone although these conditions usually affect the sides of the chest around the area of the lungs.
  • Psychological conditions like panic and anxiety attacks may cause a perceived pain under the breast bone which may be related to an increased heart rate (palpitations), heartburn or psychogenic pain (perceived pain).
  • Surgery of the organs within the thoracic (chest cavity) may require separation of the bones of the chest. Cardiothoracis or open heart surgery may be the cause of long term pain in or on the sides of the breast bone even after the wounds heal.
  • Other conditions, which are not common causes of breast bone pain, may include acute pancreatitis, hiatal hernia, stomach ulcers and causes of excessive belching or upper middle abdominal pain. Cancer of the lungs, airways, lung abscess and sarcoidosis may also cause breast bone pain.

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Article reviewed by Dr. Greg. Last updated on September 15, 2010