I have chest pain on the right side that worsens with breathing and radiates to my back after a past sternum and cervical spine fracture, what could be causing this?

Right-Sided Chest Pain After Sternum and Cervical Spine Fractures

You need urgent medical evaluation to rule out life-threatening complications, particularly pulmonary embolism, which occurs in 37% of trauma patients within the first 4 days after injury and can present with pleuritic chest pain radiating to the back. 1

Immediate Life-Threatening Causes to Exclude

Your symptom pattern—right-sided chest pain worsening with breathing and radiating to your back—raises several urgent concerns that require immediate evaluation:

Pulmonary Embolism (Most Critical)

• PE occurs early after trauma, with 37% of cases diagnosed within days 1-4 post-injury, contrary to the common misconception that it only occurs 5-7 days later 1
• Your combination of chest/neck trauma places you at significant risk, as PE occurs even without lower extremity fractures 1
• Classic presentation includes pleuritic chest pain (pain with breathing), tachycardia in >90% of patients, and dyspnea 2, 3
• This is a medical emergency—you should go to the emergency department immediately or call 9-1-1 2

Acute Coronary Syndrome

• While less likely given your age and trauma history, ACS must be excluded with any chest pain radiating to the back 3
• Can present with pain at rest, associated with diaphoresis, dyspnea, or nausea 2, 3

Pneumothorax

• Presents with dyspnea, pain on inspiration, and unilateral absence of breath sounds 2, 3
• Can develop as a delayed complication after chest trauma 2

Musculoskeletal Causes Related to Your Injuries

Sternal Fracture Complications

• Chronic sternal fractures can cause debilitating chest pain that persists or worsens months to years after injury 4
• Sternal fracture nonunion or malunion commonly causes ongoing pain with breathing and movement 5, 4
• Your sternum fracture from a year ago may have developed a painful nonunion requiring surgical repair 4

Rib Fractures (Including First Rib)

• First rib fractures can occur with sternal injuries and mimic symptoms of myocardial infarction or pulmonary embolism 6
• These fractures may not be visible on standard chest X-rays and require oblique cervical spine views 6
• Rib injuries combined with sternal fractures can cause persistent pleuritic pain 7

Costochondritis/Intercostal Injury

• Musculoskeletal chest pain from costochondral junction inflammation or intercostal myofascial injury presents with pain worsening with breathing 2
• Pain is typically reproducible with palpation of the chest wall 2, 3

What You Must Do Now

Immediate Actions

1. Go to the emergency department immediately or call 9-1-1—do not drive yourself 2
2. The ED must obtain an ECG within 10 minutes of arrival to exclude cardiac causes 2
3. You require urgent imaging, likely including:
   • CT pulmonary angiogram to exclude PE 5
   • Chest X-ray to assess for pneumothorax or rib fractures 2
   • Possibly oblique cervical spine films if first rib fracture is suspected 6

Critical Red Flags Requiring Emergency Care

• Any associated dyspnea, tachycardia, or feeling of impending doom 2, 1
• Sudden worsening of pain 2
• New onset sweating, nausea, or lightheadedness 2
• Unilateral decreased breath sounds 2

Common Pitfalls to Avoid

• Do not assume this is "just musculoskeletal" because your injuries were a year ago—PE can occur as a late complication, and chronic sternal fractures cause ongoing symptoms 1, 4
• Do not wait to see if symptoms improve—37% of post-trauma PEs occur within the first 4 days, but they can also occur later 1
• Hypoxia after chest trauma is often incorrectly attributed to other causes when PE is the actual culprit 1
• Sternal fractures combined with thoracic spine injuries create a unique biomechanical situation that can worsen over time 7

Bottom line: Your symptom pattern of pleuritic chest pain radiating to the back after significant chest trauma requires immediate emergency evaluation to exclude PE and other life-threatening causes before considering benign musculoskeletal explanations.