DEFINITION--Injury to the muscles and tendons that attach to the sternum (breastbone). Muscles, tendons and bone comprise units. The units stabilize the breastbone and ribs and allow their motion. A strain occurs at the weakest part of a unit. Strains are of 3 types:Mild (Grade I)--Slightly pulled muscle without tearing of muscle or tendon fibers. There is no loss of strength.
Moderate (Grade II)--Tearing of fibers in a muscle, tendon or at the attachment to a rib. Strength is diminished.
Severe (Grade III)--Rupture of the muscle-tendon-rib attachment with separation of fibers. Severe strain requires surgical repair. Chronic strains are caused by overuse. Acute strains are caused by direct injury or overstress.
BODY PARTS INVOLVED
Muscle and tendons that attach the ribs to the sternum.
Soft tissue surrounding the strain, including nerves, periosteum (covering to bone), blood vessels and lymph vessels.
SIGNS & SYMPTOMS
Pain when moving or stretching, especially "pushing" movements of the arms.
Swelling around the injury.
Loss of strength (moderate or severe strain).
Crepitation ("crackling") feeling and sound when the injured area is pressed with fingers.
Calcification of muscles or tendons (visible with X-rays).
Prolonged overuse of muscle-tendon units attached to the sternum and ribs.
Single violent injury or force applied to the muscle-tendon units around the sternum and ribs.
RISK INCREASES WITH
Any cardiovascular medical problem that results in decreased circulation.
Medical history of any bleeding disorder.
Previous sternum or rib injury.
Poor muscle conditioning.
HOW TO PREVENT
Participate in a strengthening and conditioning program appropriate for your sport.
Warm up before practice or competition.
Wear proper protective chest padding.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Application of tape (sometimes).
Self-care during rehabilitation.
Physical therapy (moderate or severe strain).
Surgery (severe strain).
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the chest to rule out fractures.
Prolonged healing time if activity is resumed too soon.
Proneness to repeated injury.
Inflammation at the attachment to bone (periostitis).
Prolonged disability (sometimes).
PROBABLE OUTCOMEIf this is a first-time injury, proper care and sufficient healing time before resuming activity should prevent permanent disability. Torn ligaments and tendons require as long to heal as fractured bones do. Average healing times are:
Mild strain--2 to 10 days.
Moderate strain--10 days to 6 weeks.
Severe strain--6 to 10 weeks. If this is a repeat injury, complications listed above are more likely to occur.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
Use ice massage 3 or 4 times a day for 15 minutes at a time. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
After the first 24 hours, apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
Wrap the chest with an elasticized bandage between treatments.
Massage gently and often to provide comfort and decrease swelling.
For minor discomfort, you may use:
Aspirin, acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe:
Stronger pain relievers.
Injection of a long-acting local anesthetic to reduce pain.
Injections of corticosteroids, such as triamcinolone, to reduce inflammation.
ACTIVITYResume your normal activities gradually.
DIETEat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONBegin a supervised weight-lifting program after clearance from your doctor.
CALL YOUR DOCTOR IF
You have symptoms of a moderate or severe chest-muscle strain, or a mild strain persists longer than 10 days.
Pain or swelling worsens despite treatment.