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Sudden pain in the middle of the chest sends most people straight to the worst thought. Often it is the chest wall rather than the heart — but the only safe order is to rule out the heart first.
The sternum — the breastbone — sits directly over the heart. That is why pain there is so easily mistaken for a cardiac problem, and why so many people arrive at an emergency department frightened, only to be told their heart is fine.
Being told that is a good outcome, not a wasted trip. But it leaves a question: if it was not the heart, what was it, and what can be done about it?
Call 995 or go to an emergency department if chest pain comes with any of these:
Musculoskeletal chest pain is unpleasant but not dangerous. Cardiac chest pain is treated by the minute. That asymmetry is the whole reason to check the heart first.
Call 995The most useful test is not how bad the pain is, but how it responds to pressure and movement.
| Chest wall pain | Cardiac pain | |
|---|---|---|
| What it feels like | Sharp, stabbing or aching | Pressure, squeezing or heaviness |
| Pressing on the spot | Makes it worse — it is tender | Changes nothing |
| Movement and breathing | Worse on twisting, coughing, a deep breath, or lifting the arms | Unchanged by position; worse with exertion |
| Where it goes | Stays around the breastbone and ribs | Spreads to the arm, jaw, neck, back or stomach |
| What comes with it | Nothing, or mild swelling at a rib joint | Breathlessness, cold sweats, nausea, dizziness |
If you can put a fingertip on the exact sore spot, and pressing it reproduces the pain you have been feeling, the chest wall is the likely source. That is a useful sign, though it does not by itself rule out a heart problem when the features in the right-hand column are also present.
The upper ribs do not join the breastbone directly. They connect through strips of cartilage, and those junctions can become inflamed and painful. That is costochondritis.
It is usually set off by something ordinary: a bout of heavy coughing after a chest infection, an unfamiliar gym session, overhead work, heavy lifting, or a knock to the chest. Sometimes there is no obvious trigger at all. It often settles over a few weeks, and sometimes takes a few months.
Sternum pain and costochondritis are not the same thing. Costochondritis is the most common cause of pain over the breastbone, not another name for it. Other causes include a cracked rib, a strained chest muscle, arthritis where the collarbone meets the breastbone, shingles, and pain referred from the upper back. More on those on our sternum pain page.
Once your heart and lungs have been cleared, persistent chest wall pain is worth assessing properly rather than waiting out. Book an appointment if:
Costochondritis treatment starts with the unglamorous things, and they work: pausing the movements that provoke the area while staying generally active, heat or ice, and anti-inflammatory tablets or gel for a short period.
Where that is not enough, the next steps are:
Sternum and chest wall pain is seen by Dr Mathew Tung, our neurosurgeon, who treats chest wall pain alongside neck, back and nerve pain. Bring any ECG, X-ray or hospital notes from the chest pain assessment you have already had; it saves repeating tests that have already answered the important question.
The order matters more than the diagnosis. Chest wall pain is uncomfortable but not life-threatening. A heart problem is. Rule out the heart first, then find out what is actually causing the pain — in that order, every time.
Bring the results with you. We will work out where the pain is coming from and what will settle it.
