The sternum (pl.: sternums or sterna) or breastbone is a long flat bone located in the central part of the chest. It connects to the ribs via cartilage and forms the front of the rib cage, thus helping to protect the heart, lungs, and major blood vessels from injury. Shaped roughly like a necktie, it is one of the largest and longest flat bones of the body. Its three regions are the manubrium, the body, and the xiphoid process.[1] The word sternum originates from Ancient Greek στέρνον (stérnon) 'chest'.
The sternum is a narrow, flat bone, forming the middle portion of the front of the chest. The top of the sternum supports the clavicles (collarbones) and its edges join with the costal cartilages of the first two pairs of ribs. The inner surface of the sternum is also the attachment of the sternopericardial ligaments.[2] Its top is also connected to the sternocleidomastoid muscle. The sternum consists of three main parts, listed from the top:
In its natural position, the sternum is angled obliquely, downward and forward. It is slightly convex in front and concave behind; broad above, shaped like a "T", becoming narrowed at the point where the manubrium joins the body, after which it again widens a little to below the middle of the body, and then narrows to its lower extremity. In adults the sternum is on average about 1.7cm longer in the male than in the female.[citation needed]
Manubrium
Shape of manubrium
The manubrium (Latin for 'handle') is the broad upper part of the sternum. It has a quadrangular shape, narrowing from the top, which gives it four borders. The suprasternal notch (jugular notch) is located in the middle at the upper broadest part of the manubrium. This notch can be felt between the two clavicles. On either side of this notch are the right and left clavicular notches.[1]
The manubrium joins with the body of the sternum, the clavicles and the cartilages of the first pair of ribs. The inferior border, oval and rough, is covered with a thin layer of cartilage for articulation with the body. The lateral borders are each marked above by a depression for the first costal cartilage, and below by a small facet, which, with a similar facet on the upper angle of the body, forms a notch for the reception of the costal cartilage of the second rib. Between the depression for the first costal cartilage and the demi-facet for the second is a narrow, curved edge, which slopes from above downward towards the middle. Also, the superior sternopericardial ligament attaches the pericardium to the posterior side of the manubrium.
Body
3D illustration of the body of sternum.
The body, or gladiolus, is the longest sternal part. It is flat and considered to have only a front and back surface. It is flat on the front, directed upward and forward, and marked by three transverse ridges which cross the bone opposite the third, fourth, and fifth articular depressions. The pectoralis major attaches to it on either side. At the junction of the third and fourth parts of the body is occasionally seen an orifice, the sternal foramen, of varying size and form. The posterior surface, slightly concave, is also marked by three transverse lines, less distinct, however, than those in front; from its lower part, on either side, the transversus thoracis takes origin.
The sternal angle is located at the point where the body joins the manubrium. The sternal angle can be felt at the point where the sternum projects farthest forward. However, in some people the sternal angle is concave or rounded. During physical examinations, the sternal angle is a useful landmark because the second rib attaches here.[1]
Each outer border, at its superior angle, has a small facet, which with a similar facet on the manubrium, forms a cavity for the cartilage of the second rib; below this are four angular depressions which receive the cartilages of the third, fourth, fifth, and sixth ribs. The inferior angle has a small facet, which, with a corresponding one on the xiphoid process, forms a notch for the cartilage of the seventh rib. These articular depressions are separated by a series of curved interarticular intervals, which diminish in length from above downward, and correspond to the intercostal spaces. Most of the cartilages belonging to the true ribs, articulate with the sternum at the lines of junction of its primitive component segments. This is well seen in some other vertebrates, where the parts of the bone remain separated for longer.[citation needed]
The upper border is oval and articulates with the manubrium, at the sternal angle. The lower border is narrow, and articulates with the xiphoid process.
Located at the inferior end of the sternum is the pointed xiphoid process. Improperly performed chest compressions during cardiopulmonary resuscitation can cause the xiphoid process to snap off, driving it into the liver which can cause a fatal hemorrhage.[1]
The sternum is composed of highly vascular tissue, covered by a thin layer of compact bone which is thickest in the manubrium between the articular facets for the clavicles. The inferior sternopericardial ligament attaches the pericardium to the posterior xiphoid process.
Joints
The cartilages of the top five ribs join with the sternum at the sternocostal joints. The right and left clavicular notches articulate with the right and left clavicles, respectively. The costal cartilage of the second rib articulates with the sternum at the sternal angle making it easy to locate.[3]
The transversus thoracis muscle is innervated by one of the intercostal nerves and superiorly attaches at the posterior surface of the lower sternum. Its inferior attachment is the internal surface of costal cartilages two through six and works to depress the ribs.[4]
The sternum develops from two cartilaginous bars one on the left and one on the right, connected with the cartilages of the ribs on each side.[5] These two bars fuse together along the middle to form the cartilaginous sternum which is ossified from six centers: one for the manubrium, four for the body, and one for the xiphoid process.
The ossification centers appear in the intervals between the articular depressions for the costal cartilages, in the following order: in the manubrium and first piece of the body, during the sixth month of fetal life; in the second and third pieces of the body, during the seventh month of fetal life; in its fourth piece, during the first year after birth; and in the xiphoid process, between the fifth and eighteenth years.
The centers make their appearance at the upper parts of the segments, and proceed gradually downward. To these may be added the occasional existence of two small episternal centers, which make their appearance one on either side of the jugular notch; they are probably vestiges of the episternal bone of the monotremata and lizards.[citation needed]
Occasionally some of the segments are formed from more than one center, the number and position of which vary [Fig. 6]. Thus, the first piece may have two, three, or even six centers.
When two are present, they are generally situated one above the other, the upper being the larger; the second piece has seldom more than one; the third, fourth, and fifth pieces are often formed from two centers placed laterally, the irregular union of which explains the rare occurrence of the sternal foramen [Fig. 7], or of the vertical fissure which occasionally intersects this part of the bone constituting the malformation known as fissura sterni; these conditions are further explained by the manner in which the cartilaginous sternum is formed.
More rarely still the upper end of the sternum may be divided by a fissure. Union of the various centers of the body begins about puberty, and proceeds from below upward [Fig. 5]; by the age of 25 they are all united.
The xiphoid process may become joined to the body before the age of thirty, but this occurs more frequently after forty; on the other hand, it sometimes remains ununited in old age. In advanced life the manubrium is occasionally joined to the body by bone. When this takes place, however, the bony tissue is generally only superficial, the central portion of the intervening cartilage remaining unossified.
The body of the sternum is formed by the fusion of four segments called sternebrae.[6]
Variations
In 2.5–13.5% of the population, a foramen known as sternal foramen may be presented at the lower third of the sternal body.[7] In extremely rare cases, multiple foramina may be observed. Fusion of the manubriosternal joint also occurs in around 5% of the population.[8] Small ossicles known as episternal ossicles may also be present posterior to the superior end of the manubrium.[9] Another variant called suprasternal tubercle is formed when the episternal ossicles fuse with the manubrium.[10]
Clinical significance
Bone marrow biopsy
Because the sternum contains bone marrow, it is sometimes used as a site for bone marrow biopsy. In particular, patients with a high BMI (obese or grossly overweight) may present with excess tissue that makes access to traditional marrow biopsy sites such as the pelvis difficult.
Sternal opening
A somewhat rare congenital disorder of the sternum sometimes referred to as an anatomical variation is a sternal foramen, a single round hole in the sternum that is present from birth and usually is off-centered to the right or left, commonly forming in the 2nd, 3rd, and 4th segments of the breastbone body. Congenital sternal foramina can often be mistaken for bullet holes.[11] They are usually without symptoms but can be problematic if acupuncture in the area is intended.[12]
Fractures of the sternum are rather uncommon. They may result from trauma, such as when a driver's chest is forced into the steering column of a car in a car accident. A fracture of the sternum is usually a comminuted fracture. The most common site of sternal fractures is at the sternal angle. Some studies reveal that repeated punches or continual beatings, sometimes called "breastbone punches", to the sternum area have also caused fractured sternums. Those are known to have occurred in contact sports such as hockey and football. Sternal fractures are frequently associated with underlying injuries such as pulmonary contusions, or bruised lung tissue.[13]
Dislocation
A manubriosternal dislocation is rare and usually caused by severe trauma. It may also result from minor trauma where there is a precondition of arthritis.[14]
Sternotomy
The breastbone is sometimes cut open (a median sternotomy) to gain access to the thoracic contents when performing cardiothoracic surgery. Surgical fixation of sternotomy is achieved through the use of either wire cerclage or a plate and screw technique. The incidence of sternotomy complications falls within the narrow range of 0.5% to 5%. Nevertheless, these complications can have severe consequences, including increased mortality rates, the need for reoperation, and a mortality rate as high as 40%. Such complications often entail issues like dehiscence and sternal non-union, primarily stemming from lateral forces exerted during post-operative activities such as coughing and sneezing.
Resection
The sternum can be totally removed (resected) as part of a radical surgery, usually to surgically treat a malignancy, either with or without a mediastinal lymphadenectomy (Current Procedural Terminology codes # 21632 and # 21630, respectively).
Bifid sternum or sternal cleft
A bifid sternum is an extremely rare congenital abnormality caused by the fusion failure of the sternum.[15] This condition results in sternal cleft which can be observed at birth without any symptom.[15]
Other animals
The sternum, in vertebrate anatomy, is a flat bone that lies in the middle front part of the rib cage. It is endochondral in origin.[16] It probably first evolved in early tetrapods as an extension of the pectoral girdle; it is not found in fish. In amphibians and reptiles, it is typically a shield-shaped structure, often composed entirely of cartilage. It is absent in both turtles and snakes. In birds, it is a relatively large bone and typically bears an enormous projecting keel to which the flight muscles are attached.[17] Only in mammals does the sternum take on the elongated, segmented form seen in humans.
English sternum is a translation of Ancient Greekστέρνον, sternon.[18] The Greek writer Homer used the term στέρνον to refer to the male chest,[19][20] and the term στῆθος, stithos to refer to the chest of both sexes.[19][20] The Greek physicianHippocrates used στέρνον to refer to the chest,[19][20] and στῆθος to the breastbone.[19][20] The Greek physician Galen was the first to use στέρνον in the present meaning of breastbone.[19][20]
The sternum as the solid bony part of the chest[21] can be related to Ancient Greek στερεός/στερρός, (stereόs/sterrόs),[21] meaning firm or solid.[20] The English term breastbone is actually more like the Latin os pectoris,[22][23] derived from classical Latin os, bone[24] and pectus, chest or breast.[24] Confusingly, pectus is also used in classical Latin as breastbone.[24]
Additional images
Position of sternum (shown in red). Animation.
Sternum seen posteriorly
Sternum cut along the frontal plane showing interior of the bone
Sternum, lateral aspect
Position of the sternum the thoracic cage
Computer-generated image of ribcage turntable highlighting the sternum
In vertebrate anatomy, ribs are the long curved bones which form the rib cage, part of the axial skeleton. In most tetrapods, ribs surround the chest, enabling the lungs to expand and thus facilitate breathing by expanding the chest cavity. They serve to protect the lungs, heart, and other internal organs of the thorax. In some animals, especially snakes, ribs may provide support and protection for the entire body.
In anatomy, the atlas (C1) is the most superior (first) cervical vertebra of the spine and is located in the neck.
The rib cage is an endoskeletal enclosure in the thorax of most vertebrate animals that comprises the ribs, vertebral column and sternum, which protects vital organs such as the heart, lungs and great vessels. The circumferential enclosure formed by left and right rib cages, together known as the thoracic cage, is a semi-rigid bony and cartilaginous structure which surrounds the thoracic cavity and supports the shoulder girdles to form the core part of the axial skeleton.
The clavicle, collarbone, or keybone is a slender, S-shaped long bone approximately 6 inches (15 cm) long that serves as a strut between the shoulder blade and the sternum (breastbone). There are two clavicles, one on the left and one on the right. The clavicle is the only long bone in the body that lies horizontally. Together with the shoulder blade, it makes up the shoulder girdle. It is a palpable bone and, in people who have less fat in this region, the location of the bone is clearly visible. It receives its name from Latin clavicula 'little key' because the bone rotates along its axis like a key when the shoulder is abducted. The clavicle is the most commonly fractured bone. It can easily be fractured by impacts to the shoulder from the force of falling on outstretched arms or by a direct hit.
The xiphoid process, also referred to as the ensiform process, xiphisternum, or metasternum, constitutes a small cartilaginous process (extension) located in the inferior segment of the sternum, typically ossified in adult humans. Both the Greek-derived term xiphoid and its Latin equivalent, ensiform, connote a "swordlike" or "sword-shaped" morphology.
The thorax or chest is a part of the anatomy of mammals and other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main divisions of the creature's body, each of which is in turn composed of multiple segments.
In anatomy, the axis is the second cervical vertebra (C2) of the spine, immediately inferior to the atlas, upon which the head rests.
In vertebrates, thoracic vertebrae compose the middle segment of the vertebral column, between the cervical vertebrae and the lumbar vertebrae. In humans, there are twelve thoracic vertebrae and they are intermediate in size between the cervical and lumbar vertebrae; they increase in size going towards the lumbar vertebrae, with the lower ones being much larger than the upper. They are distinguished by the presence of facets on the sides of the bodies for articulation with the heads of the ribs, as well as facets on the transverse processes of all, except the eleventh and twelfth, for articulation with the tubercles of the ribs. By convention, the human thoracic vertebrae are numbered T1–T12, with the first one (T1) located closest to the skull and the others going down the spine toward the lumbar region.
The sternal angle is the projecting angle formed between the manubrium and body of a sternum at their junction at the manubriosternal joint.
The talus, talus bone, astragalus, or ankle bone is one of the group of foot bones known as the tarsus. The tarsus forms the lower part of the ankle joint. It transmits the entire weight of the body from the lower legs to the foot.
The shoulder girdle or pectoral girdle is the set of bones in the appendicular skeleton which connects to the arm on each side. In humans it consists of the clavicle and scapula; in those species with three bones in the shoulder, it consists of the clavicle, scapula, and coracoid. Some mammalian species have only the scapula.
The costal cartilages are bars of hyaline cartilage that serve to prolong the ribs forward and contribute to the elasticity of the walls of the thorax. Costal cartilage is only found at the anterior ends of the ribs, providing medial extension.
The lateral parts of the occipital bone are situated at the sides of the foramen magnum; on their under surfaces are the condyles for articulation with the superior facets of the atlas.
The deep cervical fascia lies under cover of the platysma, and invests the muscles of the neck; it also forms sheaths for the carotid vessels, and for the structures situated in front of the vertebral column. Its attachment to the hyoid bone prevents the formation of a dewlap.
The sternoclavicular joint or sternoclavicular articulation is a synovial saddle joint between the manubrium of the sternum, and the clavicle, and the first costal cartilage. The joint possesses a joint capsule, and an articular disc, and is reinforced by multiple ligaments.
Cartilaginous joints are connected entirely by cartilage. Cartilaginous joints allow more movement between bones than a fibrous joint but less than the highly mobile synovial joint. Cartilaginous joints also forms the growth regions of immature long bones and the intervertebral discs of the spinal column.
The following outline is provided as an overview of and topical guide to human anatomy:
Each vertebra is an irregular bone with a complex structure composed of bone and some hyaline cartilage, that make up the vertebral column or spine, of vertebrates. The proportions of the vertebrae differ according to their spinal segment and the particular species.
Episternal ossicles are small bones that are sometimes present at the upper end of the chest bone. The prevalence of these ossicles is around 1.5%.
↑ This article incorporates text available under the CC BY 4.0 license.Betts, J Gordon; Desaix, Peter; Johnson, Eddie; Johnson, Jody E; Korol, Oksana; Kruse, Dean; Poe, Brandon; Wise, James; Womble, Mark D; Young, Kelly A (May 14, 2023). Anatomy & Physiology. Houston: OpenStax CNX. 7.5 Embryonic development of the axial skeleton. ISBN978-1-947172-04-3.
↑ Romer, Alfred Sherwood; Parsons, Thomas S. (1977). The Vertebrate Body. Philadelphia, PA: Holt-Saunders International. p.188. ISBN0-03-910284-X.
↑ Triepel, H. (1910). Die anatomischen Namen. Ihre Ableitung und Aussprache. Mit einem Anhang: Biographische Notizen.(Dritte Auflage). Wiesbaden: Verlag J.F. Bergmann.
1 2 3 4 5 Hyrtl, J. (1880). Onomatologia Anatomica. Geschichte und Kritik der anatomischen Sprache der Gegenwart. Wien: Wilhelm Braumüller. K.K. Hof- und Universitätsbuchhändler.
1 2 3 4 5 6 Liddell, H.G. & Scott, R. (1940). A Greek-English Lexicon. revised and augmented throughout by Sir Henry Stuart Jones. with the assistance of. Roderick McKenzie. Oxford: Clarendon Press.
1 2 Kraus, L.A. (1844). Kritisch-etymologisches medicinisches Lexikon (Dritte Auflage). Göttingen: Verlag der Deuerlich- und Dieterichschen Buchhandlung.
↑ Schreger, C.H.Th. (1805). Synonymia anatomica. Synonymik der anatomischen Nomenclatur. Fürth: im Bureau für Literatur.
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