Sternum pain after By-pass Surgery

[wn5dhm]

I am having persistent bone-like sternum pain 15 weeks after bypass surgery, and it is not getting better.  A CT scan report said the following.

FINDINGS: "No evidence of an osteomyelitis or sternal destruction is seen.  There is no peristernal abscess or bony erosion.  The margins of the sternum are somewhat irregular and there is overlap of 2-3 mm with the left side of the sternum anterior to the right in the more cephalad portion of the sternum."

CONCLUSION: "There is some overriding of the sternum and a concavity is forming in the left side of the sternum where the left overrides the right.  There is a smaller concavity in the right half of the sternum, especially at the level of the upper margin of the right ventricle.  However, there is no evidence of osteomyelitis or acute erosive or inflammatory process."

My surgeon doesn't know what to make of the sternum overlap and says the only thing he knows to do is to take out the continuous stainless steel cable that was used to reattach the sternum after surgery and see if that helps the pain, but he recommends that only as a last resort.  He said the pain may eventually go away on its own but that I should get a second opinion from someone who has had more experience with post-op sternum problems.  I don't want further surgery if it can be avoided, but the pain is really bad at times.  Will removing the cable help?  Is the sternum overlap something that needs to be corrected?  If I ignore it, will I be causing problems or damage that would make it more difficult to fix later on?  
                  

[CCF-M.D.-RCJ]

wn5dhm,

I think your surgeon's advice to get a second opinion is a wise one -- never ignore a physician who refers you away from himself for a second opinion.  This action is generally a call for help or an admission of being stymied.

Unfortunately, I'm not a surgeon and I have never encountered this problem.  Furthermore, a proper answer to your question will require looking at the CT scan, not hearing about the report.

I would urge you to see an experienced surgeon at a major medical center. Be sure to bring the scans.  Also, if you are experiencing fevers, weight loss, chills, malaise, etc; then reconsider the diagnosis of osteomyelitis with your current doctor. Sometimes a repeat CT scan will show progression or regression that can help guide decision making.

Good luck.

[wn5dhm]

If anyone reading this has had any experience with sternum pain, the sternum healing with an overlap or not otherwise healing properly after bypass surgery, I would appreciate very much hearing your comments about what was done, if anything, and what were the consequences.  Thanks.

[garyr]

at CCF whose surgeons used the mini-sternotomy, I experienced what was about average pain immediately post-op but about three weeks post-op it had not subsided and stopped responding even a little bit to three separate powerful prescription pain killers.

My cardiologist thought his diagnosis of 'costochondritis' was accurate and moved me to a new drug (I believe it was Lodine) though I'd have to double check it. Within 3 days the pain was nearly half and within a week it was nearly gone. I couldn't believe how much it helped me. IF not treated with the proper medication and pain killer, I have no doubt I'd have still been in pain 15 weks post-op.

Hope this helps. If you like I will verify the pain killer he prescribed.

[wn5dhm]

Thanks very much for the information.  If you can verify the drug that you were given, I would much appreciate it.  I will tell my doctor about it.

[garyr]

It was 300 mg of Lodine I was taking for about 3-4 weeks (9-10 weeks post-op) at that point. Toradol was tried earlier but this drug is very tough on the system and was stopped (it didn't work well, either)

[wn5dhm]

Thanks

[DelsT]

I am 41 years old.  I had a failed angioplasty last January 2002.  I then had emergency by-pass surgery. Here it is October and I am still having problems with my sternum.  My cardiologist said that it could take 1-2 years for it to completely heal.
It moves sometimes.  And makes cracking noises.  Or if I cough - it pops.  None of the drs. seem to be that concerned about it.  The pain has gotten better tho.  So it must be healing.
Thanks

[wn5dhm]

Thanks for the info.  I feel better knowing that sternum pain and healing problems after by-pass are not unusual.  My doctor put me on a heavy steroid treatment for one week, and then Vioxx daily after that.  The pain is lessened somewhat.  Next, they are going to do another angiogram to make sure the by-passes are holding up OK.  They seem to be far more concerned about that than they are about the sternum healing up with an overlap.  If the pain continues or gets worse again, they are going to consider removing the continuous cable used to bind the sternum together after surgery.  My heart surgeon says that the cable is a relatively new technique they have used up to now on about 2000 patients, and they have had to remove it two of the cases so far.  If I knew for sure that it would immediately stop the pain, I would say go for it right now. But no one so far can tell me whether the pain is coming from the cable or the sternum overlap, and it appears that there is no way to tell.  Someone suggested that maybe taking the cable out would allow the sternum to realign itself properly.  If so, that would be an easy fix for the problem.  Thanks.

[3dogs2kids]

I'm 18 months post bypass due to a miserably failed angioplasty in which the doctor slipped and severed all the main arteries in my heart causing me to have 2 stents and a triple bypass to save my life.

I do have sternum pain occasionally at this late date and it can take anywhere up to 2 years or more for the pain to go away. Part of my chest is still numb as well. I have pains in the area of the incision. It's extremely sensitive. The "overlapping" is normal as far as I know because they did have to wire you together, afterall. My  surgeon, tops in his field, advised me of the very symptoms you are complaining of before I even left the hospital. It's all in writing in a little kit I have.

You spent many hours in very strange positions on the operating table, they sawed you open, tied you shut and you are concerned because of pain 15 weeks post-op? Then you're surgeon doesn't know? I think I would take his good advice and seek another opinion before you subject yourself to unnecessary surgery and perhaps more scar tissue which can be painful.

I think we all need to relax a bit with this. Every little pain is not a problem. Concentrate on the big picture. We are alive!

Have a great day and good luck!

[DelsT]

I would love to relax about this.  However when I am in constant pain and everytime I move or cough or sneeze my sternum crackels and pops - it just seems to me that there is something wrong.  
Yes I am very glad to be alive.  I would also like to be progressing a bit more than this - its been 9 months!!!!
Why is it that most of the people that I have seen or talked to that have had their chests sawed apart do not seem to have the problems like I have been having.
For at least 1 month after surgery I could not lift my lower arm, hold a pen or feed myself.  I feel like they literally ripped me apart.

[poneken]

I am 44 year old, just had a successful Mitral Valve Repair done this summer.  However, after surgery, I have the same problem on my sternum - it pops when I cough, it clicks sometime when I turn my head or body!  It's been 4 months since the surgery, now the click is not that often, but still exists. I still can't cough freely.  

I remember when I was in hospital, one resident surgeon said to me "if the clicking don't go away in 2~3 months, we may need to redo it".  It's quite scary.  I am living a life with the fear that my sternum may not heal completely!   Does anyone know what I should expect in this situation?!  Will the sternum eventually heal?!  Thanks

[ritagangwani]

i am facing the same problem as u. too much of pain under the suture line, biting sensation of wires and numbness of left chest with some kind of pain running in diagonal direction. everone says that some nerve is pressed due to wires and i need to get them removed. pl advise!!

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