Bruised Sternum

The Sternum

• Also known as the breastbone, the sternum is a long, T-shaped flat bone found at the center of the human thorax ^[1].
• At its upper end, the sternum connects to the clavicles.  On both sides, it is articulated to ribs ^[2].
• It is made up of three parts i.e. the xiphoid process, the manubrium, and the body (also known as gladiolus) ^[3].

  

Figure 1: An illustration of the sternum: green part (manubrium);
Blue part (body); purple part (xiphoid process)
Source: Wikipedia.org

• Its T-shape resembles a sword that is pointing downward. The shape inspired the names of its parts: gladiolus means “sword” in Greek, manubrium handle, and xiphoid means sword-shaped ^[4].
• Together with the rest of the thoracic wall, the sternum’s function is to protect the inner, more delicate organs such as the lungs, heart, the esophagus, and major blood vessels against physical injury ^{[1, 2]}.

Sternum Injury

• Sternum injury (sternum contusion) happens as a result of direct physical impact on the breastbone ^[5].
• It is a rare type of injury and usually occurs in car accidents and rarely in sports involving collisions such as rugby and those that entail use of hard equipment such as balls or rackets ^[5].
• Due to the involvement of the chest in most physical exercises, a bruised sternum hampers working out and participation in sports.

Causes of Bruised Sternum

• In car accidents, if one is wearing the seatbelt it may be the cause of the injury as seat belt tries to stop driver or passenger ^[2].
• If no seat belt is worn, the impact as the driver slams on the steering may cause an impact that harms not only the sternum but other thoracic organs ^[2].

 

Image 2: An illustration of the impact of a steering wheel in an accident
Source: worldroadsafety.org

• Contact sports.
• Whooping cough:  A whooping cough may be too violent that it causes injury to the sternum in young children ^[2].

Symptoms : What does a bruised sternum feel like

• Pain on the sternum due to the physical impact
• Pain while breathing, coughing, bending and sneezing
• Tenderness on the front part of the chest lying over the sternum
• Localized swelling on the center of chest just over the sternum
• Bruises may appear on the chest later on

 

Picture 3: A picture showing visible bruises on the chest

Image Source: treatcurefast.com

Treating Bruised Sternum

• Sternum injury is usually not severe and should heal in a matter of weeks.
• However, if the pain is severe medical attention should be sought. The doctor may take x-rays to confirm that no fracture was suffered on the ribs or sternum ^[5].

• Remedies include:

Anti-inflammatory medication

These are meant to be taken under prescription. They are designed to address any inflammation caused by the impact as well as the side-effects of the inflammation. The effects attributable to inflammation may include: Swelling, localized pain, change in color (to redness) and an increase in temperature (fever) ^[2].

Icing

It serves two main purposes: relieving the pain and minimizing the inflammation-related swelling ^[6].
The ice can either e rubbed along the point of injury.
Alternatively, it can be applied along the entire thoracic region (will require more ice)
The ice should be applied 3 or 4 times per day, with each rub lasting up to 10 minutes ^[2].
Direct contact with the skin may be harmful. As such, the ice should be wrapped in a piece of cloth.

Change in lifestyle

To avoid causing further injury to the sternum, it is imperative to adjust activities one is involved in during the period of recovery. First, one has to avoid any form of heavy lifting. In addition, contact sports, intense movements that cause irritation to the chest, and bending over should be avoided ^{[2, 6]}.
For individuals that smoke, avoiding the cigarettes will reduce the healing time considerably ^[7].
If there is a cough accompanying the injury, the person should take medication to treat it as well.

Change in diet

The medical officer may suggest a change in diet to promote faster recovery.
The changes will involve taking a diet with nutrients that are crucial to the healing of the bones. A diet rich in calcium is highly recommended ^[6].

Supplements

Taking in bromelain supplements has been shown to reduce the swelling. It also minimizes the pain, and they are believed to provide essential digestive enzymes. Eating pineapples has a similar effect ^[7].
Vitamin C and K food supplements also help in the healing process. The two are essential co-factors in some bio-physiological processes, and they have been observed to reduce the recovery period significantly ^{[2, 7]}.

Micro-current therapy

This is yet another way to treat bruised bones and sternum in particular.
It is recommended for individuals that have to resume their normal schedules fast since it quickens recovery process ^[8].
The area of the chest affected by the bruise is exposed to of electric current. The current has to be quite low due to the sensitivity and tenderness of the tissues around the point of injury ^{[7, 8]}.
The electric current is aimed at correcting the electrical fields of the body that were disrupted because of the trauma resulting from the cause of injury ^[7]. As such, the method serves to heal not only the bones but the surrounding tissues as well.

Recovery Period

• The recovery period for the bruises ranges between 2 and 4 weeks.
• Patience and rest are crucial during this period ^[9].
• During the recovery period one should avoid physical activities to avoid worsening the injuries.
• Once recovered, one should start with the light-impact physical activities, and this should be under the guidance of a doctor ^[7]. The light impact training includes swimming and biking to re-acclimatize the body.

Complications

• Due to the lack of severity, there are no complications attributed to bruised sternums. However, if the patient does not take proper caution during the treatment period, the injury may become severe.
• Severe pain may be a sign of a fractured sternum and/or ribs. X-rays are necessary in such situations to confirm whether it is a fracture or bruise ^[9].

Caution

• Although seat belts have been noted to cause sternum injuries, they prevent injuries that may prove to be worse, including to internal organs such as the neck, spinal cord, and the brain. Therefore, wearing seatbelts is recommended as a method of ensuring driver and passenger safety on the road ^[10].

References:

1. Teachmeanatomy.info. The Sternum – Body – Manubrium – Xiphoid – TeachMeAnatomy [Internet]. 2016 [cited 16 January 2016]. Available from: http://teachmeanatomy.info/thorax/bones/sternum/
2. Helpyourback.org. 4 At-Home Remedies For Bruised Sternum Treatment [Internet]. 2014 [cited 16 January 2016]. Available from: http://helpyourback.org/health/at-home-remedies-for-bruised-sternum-treatment
3. Wikipedia. Sternum [Internet]. 2016 [cited 16 January 2016]. Available from: https://en.wikipedia.org/wiki/Sternum
4. InnerBody. Sternum [Internet]. 2016 [cited 16 January 2016]. Available from: http://www.innerbody.com/image_chest1/skel16.html
5. Sportsinjuryclinic.net. Bruised Sternum [Internet]. 2016 [cited 16 January 2016]. Available from: http://www.sportsinjuryclinic.net/sport-injuries/chest-abdomen-pain/bruised-sternum
6. Pocock C. Bruised Sternum | Med Health Daily [Internet]. Medhealthdaily.com. 2016 [cited 16 January 2016]. Available from: http://www.medhealthdaily.com/bruised-sternum
7. Treat, Cure Fast. Bruised Sternum Symptoms, Pain, Treatment and How to Heal a Bruised Sternum [Internet]. 2014 [cited 16 January 2016]. Available from: http://www.treatcurefast.com/bruises/heal-bruises/bruised-sternum-symptoms-treatment-pain-heal
8. Orthopedics.ygoy.com. How to Treat a Bone Bruise? – Orthopaedics [Internet]. 2016 [cited 16 January 2016]. Available from: http://orthopedics.ygoy.com/2011/09/06/how-to-treat-a-bone-bruise
9. Treat, Cure Fast. Bruised Sternum Symptoms, Pain, Treatment and How to Heal a Bruised Sternum [Internet]. 2014 [cited 16 January 2016]. Available from: http://www.treatcurefast.com/bruises/heal-bruises/bruised-sternum-symptoms-treatment-pain-heal
10. Worldroadsafety.org. World Road Safety Partnership [Internet]. 2016 [cited 16 January 2016]. Available from: http://www.worldroadsafety.org/php/allSafetyPgms.php?cid=8&pid=59