Sternum

Synonyms in a broader sense

Manubrium sterni, sternum handle, corpus sterni, sternum body, sword process, processus xiphoideus, sternum angle, sternocostal joint, sternum - ribs - joint, sternum - clavicle - joint, sternoclavicular joint

Medical: sternum

anatomy

The breastbone / sternum is made up of three parts:

• the sternum handle (manubrium sterni)
• the sternum body (corpus sterni)
• and the sword process (processus xiphoideus)

introduction

In the child, all three parts have not yet grown together. In the course of life all parts ossify into a bone.

The sternum handle represents the uppermost part of the sternum. It can be felt under the larynx under the thrush fossa (incisura jugularis). The collarbone and the first rib attach to the sternum handle. They form the collarbone - sternum joint (sternoclavicular joint) and the rib - sternum joint (sternocostal joint).

In the transition from the sternum handle to the sternum body, a small elevation can be felt, which is called the sternum angle (angulus sterni).
The second to the seventh ribs are articulated on the sternum - body (ribs - sternum - joint).

Since there is red bone marrow in the sternum for blood formation, a bone marrow puncture can be performed over the sternum / sternum. In most cases, however, punctures are performed in the groin area, as there is little risk of injury to the heart and lungs with a sternal puncture.

Figure sternum

I - III sternum -
I-III sternum

I - sternum handle -
Manubrium sterni
II - sternum body -
Corpus sterni
III - sword process -
Xiphoid process

1. Incision for that
   Collarbone -
   Incisura clavicularis
2. Sternum angle -
   Angulus sterni
3. Cartilage cartilage -
   Symphysis xiphosternalis
4. Collarbone sternum
   Joint -
   Sternoclavicular joint
5. Collarbone - Clavicle
6. Ribs - Costa

You can find an overview of all Dr-Gumpert images at: medical illustrations

Figure sternum

1. Cervical spine
2. Clavicle - sternum - joint
3. Sternum handle
4. Collarbone / clavicle

function

The Sternum / sternum forms the chest with the 12 ribs and 12 thoracic vertebrae.
The sternum stabilizes the Rib cage from the front and partially protects the lungs and heart.
Over the ribs - sternum - Joints the ribs are flexible and breathing becomes possible.
The sternum is indirectly connected to the shoulder joint via the collarbone - sternum joints.

Which muscles are attached to the sternum?

There are two muscles that make contact with the sternum. The larger of them is the pectoralis major muscle (large pectoral muscle). This powerful chest muscle has its origin, among other things, on the sternum and attaches to the upper arm bone (humerus). Its functions are to pull up, stretch out and rotate the arm internally. In addition, its lower parts serve as auxiliary breathing muscles.
The second muscle that originates from the sternum is the transversus thoracis muscle. This muscle pulls from the bottom of the sternum to the bottom of the cricoid cartilage. It helps with exhalation and is supplied by the intercostal nerves.

Which lymph nodes are there on the sternum?

Lymph nodes in the area of ​​the sternum are particularly important in breast cancer (breast cancer).
There are three large lymph node stations that can be attacked by cancer. The retrosternal lymph nodes are located directly behind the breastbone (sternum). In the case of extremely widespread breast cancer, these are also affected in Hodgkin's lymphoma.
In addition, there are the axillary lymph nodes in the area of ​​the sternum, which are located on and under the armpit. Finally, there are the so-called supraclavicular lymph nodes, which are located above the collarbone. All of these lymph nodes are connected to one another by thin lymphatic channels through which the lymph drains.

Sternum pain

The breastbone (sternum) is located in the thorax and is connected to 10 of the 12 ribs. The sternum is very superficial so that no muscle is directly over the sternum. However, some of the auxiliary respiratory muscles (for example the pectoralis muscle) arise directly from the sternum and so muscle tension can also lead to pain in the sternum.
Inexperienced lifters, in particular, can experience sternum pain if they strain the muscles in the upper chest too quickly and too much. Excessive stress can lead to so-called muscle soreness, but it can also lead to irritation or inflammation of the muscle tendons.

If the tendon of the pectoralis muscle is affected, this can lead to sternum pain, among other things. However, it can also be that no anatomical structures are to blame for the pain in the sternum, but rather an organ disease. The so-called heartburn (reflux disease) is very well known. This causes gastric acid to flow back from the stomach into the gullet (esophagus). Since the esophagus runs in the so-called mediastinum, an area behind the esophagus, heartburn can also lead to pain in the sternum. This pain does not arise in the sternum itself, so the sternum is not stressed with heartburn. Rather, the pain is projected from the body into the area of ​​the sternum, similar to a heart attack, in which the pain occurs in the left arm.

Since the heart is located directly under the breastbone, it is important to always have a cardiological examination (i.e. an examination of the heart) done if there is pain in the breastbone. It must be examined whether there are abnormalities in the heart, i.e. changes that can lead to pain in the sternum (for example, an enlarged heart (cardiac hypertrophy) or, in rare cases, a silent infarction).

In very rare cases, a so-called Tietze syndrome occurs. This is a swelling around the base of the ribs. This is where the costal cartilage is located, which articulately connects the ribs and the sternum.
In Tietze syndrome, there is an unexplained cause of a painful swelling that can usually be felt in the area of ​​the sternum.
The pain occurs suddenly, not necessarily during exertion or physical activity. Usually, however, the pain in the sternum becomes more severe with physical activity, since then there is usually increased inhalation and the costal cartilage is thus more stressed.

In general, pain in the sternum is not uncommon and can be associated with a wide variety of diseases, such as pneumonia, bruised ribs or a broken rib. It is therefore important to clarify pain in the sternum if it persists for a longer period and cannot be explained by a simple "sore muscles".

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Tension on the sternum

Tension on the breastbone (sternum) is usually the result of poor posture.
The tension becomes noticeable through a stinging or pulling in the area of ​​the sternum. Affected patients often tend to relieve themselves, which worsens the symptoms in the long term. First and foremost, an upright and stretched posture is helpful. This is particularly important for people who, for example, sit a lot for work and thus fall into a hunched position. In addition, you can do some supporting stretching exercises that stretch and relax the anterior sternum muscles. Overall, a strong back and trained abdominal muscles can also contribute to healthier posture.

Stinging on the sternum

A stinging of the breastbone (sternum) has in most cases a harmless cause.
It can be caused, for example, by muscular tension or also by heartburn. As a patient, one should pay attention to when this stinging occurs. Does it always hurt after a hearty meal or after strenuous exercise? Does it hurt regularly or does the pain go away on its own after a while? If the pain is very severe, lasts longer or even radiates into the arms, a doctor should be consulted.
A stinging sternum can also be indicative of a serious illness. For example, a heart attack, angina pectoris (“chest tightness”) or a pulmonary embolism are possible. In rare cases, the pleura, the esophagus or the pericardium are also the cause of the stinging of the sternum.

Sternum contusion

A bruised sternum is an injury that is caused by trauma. The breastbone (sternum) is part of the chest (thorax). It is connected to the top seven pairs of ribs in a cartilaginous manner and lies in the middle of the front wall of the chest. Because of this frontal position, it is at risk from many different trauma. Bruises in the sternum are particularly common in traffic accidents or sports accidents. In a car accident, for example, there is an enormous amount of force that is transmitted to the sternum via the seat belt.

In the case of sports accidents, martial arts in which the athletes have close physical contact should be emphasized. A bruised sternum is indicated by pain in the area of ​​the sternum that increases with movement and inhalation. Treatment for such an injury is usually straightforward. The patient should take a few weeks of physical rest and refrain from exercising. In the case of severe bruises in the sternum, painkillers (analgesics) are prescribed to relieve pain, especially at the beginning. Nowadays, imaging is often used for definitive clarification of the injury. In this way, the attending physician can rule out a break (fracture) of the sternum or the ribs, for example.

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Swelling of the sternum

Swelling in the sternum can have different causes. The area around the breastbone swells and is sensitive to pressure. Patients also often report a rapid pulse and excessive heat.
A common diagnosis for these symptoms is Tietze's disease. Tietze syndrome usually occurs in people between the ages of 30 and 40 and goes away on its own after a while. It is still unclear how this syndrome comes about and what the exact causes are. However, other causes for this type of complaint must also be clarified.
On the one hand, past accidents or falls must be inquired about and clarified with imaging (e.g. MRI or CT). A fracture of the sternum (sternum fracture) or an underground accumulation of fluid come into question here.
On the other hand, the sternum itself does not always have to be injured, but also the surrounding cartilage tissue of the costal arch. If this is inflamed, it is called costochondritis. This inflammation is treated with ointments and physiotherapy, among other things. Another cause of swelling around the sternum is problems in the heart (e.g. myocardial infarction) or in the lungs (e.g. pulmonary embolism). Overall, these symptoms can have many causes, so a good medical history and clinical examination are essential.

Broken sternum

The sternum is located in the thorax and can be felt along its entire length. It is cartilaginously connected to the 10th of the 12 ribs, as well as to the collarbone, the clavicle. In general, the sternum breaks extremely rarely because it is a very stable bone that is only very rarely stressed so much that a break is even possible.

However, in martial arts, falling from a horse onto an obstacle, or in a car accident in which the driver's sternum falls on the steering wheel, the sternum is so badly damaged that it is broken. Only the sternum is rarely broken. The adjacent structures, such as the ribs or collarbone, are usually also involved. However, the real problem is usually not the break itself.

Much more dramatic are the consequences that can arise from a broken sternum. Since the sternum lies above the lungs and heart, a broken sternum can injure the heart and / or lungs. In this case, in addition to severe pain in the sternum and water deposits (edema), there is also difficulty breathing. In addition, redness and bruises can form in the area of ​​the broken sternum.

As long as “only” the breastbone is broken, there are two options to choose from. On the one hand, there is conservative therapy, which means that the patient does not have to undergo an operation. This is possible with most fractures. However, the patient must keep strict rest and must not put any strain on the sternum so that the bone has the opportunity to grow back together properly.Since inhalation (inspiration) in particular can lead to pain or discomfort, it is important to prescribe adequate pain medication for the patient, since breathing must take place unhindered and without problems.

However, if the sternum is broken in a more complex way or if surrounding structures are affected, the fracture may need to be operated on. In this case, the patient is given a plate placed in the area of ​​the fracture. However, this plate should be removed again as soon as the sternum has grown sufficiently together. Despite the plate, a broken sternum should be spared so that it can grow together adequately and there are no misalignments.

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Cracking sternum

The sternum is built into the body in many ways. If there is a cracking in the area of ​​the sternum, this can have different causes.
On the one hand, the cracking in the sternum can be attributed to an incorrect posture and thus also to incorrect tension in muscle groups. Above all, patients who spend a lot of time sitting at their desks or computers all day long and often prop themselves up with their elbows train themselves in the wrong posture. As a result, the sternum is incorrectly stressed. However, if the patient stretches, the sternum cracks, which is due to the fact that the ribs are stretched further and the muscles also pull the ribs and sternum.

Basically, the cracking in the sternum can also be traced back to a blockage in the cervical or thoracic spine or in the sternocostal joint (the joint that connects the ribs and sternum).
As soon as the patient stretches, he straightens the joint back into the correct position, there is a short crack and the pain, or rather the feeling of pressure in the sternum, disappears. However, if there is always a feeling of pressure and cracking in the sternum, you should consult a physiotherapist or an osteopath. These can help the patient to avoid the feeling of pressure and cracking through appropriate posture.

You can find more about this topic on our website Cracking sternum

Can you straighten or mobilize a blockage in the sternum?

A blockage on the breastbone is often noticeable by a clicking sound and can be extremely painful. In mild cases, various strength and stretching exercises that can be carried out by the patient can help. A new method is the use of so-called fascia balls. These tennis ball-sized balls are hard and have a rough surface. The patient lies on his back and rolls the fascia ball from the lower end of the sternum to the upper one. This exercise is repeated a few times.

If the pain becomes very severe, a physiotherapist or a chiropractor should be consulted. They have specialist knowledge and can use specific tests to determine exactly which joint is affected. In most cases, the problem is with the two clavicle-sternum joints (sternoclavicular joints). This joint is the connection between the clavicle and breastbone. Poor posture can block it, causing severe pain. These radiate into the arms, neck and head, making it difficult for the patient to pinpoint the cause of the pain. The chiropractor is able to straighten and mobilize this joint. The first attempts are often painful and the treatment takes a long time.

Inflammation of the sternum (Tietze syndrome)

There is no inflammation in the breastbone itself.
However, the joints that connect the ribs to the sternum may become inflamed. It is believed that the so-called Tietze syndrome, a painful disease of the cartilage that connects the ribs to the sternum, is caused by inflammation. In addition to the pain, there is also swelling in the area of ​​the affected joints (usually the cartilaginous joint of the 2nd to 5th rib).

But not only the rib joints (sternocostal joints) can be inflamed, inflammation can also occur in the area behind the sternum, the so-called mediastinum (mediastinitis), which then manifests itself in pain in the sternum, among other things.
However, since the lungs, esophagus and heart are also affected, symptoms such as shortness of breath, fever and cardiac arrhythmias usually dominate. Although the inflammation is associated with a high death rate (lethality), the sternum itself is hardly stressed by the inflammation.

Read more on the topic: Tietze Syndrome

Tumor on the sternum

A tumor on the sternum is a mass in the area of ​​the sternum.
The tumors are divided into three different categories, each taking up about a third. There are benign tumors, malignant tumors and tumors that are primarily located in another organ and have spread into the sternum (metastases). The benign tumors tend to be less aggressive and grow more slowly. In addition, they are localized and scatter less into the surrounding tissue. Malignant tumors, on the other hand, are more aggressive and grow quickly. This distinction can be made using a histological examination, which can also determine the exact origin of the tumor.

In most cases, a tumor in the sternum is an incidental finding that is detected on an MRI or CT scan. In rare cases, when the tumor is already very large, the patients feel the tumor themselves and then go to the doctor. After a tumor has been diagnosed, surgery usually follows. The tumor is removed with the affected part of the sternum. Chemotherapy is often not carried out, but it depends on the type of tumor.

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