What could be causing my sternum pain that feels like bruising?

Sternum Pain That Feels Like Bruising

Your sternum pain that feels bruised is most likely costochondritis—inflammation of the cartilage connecting your ribs to your breastbone—which is the most common cause of nontraumatic musculoskeletal chest wall pain (42% of cases). 1, 2

Immediate Considerations: Rule Out Serious Causes First

Before attributing your pain to costochondritis, serious cardiac and thoracic emergencies must be excluded, especially if you have certain risk factors or accompanying symptoms 3:

Red flags requiring immediate emergency evaluation:

• Pain that interrupts normal activity, occurs with exertion, or is accompanied by sweating, nausea, vomiting, or lightheadedness 3
• Sudden onset "ripping" or "tearing" pain (suggests aortic dissection) 3
• Pain with shortness of breath and absent breath sounds (suggests pneumothorax) 4
• Age ≥35 years with cardiac risk factors (diabetes, hypertension, smoking, family history) 5

Reassuring features that suggest musculoskeletal cause:

• Pain that varies with breathing, body position, or food intake 3
• Pain well-localized on the chest wall with local tenderness to touch 3
• Pain reproduced by pressing on specific areas of your chest 1, 2

Diagnosing Costochondritis

The hallmark finding is tenderness when pressing on the costochondral joints (where ribs meet the breastbone), particularly ribs 6 and 7. 1, 2 The pain is typically:

• Stinging (53%) or pressing (35%) in quality 1
• Located behind the breastbone (52%) or on the left side (69%) 1
• Occurring more than once daily (63% of cases) 1
• Often chronic, lasting more than 6 months (55% of cases) 1

Treatment Algorithm

First-line treatment: NSAIDs (ibuprofen, naproxen) for 1-2 weeks 1, 2, 5

• This addresses the underlying inflammatory component
• Use acetaminophen if NSAIDs are contraindicated 1, 2

Add local heat or ice application 1, 2

• Can be used simultaneously with medication
• Apply to the tender areas for 15-20 minutes several times daily

If symptoms persist after 1-2 weeks:

• Add low-dose colchicine to your NSAID regimen 1, 2
• Consider topical lidocaine patches for localized relief with minimal systemic effects 1, 2

Avoid activities that worsen the pain 5

• Particularly those involving chest muscle overuse or repetitive upper body movements

When to Seek Further Evaluation

Return for reassessment if: 1

• Pain persists beyond 2-4 weeks despite treatment
• Pain worsens or new symptoms develop
• You develop any of the red flag symptoms mentioned above

Important Caveats

Costochondritis is a diagnosis of exclusion—cardiac causes must be ruled out first, especially in patients over 35 or with cardiac risk factors. 3, 5 Even though 3-6% of patients with chest wall tenderness have underlying coronary artery disease, the combination of reproducible pain with palpation and absence of cardiac risk factors makes costochondritis highly likely. 5

If you're over 35 years old or have any cardiac risk factors, you should have an ECG performed before accepting a diagnosis of costochondritis. 5 This is non-negotiable given the potential for missing serious cardiac disease.

Costochondritis, while painful and sometimes chronic, is benign and self-limited in most cases. 5, 6 The key is ensuring nothing more serious is causing your symptoms before proceeding with conservative treatment.