The sternum, or breast bone, can be damaged in many ways. Car accidents can easily lead to fracture of the sternum if drivers who are not wearing seat belts are struck by the steering wheel. Athletes who exercise regularly and forcefully can twist their upper torso, causing injury to the sternum. Falls during exercise and sport can cause trauma and fracture to the breastbone.
I fell in January 2012 while skiing in France and ended up in hospital in the emergency room with severe pain caused by injury to my sternum. What happened was this. While skiing in the Queyras, a beautiful natural park in Provence in the Alps, I fell heavily on my side. I landed on my ribs on my left side and also twisted my upper torso. For a moment I thought I’d broken a rib, but I’d broken a rib once in my youth and realised the pain this time was not so acute. I could breathe deeply without making the pain worse. So, feeling sure no bones were broken, I stopped skiing that afternoon and made sure I got a good night’s sleep. The next day I had pain around the edge of my ribs and under my arm but it was bearable and I did a little skiing that day. As the pain subsided over the weekend I thought no more about the fall.
Several days later, however, I was woken in the night by a powerful pain in the centre of my chest. It was so severe that I thought I must be having a heart attack. Calming down, I tried to assess my symptoms objectively. I wasn’t sweating. I didn’t have palpitations.I had no pain radiating out to my back, shoulder or jaw. I didn’t feel sick. I wasn’t having heartburn or trouble swallowing. I found that if I sat up and leant forward, the pain lessened. I had no symptoms of indigestion and I hadn’t been drinking alcohol and hadn’t eaten a heavy meal.
Taking those facts together, I reasoned that I probably wasn’t suffering from a heart attack or a hiatus hernia. What other possibilities were there? Pleurisy was one. But in that case the pain would most likely be constant and not “positional”. I could alleviate the pain by changing position.
The most likely case was a fractured or damaged sternum as a consequence of my fall days earlier. Splinters of sternum can, in severe cases, harm the heart or penetrate the lungs. I spent a very uncomfortable and sleepless night sitting up and leaning forward.
The next day I went ot see my doctor and after a thorough examination she sent me straight to a radiographer for X-rays. “You’ve either damaged or fractured the end of your sternum” she said “or damaged the cartilage right there in the centre of your chest.”
She explained that usually there is no treatment for a broken sternum apart from painkillers and rest. The bone will heal itself over time. If a fracture is complex, however, surgery may be needed.
The radiographer took three X rays and passed them to a consultant. He showed me that there was no fracture but he carried out a manual examination and pressing on the end of the sternum had me wincing in pain. The diagnosis was that I’d injured my sternum when I fell, skiing, and that I’d probably worsened the injury by continuing to ski in the days that followed.
The consultant told me that sternum injuries can take several weeks to heal and that the pain can often be severe. He wrote me a prescription for a mix of paracetamol, caffeine and opium. (Poudre d’opium, as this is France.) “You’ll need a narcotic” he said “as the pain will be severe at night for several more nights yet.” He also gave me a painkilling gel to rub into my chest at the most painful point – the very end of the sternum.
He told me to move and breathe as normally as possible but not to lift anything heavy for at least three weeks. “The sternum is easily injured” he said “and takes time to heal. The stress and strain of lifting any heavy weight can put your recovery right back to square one.”
He assured me that the mix of a powerful narcotic analgesic, rest, nomal but gentle movement, curative sleep and the passage of time would allow my sternum to heal naturally. As I got ready to leave the clinic he asked: “How was the skiing anyway?”
“Great” I said. “Wonderful pistes. Plenty of snow. Hot sun and blue skies.”
“Will the sternum injury put you off skiing again?” he asked.
“No” I said. “It won’t put me off skiing. But it’ll certainly put me off falling.”
“The sternum’s easily injured” he said. “People tend to think if they fall that they’ll hurt or break a leg or an arm, or maybe an ankle, a rib or a collar bone. Once people know how painful sternum injuries are, they’re likely to pay a bit more attention to a bone that has a very important anatomical role although people hardly think about it. It’s a crucial line of defense against injuries to the heart and lungs.”
That’s certainly the case with me now. I’d never given a moment’s thought to my sternum but a simple fall taught me not only how important it is but how painful it can be when injured. Luckily in this case the prognosis was for a full recovery, aided by painkillers, rest and time.