The sternum, often called the breastbone, is the flat, dagger-shaped bone located centrally in the chest, serving as an anchor for the ribs and protecting the internal organs. A bruise, or contusion, is a common injury where blunt force trauma damages the underlying soft tissues and small blood vessels without breaking the skin. A bruised sternum, or sternal contusion, is a musculoskeletal injury resulting from a significant impact to this central chest area. This kind of trauma causes localized bleeding and swelling beneath the skin, creating a painful spot on the chest wall.
Defining the Injury and Common Causes
A sternal contusion involves trauma to the chest wall tissues overlying the breastbone, including the sensitive periosteum, the dense membrane covering the bone surface. This impact can also affect the surrounding cartilage that connects the ribs to the sternum, leading to localized inflammation and bleeding into the tissues.
The primary cause of a bruised sternum is direct, blunt force trauma to the chest. Motor vehicle accidents are a frequent source, often due to the chest striking the steering wheel or the decelerating force of a seatbelt tightening across the sternum in a collision. Other common causes include falls directly onto a hard surface, high-impact contact sports injuries, or chest compressions administered during cardiopulmonary resuscitation (CPR).
Recognizing the Symptoms
The most noticeable sign of a sternal contusion is sharp, localized pain and tenderness when pressure is applied directly to the breastbone. This pain is superficial, meaning it is felt on the surface and does not radiate outward to the arms or jaw. Swelling may appear over the injured area, and visible discoloration, ranging from red to purple-blue, can develop hours or days after the initial trauma due to blood pooling beneath the skin.
The pain is often exacerbated by movements that engage the chest wall, such as torso rotation or bending. Pain increases sharply during deep breathing, coughing, or sneezing because these actions cause the chest cavity to expand, placing strain on the injured tissues. Stiffness in the chest area can also be present, limiting mobility and discouraging the patient from taking full breaths.
Immediate Care and When to Seek Medical Help
Initial self-management for a simple sternal contusion focuses on reducing pain and inflammation. Rest is paramount; the patient must avoid activities, such as heavy lifting or strenuous exercise, that increase chest pain. Applying a cold compress or ice pack to the bruised area for 10 to 20 minutes, several times a day, can help limit swelling in the first 48 hours.
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen can be used to manage discomfort, which is important for maintaining normal breathing function. Patients should consciously practice taking deep breaths and coughing periodically to prevent fluid buildup in the lungs. To minimize pain while coughing, a patient can “splint” the chest by holding a pillow firmly against the sternum.
Immediate medical evaluation is necessary if the injury suggests a more serious underlying issue. Seek emergency care if you experience increasing shortness of breath, pain that suddenly worsens, or difficulty taking a full breath. Other red flags include lightheadedness, a rapid heart rate, massive swelling or deformity of the chest, or coughing up blood. Because the force required to bruise the sternum can also cause fractures or damage to the heart and lungs, a medical professional must rule out these internal injuries, especially following high-energy trauma.
Recovery Expectations
The recovery period for a bruised sternum is highly variable, depending on the extent of the trauma. A mild sternal contusion may feel significantly better within two to four weeks. However, complete resolution of tenderness and symptoms can take several months, especially if the trauma was severe or involved surrounding cartilage.
The gradual reintroduction of physical activity is guided by the patient’s level of pain. It is recommended to avoid high-impact activities or contact sports for at least six weeks to prevent re-injury and allow the tissues to fully stabilize. If pain persists or worsens beyond the expected timeline, a follow-up with a specialist may be necessary to investigate other possibilities, such as costochondritis or a non-healing fracture.