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Gastrointestinal conditions such as acid reflux can also cause pain behind the sternum. People may believe that their sternum pain is a heart attack symptom. However, it is possible to differentiate the two. In this article, learn about the causes of sternum pain and the differences between sternum pain and heart problems. What is the sternum Share on PinterestTara Moore/Getty ImagesThe sternum is a flat T-shaped bone that sits at the front of the chest and connects to the ribs with cartilage. It forms part of the rib cage, a series of bones that protects the heart and lungs from injuries. People often refer to the sternum as the breastbone. Sternum and substernal pain Sternum pain can result from problems with muscles and bones near the sternum, as well as the sternum itself. Substernal pain is discomfort occurring behind or below the sternum. It often results from gastrointestinal conditions. Some of the most common causes of sternum and substernal pain are:costochondritissternum fracturesternoclavicular joint injurycollarbone injuriesmuscular strain or bruiseherniaacid refluxpleurisybronchitispneumonia Costochondritis Costochondritis is inflammation of the cartilage between the sternum and ribs. The medical term for this area is the costochondral joint. The symptoms of costochondritis include:sharp pain on the side of the sternum areapain that worsens with a deep breath or a coughdiscomfort in the ribs Inflammation in the costochondral joint may occur due to injury, infection, or irritation. A person may experience costochondritis due to:impact traumarespiratory tract infectionssevere coughingphysical strains Learn more about costochondritis here. Sternum fracture Like fractures in other parts of the body, sternum fractures can cause a lot of pain. Sternum fractures usually occur as a direct result of trauma, such as a car accident or sports injury. People who believe they may have a sternum fracture should seek immediate medical attention in case of additional damage to the heart and lungs. Symptoms of a sternum fracture include:pain during inhaling or coughingswelling over the sternumdifficulty breathing Learn more about fractures here. Sternoclavicular joint injury The sternoclavicular joint connects the top of the sternum to the collarbone. Injuries to this joint generally cause pain and discomfort at the top of the sternum in the upper chest area. People experiencing sternum pain due to a sternoclavicular joint injury will often experience the following:mild pain or swelling in the upper chest areadifficulty or pain when moving the shoulderpopping or clicking around the joint Collarbone injuries The collarbone connects to the top corners of the sternum by cartilage. Due to the direct connection between the two structures, injuries to the collarbone may cause pain in the sternum area. Collarbone trauma Impact and stress trauma can damage, or even fracture, a person’s collarbone. Collarbone trauma may affect its connection to the sternum and the surrounding musculature. This may mean a person feels pain either in or around their sternum. Depending on the location of collarbone trauma, other symptoms may include:severe pain when raising the armbruising or swelling in the upper chest areaabnormal positioning or sagging of the shoulderclicking and grinding in the shoulder joint Muscular strain or bruise A great many muscles connect to the sternum and ribs. Injuries or trauma can result in bruising these muscles, which may cause them to ache. Strenuous or repetitive movements can also cause strains in these muscles. Learn more about muscle strains here. Hernia Most hernias occur in the abdomen. However, a hiatal hernia can affect the chest area and cause substernal pain. A hiatal hernia occurs when the stomach moves past the diaphragm and into the chest. Symptoms of a hiatal hernia include:frequent burpingheartburnvomiting blooda feeling of fullnesstrouble swallowing People with substernal pain and symptoms of a hiatal hernia should see a doctor for prompt treatment. Learn more about hernias here. Acid reflux or GERD Acid reflux happens when stomach acid wears away the lining of the windpipe (esophagus). This happens primarily in people with gastroesophageal reflux disease (GERD). Acid reflux may cause substernal pain and discomfort in the chest. Pain in this region can also result from inflammation or a spasm of the windpipe. People with GERD should talk with their doctor about preventing further damage to this area. Learn the difference between heartburn, acid reflux, and GERD here. Pleurisy Pleura are sheets of tissue between the lungs and ribcage. Inflammation to these tissues is pleurisy. Pleurisy can cause a sharp, stabbing pain at the site of irritation, which may worsen if a person breathes deeply, coughs, or wheezes. If inflammation occurs toward the upper middle chest, pleurisy may cause substernal pain. Learn more about pleurisy here. Bronchitis Bronchitis is the inflammation of the primary airways of the lungs. The condition can cause:chest painsevere coughing spellsshortness of breathwheezing Inflammation of the primary airways may cause substernal pain. Learn more about bronchitis here. Pneumonia Pneumonia is a common lung infection that causes air sacs in the lungs to inflame and fill with fluid. The medical term for these air sacs is alveoli. Pneumonia can cause sharp chest pains, which a person may feel behind their sternum. Other symptoms of pneumonia include.severe coughingshortness of breathfeversweatingnausea and vomitingloss of appetiteconfusion Infectious bacteria, viruses and fungi can cause pneumonia. Learn more about pneumonia here. Symptoms of sternum pain Symptoms of sternum pain vary depending on the cause. The most common symptom is discomfort and pain in the center of the chest, which is the location of the sternum. Other associated symptoms may include:pain or discomfort in the ribspain that worsens during deep breathing or coughingmild, aching pain in the upper chestswelling in the upper cheststiffness in the shoulder jointssevere pain when raising the armssigns of collarbone trauma, such as bruising or swellingdifficulty breathinggrinding or popping sensation in joints near the sternumfrequent belchingheartburnfeeling too fullthrowing up blood Sternum pain vs heart attack People experiencing chest pain may worry they are having a heart attack. However, sternum pain differs from heart attack pain. People who are having a heart attack experience specific signs before the heart attack itself, whereas most sternum pain starts suddenly. A heart attack often occurs with the following symptoms:pressure, squeezing, or fullness in the center of the chestsweatingnauseashortness of breathlightheadedness However, anyone who thinks they are having a heart attack should seek immediate medical attention. When to see a doctor While sternum pain is not usually serious, there are some causes of sternum pain that require immediate medical attention. A person should seek emergency medical attention if the pain:started as a result of direct traumais accompanied by heart attack symptomsis persistent and does not improve over timeis accompanied by intense vomiting or vomiting blood A person should also speak to a doctor if the pain in their sternum gets worse or does not improve over time. Summary Physical trauma, costochondritis, and muscle strains are common causes of sternum pain. Conditions such as pneumonia, pleurisy and GERD can also cause pain in nearby tissue that people may mistake for sternum pain. Read the article in Spanish. Last medically reviewed on July 5, 2022Body AchesAcid Reflux / GERDBones / OrthopedicsPain / Anesthetics 12 sourcescollapsedMedical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Altalib, A. A., et al. (2021). Anatomy, thorax, sternum.https://www.ncbi.nlm.nih.gov/books/NBK541141/Bentley, T. P., et al. (2022). Sternal fracture.https://www.ncbi.nlm.nih.gov/books/NBK507790/Chronic bronchitis. (n.d.).https://www.lung.org/lung-health-diseases/lung-disease-lookup/chronic-bronchitisClavicle fracture (broken collarbone). (2022).http://orthoinfo.aaos.org/topic.cfm?topic=A00072Costochondritis. (2019).https://www.nhs.uk/conditions/costochondritis/Hiatal hernia. (2018).https://medlineplus.gov/hiatalhernia.htmlKiel, J., et al. (2022). Sternoclavicular joint injury.https://www.ncbi.nlm.nih.gov/books/NBK507894/Pleurisy. (2020).https://www.nhs.uk/conditions/pleurisy/Pneumonia. (n.d.).https://www.lung.org/lung-health-diseases/lung-disease-lookup/pneumoniaSprains and strains. (2021).http://www.nhs.uk/Conditions/Sprains/Pages/Introduction.aspxThompson, A. D., et al. (2020).https://www.msdmanuals.com/en-gb/professional/cardiovascular-disorders/symptoms-of-cardiovascular-disorders/chest-painWhat are the symptoms of a heart attack? (2022).https://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/signsFEEDBACK:Medically reviewed by Megan Soliman, MD — By Jenna Fletcher — Updated on July 5, 2022 Latest newsWhat sets 'SuperAgers' apart? 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