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The sternum or breastbone is a long flat bone located in the central part of the
chest The thorax or chest is a part of the anatomy of humans, 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 crea ...
. It connects to the
rib In vertebrate anatomy, ribs ( la, costae) 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 ches ...
s via
cartilage Cartilage is a resilient and smooth type of connective tissue. In tetrapods, it covers and protects the ends of long bones at the joints as articular cartilage, and is a structural component of many body parts including the rib cage, the neck ...
and forms the front of the
rib cage The rib cage, as an enclosure that comprises the ribs, vertebral column and sternum in the thorax of most vertebrates, protects vital organs such as the heart, lungs and great vessels. The sternum, together known as the thoracic cage, is a sem ...
, thus helping to protect the
heart The heart is a muscular Organ (biology), organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as ca ...
,
lungs The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either si ...
, and major
blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide awa ...
s from injury. Shaped roughly like a
necktie A necktie, or simply a tie, is a piece of cloth worn for decorative purposes around the neck, resting under the shirt collar and knotted at the throat, and often draped down the chest. Variants include the ascot, bow, bolo, zipper tie, crav ...
, 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. The word "sternum" originates from the Ancient Greek στέρνον (stérnon), meaning "chest".


Structure

The sternum is a narrow, flat bone, forming the middle portion of the front of the
chest The thorax or chest is a part of the anatomy of humans, 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 crea ...
. The top of the sternum supports the clavicles (collarbones) and its edges join with the costal cartilages of the first two pairs of
rib In vertebrate anatomy, ribs ( la, costae) 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 ches ...
s. The inner surface of the sternum is also the attachment of the sternopericardial ligaments. Its top is also connected to the
sternocleidomastoid muscle The sternocleidomastoid muscle is one of the largest and most superficial cervical muscles. The primary actions of the muscle are rotation of the head to the opposite side and flexion of the neck. The sternocleidomastoid is innervated by the access ...
. The sternum consists of three main parts, listed from the top: * Manubrium * Body (gladiolus) * Xiphoid process 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 17 cm, longer in the male than in the female.


Manubrium

The manubrium (
Latin Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally a dialect spoken in the lower Tiber area (then known as Latium) around present-day Rome, but through ...
for "handle") is the broad upper part of the sternum. It has a
quadrangular Quadrangle or The Quadrangle may refer to: Architecture *Quadrangle (architecture), a courtyard surrounded by a building or several buildings, often at a college Various specific quadrangles, often called "the quad" or "the quadrangle": North A ...
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. The manubrium joins with the body of the sternum, the clavicles and the cartilages of the first pair of
rib In vertebrate anatomy, ribs ( la, costae) 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 ches ...
s. 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 The pericardium, also called pericardial sac, is a double-walled sac containing the heart and the roots of the great vessels. It has two layers, an outer layer made of strong connective tissue (fibrous pericardium), and an inner layer made ...
to the posterior side of the manubrium.


Body

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 The pectoralis major () is a thick, fan-shaped or triangular convergent muscle, situated at the chest of the human body. It makes up the bulk of the chest muscles and lies under the breast. Beneath the pectoralis major is the pectoralis minor, ...
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 The sternal angle (also known as the angle of Louis, angle of Ludovic or manubriosternal junction) is the synarthrotic joint formed by the articulation of the manubrium and the body of the sternum. The sternal angle is a palpable clinical landma ...
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. 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
cartilage Cartilage is a resilient and smooth type of connective tissue. In tetrapods, it covers and protects the ends of long bones at the joints as articular cartilage, and is a structural component of many body parts including the rib cage, the neck ...
s 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. 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.


Xiphoid process

Located at the inferior end of the sternum is the pointed xiphoid process. Improperly performed chest compressions during
cardiopulmonary resuscitation Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spont ...
can cause the xiphoid process to snap off, driving it into the liver which can cause a fatal hemorrhage. The sternum is composed of highly
vascular The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide away f ...
tissue, covered by a thin layer of compact bone which is thickest in the manubrium between the
articular facets A joint or articulation (or articular surface) is the connection made between bones, ossicles, or other hard structures in the body which link an animal's skeletal system into a functional whole.Saladin, Ken. Anatomy & Physiology. 7th ed. McGraw- ...
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 sternocostal joints, also known as sternochondral joints or costosternal articulations, are synovial plane joints of the costal cartilages of the true ribs with the sternum. The only exception is the first rib, which has a synchondrosis joint ...
. 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. The transversus thoracis muscle is innervated by one of the
intercostal nerves The intercostal nerves are part of the somatic nervous system, and arise from the anterior rami of the thoracic spinal nerves from T1 to T11. The intercostal nerves are distributed chiefly to the thoracic pleura and abdominal peritoneum, and di ...
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.


Development

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. 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 Ossification (also called osteogenesis or bone mineralization) in bone remodeling is the process of laying down new bone material by cells named osteoblasts. It is synonymous with bone tissue formation. There are two processes resulting in ...
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. Occasionally some of the segments are formed from more than one center, the number and position of which vary
ig. 6 IG, Ig, or ig may refer to: Companies * IG Farben, a former German industrial conglomerate * IG Group, a UK financial services company * IG Recordings, a record label formed by the Indigo Girls, an American folk/rock duo * Production I.G, a Japane ...
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 ig. 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 A fissure is a long, narrow crack opening along the surface of Earth. The term is derived from the Latin word , which means 'cleft' or 'crack'. Fissures emerge in Earth's crust, on ice sheets and glaciers, and on volcanoes. Ground fissure ...
. Union of the various centers of the body begins about
puberty Puberty is the process of physical changes through which a child's body matures into an adult body capable of sexual reproduction. It is initiated by hormonal signals from the brain to the gonads: the ovaries in a girl, the testes in a ...
, and proceeds from below upward
ig. 5 IG, Ig, or ig may refer to: Companies * IG Farben, a former German industrial conglomerate * IG Group, a UK financial services company * IG Recordings, a record label formed by the Indigo Girls, an American folk/rock duo * Production I.G, a Japane ...
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. In early life, the sternum's body is divided into four segments, not three, called ''sternebrae'' (singular: ''sternebra'').


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. In extremely rare cases, multiple foramina may be observed. Fusion of the manubriosternal joint also occurs in around 5% of the population. Small ossicles known as episternal ossicles may also be present posterior to the superior end of the manubrium. Another variant called suprasternal tubercle is formed when the episternal ossicles fuse with the manubrium.


Clinical significance


Bone marrow biopsy

Because the sternum contains
bone marrow Bone marrow is a semi-solid biological tissue, tissue found within the Spongy bone, spongy (also known as cancellous) portions of bones. In birds and mammals, bone marrow is the primary site of new blood cell production (or haematopoiesis). It i ...
, 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 The pelvis (plural pelves or pelvises) is the lower part of the trunk, between the abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also called bony pelvis, or pelvic skeleton). The ...
difficult.


Sternal opening

A somewhat rare
congenital disorder A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities c ...
of the sternum sometimes referred to as an
anatomical variation An anatomical variation, anatomical variant, or anatomical variability is a presentation of body structure with morphological features different from those that are typically described in the majority of individuals. Anatomical variations are categ ...
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. They are usually without symptoms but can be problematic if acupuncture in the area is intended.


Fractures

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 Comminuted may refer to: *Comminution, the process in which solid materials are reduced in size, by crushing, grinding and other processes *Bone fracture A bone fracture (abbreviated FRX or Fx, Fx, or #) is a medical condition in which there ...
fracture. The most common site of sternal fractures is at the
sternal angle The sternal angle (also known as the angle of Louis, angle of Ludovic or manubriosternal junction) is the synarthrotic joint formed by the articulation of the manubrium and the body of the sternum. The sternal angle is a palpable clinical landma ...
. 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 contusion A pulmonary contusion, also known as lung contusion, is a bruise of the lung, caused by chest trauma. As a result of damage to capillaries, blood and other fluids accumulate in the lung tissue. The excess fluid interferes with gas exchange, pot ...
s, or bruised lung tissue.


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.


Sternotomy

The breastbone is sometimes cut open (a
median sternotomy Median sternotomy is a type of surgical procedure in which a vertical inline incision is made along the sternum, after which the sternum itself is divided using a sternal saw. This procedure provides access to the heart and lungs for surgical pro ...
) to gain access to the thoracic contents when performing
cardiothoracic surgery Cardiothoracic surgery is the field of medicine involved in surgical treatment of organs inside the thoracic cavity — generally treatment of conditions of the heart (heart disease), lungs ( lung disease), and other pleural or mediastinal str ...
.


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 The Current Procedural Terminology (CPT) code set is a procedural code set developed by the American Medical Association (AMA). It is maintained by the CPT Editorial Panel. The CPT code set describes medical, surgical, and diagnostic services and ...
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. This condition results in sternal cleft which can be observed at birth without any symptom.


Other animals

The sternum, in vertebrate anatomy, is a flat bone that lies in the middle front part of the
rib cage The rib cage, as an enclosure that comprises the ribs, vertebral column and sternum in the thorax of most vertebrates, protects vital organs such as the heart, lungs and great vessels. The sternum, together known as the thoracic cage, is a sem ...
. It is endochondral in origin. It probably first evolved in early
tetrapod Tetrapods (; ) are four-limbed vertebrate animals constituting the superclass Tetrapoda (). It includes extant and extinct amphibians, sauropsids ( reptiles, including dinosaurs and therefore birds) and synapsids ( pelycosaurs, extinct t ...
s as an extension of the
pectoral girdle 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 ...
; it is not found in
fish Fish are Aquatic animal, aquatic, craniate, gill-bearing animals that lack Limb (anatomy), limbs with Digit (anatomy), digits. Included in this definition are the living hagfish, lampreys, and Chondrichthyes, cartilaginous and bony fish as we ...
. In
amphibian Amphibians are four-limbed and ectothermic vertebrates of the class Amphibia. All living amphibians belong to the group Lissamphibia. They inhabit a wide variety of habitats, with most species living within terrestrial, fossorial, arbo ...
s and
reptile Reptiles, as most commonly defined are the animals in the class Reptilia ( ), a paraphyletic grouping comprising all sauropsids except birds. Living reptiles comprise turtles, crocodilians, squamates ( lizards and snakes) and rhynchocephalia ...
s it is typically a shield-shaped structure, often composed entirely of
cartilage Cartilage is a resilient and smooth type of connective tissue. In tetrapods, it covers and protects the ends of long bones at the joints as articular cartilage, and is a structural component of many body parts including the rib cage, the neck ...
. It is absent in both
turtle Turtles are an order of reptiles known as Testudines, characterized by a special shell developed mainly from their ribs. Modern turtles are divided into two major groups, the Pleurodira (side necked turtles) and Cryptodira (hidden necked t ...
s and
snake Snakes are elongated, limbless, carnivorous reptiles of the suborder Serpentes . Like all other squamates, snakes are ectothermic, amniote vertebrates covered in overlapping scales. Many species of snakes have skulls with several more ...
s. In
bird Birds are a group of warm-blooded vertebrates constituting the class Aves (), characterised by feathers, toothless beaked jaws, the laying of hard-shelled eggs, a high metabolic rate, a four-chambered heart, and a strong yet lightweig ...
s it is a relatively large bone and typically bears an enormous projecting
keel The keel is the bottom-most longitudinal structural element on a vessel. On some sailboats, it may have a hydrodynamic and counterbalancing purpose, as well. As the laying down of the keel is the initial step in the construction of a ship, in Br ...
to which the flight muscles are attached. Only in
mammal Mammals () are a group of vertebrate animals constituting the class Mammalia (), characterized by the presence of mammary glands which in females produce milk for feeding (nursing) their young, a neocortex (a region of the brain), fur ...
s does the sternum take on the elongated, segmented form seen in humans.


Arthropods

In
arachnid Arachnida () is a class of joint-legged invertebrate animals (arthropods), in the subphylum Chelicerata. Arachnida includes, among others, spiders, scorpions, ticks, mites, pseudoscorpions, harvestmen, camel spiders, whip spiders and vinegar ...
s, the sternum is the ventral (lower) portion of the
cephalothorax The cephalothorax, also called prosoma in some groups, is a tagma of various arthropods, comprising the head and the thorax fused together, as distinct from the abdomen behind. (The terms ''prosoma'' and ''opisthosoma'' are equivalent to ''cepha ...
. It consists of a single
sclerite A sclerite (Greek , ', meaning " hard") is a hardened body part. In various branches of biology the term is applied to various structures, but not as a rule to vertebrate anatomical features such as bones and teeth. Instead it refers most commonly ...
situated between the coxa, opposite the
carapace A carapace is a dorsal (upper) section of the exoskeleton or shell in a number of animal groups, including arthropods, such as crustaceans and arachnids, as well as vertebrates, such as turtles and tortoises. In turtles and tortoises, the unde ...
.


Etymology

English ''sternum'' is a translation of
Ancient Greek Ancient Greek includes the forms of the Greek language used in ancient Greece and the ancient world from around 1500 BC to 300 BC. It is often roughly divided into the following periods: Mycenaean Greek (), Dark Ages (), the Archaic pe ...
, '.Triepel, H. (1910). ''Die anatomischen Namen. Ihre Ableitung und Aussprache. Mit einem Anhang: Biographische Notizen.''(Dritte Auflage). Wiesbaden: Verlag J.F. Bergmann. The Greek writer
Homer Homer (; grc, Ὅμηρος , ''Hómēros'') (born ) was a Greek poet who is credited as the author of the ''Iliad'' and the ''Odyssey'', two epic poems that are foundational works of ancient Greek literature. Homer is considered one of the ...
used the term to refer to the ''male chest'',Hyrtl, J. (1880). ''Onomatologia Anatomica. Geschichte und Kritik der anatomischen Sprache der Gegenwart.'' Wien: Wilhelm Braumüller. K.K. Hof- und Universitätsbuchhändler.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. and the term , ' to refer to the ''chest of both sexes''. The Greek
physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
Hippocrates Hippocrates of Kos (; grc-gre, Ἱπποκράτης ὁ Κῷος, Hippokrátēs ho Kôios; ), also known as Hippocrates II, was a Greek physician of the classical period who is considered one of the most outstanding figures in the history o ...
used στέρνον to refer to the ''chest'', and στῆθος to the ''breastbone''. The Greek physician
Galen Aelius Galenus or Claudius Galenus ( el, Κλαύδιος Γαληνός; September 129 – c. AD 216), often Anglicized as Galen () or Galen of Pergamon, was a Greek physician, surgeon and philosopher in the Roman Empire. Considered to be o ...
was the first to use in the present meaning of ''breastbone''. The sternum as the solid bony part of the chestKraus, L.A. (1844). ''Kritisch-etymologisches medicinisches Lexikon'' (Dritte Auflage). Göttingen: Verlag der Deuerlich- und Dieterichschen Buchhandlung. can be related to Ancient Greek , ''()'', meaning ''firm'' or ''solid''. The English term breastbone is actually more like the Latin ''os pectoris'',Schreger, C.H.Th. (1805). ''Synonymia anatomica. Synonymik der anatomischen Nomenclatur.'' Fürth: im Bureau für Literatur.Siebenhaar, F.J. (1850). ''Terminologisches Wörterbuch der medicinischen Wissenschaften.'' (Zweite Auflage). Leipzig: Arnoldische Buchhandlung. derived from classical Latin ''os'', boneLewis, C.T. & Short, C. (1879). ''A Latin dictionary founded on Andrews' edition of Freund's Latin dictionary.'' Oxford: Clarendon Press. and ''pectus'', chest or breast. Confusingly, ''pectus'' is also used in classical Latin as ''breastbone''.


Additional images

File:Sternum animation3.gif, Position of sternum (shown in red). Animation. File:Sobo 1909 31.png, Sternum seen posteriorly File:Sobo 1909 181.png, Sternum cut along the frontal plane showing interior of the bone File:Sobo 1909 32.png, Sternum, lateral aspect File:Sternum location.png, Position of the sternum the thoracic cage File:Sternum.gif, Computer-generated image of ribcage turntable highlighting the sternum File:Sternum Anatomy by Jason Christian.webm, Sternum anatomy


See also

* Pectus carinatum * Pectus excavatum


References


External links

* {{Authority control Bones of the thorax Flat bones