Can you actually dislocate your sternum?

Dislocations involving the sternum are real, documented injuries, though they are uncommon and the term covers more ground than most people expect. The sternum is not a single sealed-off bone but a structure with multiple joints connecting it to the collarbones, the ribs, and its own internal segments. Any of those joints can shift out of alignment under enough force. What makes these injuries tricky is that they range from mildly painful inconveniences to genuine emergencies depending on where and in which direction the dislocation occurs.

Where Exactly a Dislocation Can Happen

When people ask about “dislocating the sternum,” they are usually imagining the breastbone itself popping loose. That is not quite how it works. The sternum sits at the front of the chest and connects to surrounding structures at several distinct joints, each of which can be disrupted separately.

The most commonly discussed is the sternoclavicular joint, where the inner end of the collarbone meets the top of the sternum. This is the joint that anchors your entire arm to your trunk, and it can subluxate (partially shift) or fully dislocate forward or backward. Anterior dislocations, where the collarbone pushes forward relative to the sternum, are more common than posterior ones.¹

The sternum itself has an internal joint called the manubriosternal joint, where the upper segment (the manubrium) meets the longer body of the sternum. This joint can dislocate from direct blunt trauma, though it is considered rare.² At the bottom of the sternum, the xiphoid process connects through the xiphisternal joint, which can subluxate during rapid acceleration or deceleration injuries involving the chest or upper abdomen.³ And the sternocostal joints, where the ribs attach to the sternum’s edges, can also dislocate, a phenomenon described as the “stairway phenomenon” when it occurs as a complication after chest surgery.⁴

So the short version: you cannot dislocate the sternum the way you dislocate a shoulder, because the sternum is a bone, not a ball-and-socket joint. But you can absolutely dislocate any of the joints that hold the sternum in place, and that is what clinicians mean when they talk about sternal dislocations.

Why Direction Matters More Than You’d Think

For sternoclavicular joint dislocations, the direction the collarbone shifts relative to the sternum changes everything about how serious the injury is. Anterior dislocations, where the collarbone pokes forward under the skin, tend to be painful and visible but are not usually dangerous. They are the more common type and often settle down with conservative treatment.

Posterior dislocations are a different story. When the collarbone pushes backward behind the sternum, it enters the space occupied by the trachea, esophagus, and major blood vessels. A posterior sternoclavicular dislocation is considered a potentially life-threatening injury because of the risk of compressing or tearing those structures.⁵ Symptoms can include difficulty breathing, trouble swallowing, or a sensation of pressure deep in the chest. In children and adolescents, the risk is particularly concerning because the medial clavicular growth plate has not yet fused, making it vulnerable to injury patterns that mimic dislocation but actually involve fracture through the growth plate.⁶

The same anterior-versus-posterior distinction applies to chronic instability. Most ongoing sternoclavicular instability involves the collarbone drifting forward, but posterior instability carries a higher risk of serious complications because of those nearby vital structures.⁷

How These Injuries Happen

Most sternoclavicular dislocations result from high-energy trauma. Car crashes and contact sports are the classic mechanisms, particularly collisions where a force is applied to the outer shoulder and transmitted inward along the collarbone. A direct blow to the front of the chest can also cause it. Sports like rugby, football, and wrestling are well-known contexts for these injuries, and stress-related injuries of the thoracic cage, including sternoclavicular dislocations, show up in athletic imaging studies.⁸

Manubriosternal dislocations typically require significant blunt force to the chest, the kind of impact seen in car collisions or falls from height. The manubriosternal joint in adults becomes increasingly stiff and even fuses with age, which is why this injury is rare but not impossible. In younger people whose sternum is still developing, the joints between sternal segments have more cartilage and are somewhat more susceptible to displacement.

Xiphisternal subluxation tends to follow rapid deceleration events or direct impacts to the lower chest and upper abdomen. It also shows up in people who do heavy overhead pressing or similar loaded movements that place repetitive stress on the lower sternum. The xiphoid itself is a small, thin projection of cartilage and bone, and it can become irritated or shift without the dramatic force needed to dislocate the larger sternal joints.

Why These Injuries Are Easy to Miss

One of the underappreciated challenges with sternal-area dislocations is that they are often missed on initial imaging. Standard chest X-rays are not great at showing what is going on at the sternoclavicular joint because the overlapping structures of the spine, ribs, and shoulder blade obscure the view. CT scanning is the preferred imaging method for evaluating both sternoclavicular dislocations and sternal fractures.⁹ Even early research on CT for this area found it was faster, less uncomfortable for the patient, and provided better diagnostic information than older imaging techniques like conventional tomography.¹⁰

For sternal fractures specifically, multidetector CT with reconstructed images in different planes has been shown to be far more accurate than lateral radiographs. In one comparison, CT had an accuracy of about 97% for detecting sternal fractures versus roughly 77% for standard X-rays.¹¹ This matters because sternal fractures and sternal dislocations can present with similar symptoms, and telling them apart changes how treatment proceeds.

The practical takeaway: if you have significant chest pain after an impact and standard X-rays look normal, that does not necessarily rule out a sternal or sternoclavicular problem. Asking for a CT scan is reasonable if there is clinical suspicion.

Sternal Fracture Versus Sternal Dislocation

People sometimes confuse sternal fractures with sternal dislocations, and the distinction is worth understanding. A fracture breaks the bone itself; a dislocation shifts a joint out of position. Both can happen in the same area and from similar mechanisms, and in some cases they can coexist. Sternal fractures are usually caused by blunt force trauma and can range from hairline cracks that heal on their own to fully displaced breaks that require surgical reduction and fixation.¹²

CPR is one context where this distinction comes up frequently. Chest compressions are forceful by design, and sternal fractures are a recognized complication. One study of patients who received mechanical chest compressions found that about 42% had a sternal fracture and roughly 64% had at least one rib fracture afterward.¹³ True dislocations from CPR are less commonly reported, but the repetitive loading on the sternocostal and manubriosternal joints can certainly stress those areas.

Treatment Options

How a sternal-area dislocation is treated depends on the joint involved, the direction of displacement, and how quickly the injury is addressed. For sternoclavicular joint dislocations, the first-line approach is typically closed reduction, where a physician manipulates the joint back into position without surgery. One study found that closed reduction worked as definitive treatment in about 38% of patients, and it was significantly more likely to succeed when performed within ten days of injury.¹⁴ The implication is straightforward: earlier treatment gives you a better shot at avoiding the operating room.

For posterior sternoclavicular dislocations that cannot be reduced with manipulation, or that recur, surgical reconstruction becomes the path forward. One established technique involves threading a tendon graft in a figure-of-eight pattern to stabilize the joint, and this can be done reliably when appropriate surgical steps are followed.¹⁵ Chronic cases where pain persists despite nonsurgical management, including steroid injections and physical therapy, tend to be the ones that ultimately need this kind of reconstruction.

Manubriosternal dislocations in children have been managed with closed reduction alone, with callus formation gradually stabilizing the displaced segment over time.¹⁶ In adults, when the manubriosternal joint is unstable and displaced, dual locking plate fixation has been used successfully to hold the segments in place while providing stronger fixation than older techniques.¹⁷

Physical Therapy and Long-Term Recovery

For anterior sternoclavicular instability that does not require surgery, structured physical therapy can produce good outcomes. A prospective case series following patients with atraumatic anterior sternoclavicular instability found that 93% achieved a stable joint after physiotherapy. Patients who stuck with their rehabilitation program did better on average, with higher functional scores and lower pain levels than those who were not compliant.¹⁸ The rehabilitation typically focuses on strengthening the muscles around the shoulder girdle and improving scapular control, since these muscles help take load off the sternoclavicular joint.

Recovery timelines vary considerably. A mild sprain of the sternoclavicular ligaments may resolve in a few weeks with rest and activity modification. A surgically reconstructed posterior dislocation might involve six months or more before full return to activity. The key variable is whether the joint remains stable as you gradually reload it, not just whether the pain settles down.

That Popping or Cracking Sensation

Many people who search for information about sternal dislocations are not actually dealing with trauma. They are experiencing a popping, clicking, or cracking sensation in the center of their chest, particularly during stretching, deep breathing, or exercise. This is almost always a different situation from a true dislocation.

Evidence from biomechanical and clinical literature suggests that sternal and chest wall cracking most often reflects musculoskeletal causes: sternoclavicular joint dysfunction, involvement of the sternocostal or costochondral joints, or slipping rib syndrome. It may also occur with overload or stress-related injury.¹⁹ In most cases, these sounds are benign, similar to cracking your knuckles. They become concerning when accompanied by significant pain, visible deformity, or difficulty breathing.

One common scenario involves a person whose sternoclavicular joint “pops” during bench pressing, push-ups, or dips. If the joint is hypermobile but not truly unstable, this is generally more annoying than dangerous. But if the popping is associated with the joint visibly shifting out of position and back, or with progressive pain after activity, that warrants medical evaluation rather than just working through it.

Connective Tissue Disorders and Recurrent Sternal Problems

People with hypermobility syndromes or connective tissue disorders are at higher risk of recurrent subluxations around the sternum. In conditions like Ehlers-Danlos syndrome, structural alterations of the chest wall are well documented, including recurrent rib subluxations and various pectus deformities.²⁰ The collagen abnormalities in these conditions make joint capsules and ligaments stretchier than normal, so the sternoclavicular and sternocostal joints may shift repeatedly without the kind of high-energy trauma usually required.

If you are someone who experiences frequent chest wall popping, subluxation sensations, or sternal-area pain without any clear injury, and you also have generalized joint hypermobility, it is worth raising this pattern with a physician familiar with connective tissue disorders. The management approach is different from treating a one-time traumatic dislocation. It tends to focus more on long-term joint stabilization through targeted strengthening, activity modification, and sometimes bracing, rather than surgical repair.

Chest Pain and the Cardiac Question

Sternal-area pain is anxiety-inducing for an obvious reason: it sits right over your heart. Many people who end up in emergency departments with chest pain turn out to have musculoskeletal causes rather than cardiac ones. One diagnostic study evaluated a physical examination maneuver called the “sternal brace” and found that if a patient’s pain decreased by a certain threshold during the test, there was roughly a 98.5% chance the pain was noncardiac in origin.²¹

This does not mean you should self-diagnose chest pain as musculoskeletal. But it is worth knowing that the overlap between sternal joint problems and cardiac-sounding symptoms is real, and clinicians are actively developing better tools to tell the two apart. If your chest pain is reproducible by pressing on the sternum, changes with body position, or gets worse with specific arm movements, those are all clues pointing toward a musculoskeletal source. None of them is a guarantee, and anyone with new or severe chest pain should still be evaluated urgently. The point is that not every alarming-sounding sternal pop or ache is a cardiac event, and understanding the anatomy of the joints in that area can help you give your physician better information about what you are experiencing.

Sternal Anatomy Varies More Than You’d Expect

One reason sternal injuries and their imaging can be confusing is that the sternum itself is surprisingly variable from person to person. A study examining sternal development and variations using CT found significant differences across age groups in the thickness and dimensions of the manubrium and sternal body, along with wide variation in how and when the different sternal segments fuse together. The xiphoid process, in particular, showed developmental variations in its shape, direction, and whether it calcified or remained cartilaginous.²²

This variability means that what looks like an abnormality on imaging might actually be a normal anatomical variant, and vice versa. A sternal segment that appears displaced could be a congenital variation, not a traumatic dislocation. Radiologists and emergency physicians factor this in when reading scans, but it is a genuine source of diagnostic uncertainty, particularly in patients without a clear trauma history. For the person sitting in the emergency department wondering whether something is wrong with their breastbone, the honest answer is that the sternum is a more complex and individually variable structure than most anatomy diagrams suggest.