Question
I very recently started waking up with pain in my sternum when I wake up. I do sleep on my side, usually the right. I have never had this problem before, I am 22, and have always slept like this. I'm a massage therapist so I understand that I'm compressing my chest when I sleep and sleeping on my back or hugging a pillow might help to relieve it, but why would the pain start now? Could my ribs be out of alignment? Could the constant pressure on the sternum be causing it to wear down in the same way the knees can? It definitely feels musculoskeletal but I need more info than that. Thank you!

Answer
Rebecaa,

Pain in the sternum can be due to costochondritis. Costochondritis is an inflammatory process of the costochondral or costosternal joints that causes localized pain and tenderness. Any of the seven costochondral junctions may be affected, and more than one site is affected in 90% of cases. The second to fifth costochondral junctions most commonly are involved. Costochnodritis is typically self-limiting.

The onset of costochondritis is often insidious. Chest wall pain with a history of repeated minor trauma or unaccustomed activity (eg, painting, moving furniture) is common. Pain may be described as follows:

   * Exacerbated by trunk movement, deep inspiration, and/or exertion
   * Lessens with decreased movement, quiet breathing, or change of position
   * Sharp, nagging, aching, or pressurelike
   * Usually quite localized but may extend or radiate extensively
   * May be severe
   * May wax and wane
 
Pain with palpation of affected costochondral joints is a constant finding in costochondritis.
         o The second through the fifth costochondral junctions typically are involved. More than one junction is involved in more than 90% of patients.
         o Surprisingly, patients may not be aware of the chest wall tenderness until examination.

The diagnosis should be reconsidered in the absence of local tenderness to palpation.
         o Tietze syndrome is characterized by nonsuppurative edema.
         o Costochondritis has no palpable edema.

The etiology of costochondritis is not well defined. Repetitive minor trauma has been proposed as the most likely cause.

Differential diagnoses include:

   * Blunt abdominal trauma
   * Acromioclavicular injury
   * Anxiety
   * Gout and Pseudogout
   * Herpes Zoster
   * Myocardial Infarction
   * Neoplasms of the lung
   * Sternoclavicular joint injury

The goal of therapy is to reduce inflammation. To accomplish this goal, nonsteroidal anti-inflammatory drugs (NSAIDs) are useful. Additional treatment steps may also include:

   * Local heat
   * Local infiltration of local anesthetic, steroid, or intercostal nerve block (reserved for refractory cases)
   * Biofeedback
   * Gentle stretching of the pectoralis muscles 2-3 times a day may be beneficial
   * Primary care follow-up with persistent symptoms

Preventative measures include:

   * Avoid repetitive misuse of muscles.
   * Modify improper posture or ergonomics of the home or work place.

The prognosis for patients with costochondritis is excellent. After 1 year, about half of patients still may have discomfort; approximately one third report tenderness with palpation.

Please see these links for some additional information on costochondritis:

http://tinyurl.com/9e7dx

http://tinyurl.com/3naj94e

(Reference credit: Information cited here is taken from Medscape; the link to that article is given above).

You should see your primary care provider or a musculoskeletal-based chiropractor for a definitive diagnosis. Anytime chest pain is present, cardiac problems and gastrointestinal problems (such as acid reflux or ulcers) should be ruled out by a medical physician.

Please note that information provided here is for general education purposes only, and does not constitute a diagnosis.

I hope that this helps to answer your question.