Sternal Pain?

**karen.hankey** · 08-11-2007 09:37 AM

I saw a 30 year old lady yesterday who was complaining of pain on the right hand side of her sternum at the lower end. Also recently she is now feeling it in her thoracic spine, but it started a few months ago in the front.

She has no pain breathing, coughing or sneezing. There has been no trauma. She also suffered with a sacro-iliac joint problem after pregnancy 18 months ago, and is now pregnant again - don't know if this has any significance.

Objectively she had pain on PA of the ribs just lateral to the sternum, but no other findings. My thinking was an inflammation of these joints, but why would it come on with no incident and I would have expected it to ease. Any help much appreciated.

The only last thing of note is that she is in a manual job which used to involve lifting heavy objects. She has now stopped this but only due to being pregnant.

**Laura01** · 04-12-2007 03:12 PM

I have seen a similar patient with an unusual presentation of pain which doesn't appear to be reproducable mechanically. I was thinking costochondritis. This patient may have some instability in the joints with the sternum anteriotly and at the ribs articulation with the spine due to the hormonal changes associated with pregnancy. The other thing is to look out for abnormal breathing patterns ie when the patient stressed? I would also check 1st rib level.