Sternum pain is most often caused by inflammation in the cartilage connecting your ribs to your breastbone, a condition called costochondritis. Musculoskeletal problems account for roughly 33% to 47% of chest pain cases seen in outpatient settings, and costochondritis alone makes up about 30% of emergency visits for non-traumatic, non-cardiac chest pain. While that’s the leading cause, sternum pain can also come from acid reflux, injuries, anxiety, or less commonly, the heart or lungs.
Costochondritis: The Most Common Cause
Costochondritis is inflammation at the joints where your upper ribs attach to the sternum. The pain is typically sharp or stabbing, though it can also feel dull and gnawing. It often gets worse when you take a deep breath, cough, or move your upper body. The hallmark sign is tenderness when you press on the area where one or two ribs meet the breastbone. If pressing on that spot reproduces the pain you’ve been feeling, costochondritis is a likely explanation.
Vigorous upper body activity, heavy lifting, repetitive motions, and forceful coughing can all trigger it. Sometimes there’s no clear trigger at all. The condition usually resolves on its own, but it can linger for several weeks and occasionally longer. Over-the-counter anti-inflammatory medications and rest from aggravating activities are typically enough to manage it.
A related but rarer condition, Tietze syndrome, causes the same type of pain but with visible swelling at the rib-sternum joint. If the area looks puffy or swollen, that points toward Tietze syndrome rather than standard costochondritis, where swelling is absent.
Acid Reflux and Heartburn
Gastroesophageal reflux disease (GERD) causes a burning pain behind the breastbone that can easily be mistaken for a musculoskeletal or cardiac problem. The sensation rises from the lower tip of your sternum toward your throat and tends to worsen after eating, when lying down, or when bending over. Some people also experience difficulty swallowing or pain while swallowing.
This happens when the muscular valve at the bottom of your esophagus weakens or relaxes at the wrong times, allowing stomach acid to wash back up. The acid irritates the lining of the esophagus, producing that characteristic burning sensation right behind the breastbone. If your sternum pain correlates with meals, has a burning quality, or improves with antacids, reflux is a strong possibility.
Sternal Fractures and Trauma
A direct blow to the chest can fracture the sternum. Motor vehicle collisions account for about 68% of sternal fractures, often from the seatbelt or steering wheel. Falls, motorcycle and cycling accidents, and sports injuries make up the rest. Stress fractures can also develop from repetitive strain in activities like weightlifting or golf, particularly in people with osteoporosis.
A fractured sternum typically causes sharp, localized pain that worsens with breathing, twisting, or pressing on the bone. About half of cases also show visible bruising, soft tissue swelling, or a palpable deformity at the fracture site. You might feel or hear a grinding sensation (crepitus) when touching the area. Standard front-facing chest X-rays catch only about 50% of sternal fractures, so a lateral view or CT scan is often needed for a definitive diagnosis.
Most isolated sternal fractures heal on their own within 10 weeks, though chest pain can persist for 8 to 12 weeks after the injury. A small number of people develop chronic pain or incomplete healing.
Anxiety and Panic Attacks
Panic attacks frequently produce real, physical chest pain. During a panic attack, hyperventilation can cause the small muscles between your ribs to strain or spasm, creating pain that feels like it’s coming from the sternum. This isn’t imaginary pain. The muscle tension is genuine, and it can be intense enough to send people to the emergency room convinced they’re having a heart attack.
The key difference is that panic-related chest pain usually comes with rapid breathing, tingling in the hands or face, a racing heartbeat, and a sense of overwhelming dread. It tends to peak within minutes and gradually fade, rather than building steadily or lasting for hours.
Pleurisy
The lungs are wrapped in a double-layered membrane called the pleura. When these layers become inflamed, typically from a viral infection, they rub against each other like sandpaper with every breath. This produces a sharp, stabbing pain that worsens when you inhale, cough, or sneeze, and noticeably lessens or stops when you hold your breath. The pain can spread to your shoulders or back and may worsen with any upper body movement.
Pleurisy pain is sometimes felt centrally near the sternum, though it more often localizes to one side of the chest. Shortness of breath is common because people instinctively take shallow breaths to avoid triggering the pain. Fever may or may not be present.
How to Tell Sternum Pain From Heart Pain
The distinction matters, and there are reliable clues. Musculoskeletal sternum pain is usually sharp, well-localized, and reproducible: if you can press on a specific spot and trigger the exact pain you’ve been feeling, it’s very likely coming from the chest wall rather than the heart. It also tends to change with breathing, movement, or body position.
Heart-related chest pain feels different. People experiencing a heart attack typically describe pressure, squeezing, tightness, or heaviness rather than sharp or stabbing pain. They often say it feels like something is sitting on their chest. The discomfort may radiate to the jaw, neck, back, shoulders, or arms. It’s accompanied by sweating, nausea, shortness of breath, lightheadedness, or a rapid or irregular heartbeat.
If your chest pain lasts longer than five minutes, doesn’t improve with rest, or comes with any of those accompanying symptoms, treat it as an emergency. That’s one situation where speed matters far more than a correct self-diagnosis.
What Happens During a Medical Evaluation
When you see a provider for sternum pain, the first goal is ruling out life-threatening causes. An electrocardiogram (EKG) is typically done within 10 minutes of arrival to check for signs of a heart attack. A chest X-ray may follow to look for fractures, pneumonia, a collapsed lung, or other structural problems.
If those initial tests are normal and the physical exam reveals tenderness at the rib-sternum joints, costochondritis is the likely diagnosis. No blood test or imaging study can confirm costochondritis directly. It’s diagnosed by pressing on the chest wall, finding reproducible tenderness, and ruling out other causes. In cases where heart disease remains a concern, a CT angiogram of the coronary arteries can effectively rule out blocked arteries and speed up diagnosis compared to traditional stress testing.
Less Common Causes
Sternalis syndrome is a rare condition caused by accessory muscle fibers on the front of the chest wall. These small muscles, present in roughly 8% of people, can spasm and produce intense pain localized to both sides of the sternum. It closely mimics cardiac and musculoskeletal conditions and is frequently misdiagnosed.
Other less common causes include infections of the sternum or surrounding joints (more often seen in people with compromised immune systems or intravenous drug use), inflammatory arthritis conditions that affect the spine and chest wall, and rarely, tumors involving the sternum or nearby structures. These are uncommon enough that they’re usually considered only after the more typical causes have been ruled out.