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Pain over the breastbone usually comes from the chest wall — the joints, cartilage and muscles around it — and settles with simple treatment. If your heart has been checked and cleared, or you have been sent home after a chest pain assessment, we can work out what is causing it and treat it.
The sternum, or breastbone, sits in the middle of the chest. The ribs join it through strips of cartilage, and the collarbones meet it at the top. Any of those joints, the cartilage, or the muscles across the chest can become painful.
The commonest cause is costochondritis: irritation of the cartilage where the upper ribs meet the breastbone. It often follows a chest infection with a lot of coughing, an unaccustomed workout, or a knock to the chest, and it usually settles over weeks.
The upper ribs join the breastbone through strips of cartilage. Those joints are where costochondritis is felt, and where pressing reproduces the pain.
What the picture cannot show is where the pain starts. The same spot can hurt because of the joints at the front, or because the upper back is referring pain forwards along a rib — which is why the back is examined too.
Sternum pain and costochondritis are not the same thing. Costochondritis is one cause of pain over the breastbone — the most common one, but not the only one. The examination is what separates them.
Most chest pain seen in a clinic comes from the chest wall. These are the differences that matter.
| Chest wall | Heart | Lungs | |
|---|---|---|---|
| How it feels | Sharp, and you can point to it with one finger | Pressure, tightness or heaviness, hard to point to | Sharp, and worse on breathing in |
| Brought on by | Movement, twisting, deep breaths, coughing, pressing on it | Exertion or stress, sometimes at rest | Breathing; may follow a long flight, surgery or illness |
| Pressing on the spot | Reproduces the pain | Makes no difference | Makes no difference |
| Other signs | None | Sweating, nausea, breathlessness, pain into the jaw or arm | Breathlessness, fever, coughing blood, a swollen calf |
| What to do | Book with us | Call 995 | Call 995 |
Tenderness when you press points strongly to the chest wall. It does not, on its own, rule out a heart problem when the other features above are present.
Whatever you think is causing it, chest pain with any of these should be assessed as an emergency rather than at a clinic:
This is the one kind of pain where it is better to be checked and told it was nothing. Heart and lung causes are treated by the minute, and cannot be ruled out over the phone.
Call 995Pain felt over the breastbone sometimes starts in the upper back. The joints between the vertebrae, and the joints where each rib meets the spine, can refer pain forwards along the rib to the front of the chest. It tends to be a band of pain on one side, worse on twisting or after long periods hunched over a desk, and pressing beside the spine often reproduces it.
Where that is the source, treating the chest wall alone does little, and the upper back is what needs attention. See back pain and rhomboid pain.
Costochondritis has no test. It is diagnosed from the history and examination, and tests are used to exclude other causes rather than to confirm it.
Most chest wall pain settles within a few weeks, though it can take longer. Treatment is aimed at calming the irritated joints and letting the area recover.
A pause from press-ups, bench pressing, heavy lifting and hard chest work, while staying generally active. Heat or ice, whichever suits you better.
Anti-inflammatory tablets or gel over the tender area for a short period.
Gentle stretching of the chest and upper back, posture work, and breathing exercises. Where the upper back is the source, treatment is directed there.
For pain that has not settled, a local anaesthetic and steroid injection into the tender joint can help.
A cracked rib, shingles, reflux or an upper back problem each need their own treatment; the chest wall pain settles as they do.
Chest wall pain is sharp, easy to point to, and reproduced by pressing or moving. Heart pain is more often pressure or heaviness, brought on by exertion, and comes with sweating, nausea or breathlessness. If there is any doubt, call 995 — that is the safer mistake to make.
Usually a few weeks. Some people have it for a few months, particularly if the chest keeps being aggravated by coughing or training.
Keep moving, but pause the movements that provoke it — press-ups, bench pressing, heavy pulling. Walking and lower-body work are usually fine.
Breathing in moves every rib joint. If those joints are inflamed, the movement itself hurts, which is why the pain eases when you breathe quietly.
Yes. The joints of the upper back and the rib joints beside the spine can refer pain round to the front of the chest, usually as a band on one side.
No. Bring any ECG, X-ray or hospital notes if your chest pain has already been assessed elsewhere.
Back pain · Rhomboid pain · Myofascial pain · Neck pain · Shoulder pain
If your chest pain has already been checked and your heart is clear, bring those results. It saves repeating them.
