“What About Sternal Nonunion After Heart Surgery?” asks John

I just received a great question from John about sternal clicking after open heart surgery.

In his email, John writes to me, “Adam,  I have a sternal click.  It started 2 days post op where I was having trouble sleeping on my back. Attempting to sleep on my side, I felt a decisive “thud” and immediately rolled back and my chest seemed to right itself back.  I continued to experience this click as I had little sternal pain and was liberal in my movements.  I then researched the topic and came across some info on nonunion of the sternotomy and became concerned.  Is this common for patients? What is a nonunion of the sternum? What can be done to prevent this? What can be done to correct it? Thanks! John”

Xray of Sternon NonunionXray of Sternal Nonunion

To get John an expert response, I contacted Dr. T. Sloane Guy, from Weill Cornell Medicine. Dr. Guy is the chief of cardiac surgery at Temple and has help several patients in our community including Scott Carson, Arthur Rundstrom, Arthur Perry and Joseph Gowaskie.

Dr. T. Sloane Guy, Temple HealthDr. T. Sloane Guy, Heart Surgeon 

In his response to John’s question about sternal clicking, Dr. Guy writes:

John, Sorry to hear of your trouble.  Yes, sternal “non-union” can occur.  This is where the two halves of the sternum or breastplate fail to heal together as they should after heart surgery.  Early after heart surgery, this may mandate an operation to fix the problem depending on the presence, absence, or extent of infection.  Later, after the chest is healed, if a sternal non-union is present, it can be treated easily with sternal plating or sometimes just left alone depending on symptoms.  The best way to sort this out is with a CT scan of the chest to really see the problem and a visit with the patient to determine the level of significance of the problem. It can heal by itself.  It is fairly uncommon but not rare and in my practice we see in once a year or so.

So you know… Like John,  I also experienced sternal clicking and incision irritation following my surgery. In time, the click and the discomfort went away. During cardiac rehabilitation, I found that stretching and exercise were very helpful in this process. Even now, 9 years after my surgery, my chest can get a little annoying at times. However, once I stretch and/or exercise, the discomfort just goes away.

I hope this helped John (and perhaps you) learn more about the possibility and treatment of sternal nonunion after heart valve surgery.

  • To watch Dr. Guy’s video about robotic mitral valve surgery, click here.

Keep on tickin!

Adam Pick
Written by Adam Pick

Adam Pick is a patient, author of The Patient's Guide To Heart Valve Surgery and the founder of HeartValveSurgery.com.

To learn how Adam has helped millions of people with heart valve disease, watch Adam's video, subscribe to his free newsletter, or visit his Facebook, or Twitter pages.

  • Carol StJohn

    I had post sternum clicking but was fore warned about it…it would happen when I moved the wrong way or if I pushed or pulled with my arms..,it has been almost 7 months post op and the clicking only occurred for the first 2 weeks…everything is fine now..

  • Hey Carol, Great to hear your expectation about the clicking was managed. That’s great. And, it’s great to hear your click went away so quick! 🙂

  • Theresa Ramsburg Kinsey

    I don’t have clicking, but I have a big groove that never filled in completely. It doesn’t give me any problem just feels weird if I run my fingers down my incision.

  • Hi Theresa, Where is the groove in your incision? Glad to hear it’s not causing any issues!

  • Theresa Ramsburg Kinsey

    The groove is under my incision, in my sternum. My cardiologist seem a little baffled.

  • Robert Crutchfield

    I had the sternum clicking for a very short period during my rehab stay….then one day it just stopped and I have had no clicking since (a year next month)! They wire those halfs together pretty good, so the healing can take place not unlike a broken arm or whatever. I will admit it scared me when it first clicked until my surgeon explained that it is pretty common and usually BRIEF!

  • Janice Meeks

    That has been had triple bypass surgery back in July he had the clicking in the noises in his chest. In November ended up going back and getting re-cracked open and had to Talons put in and now he continues to hurt below those , the doctors just keep pushing him off to either one or the other- surgeon says go to the cardiologist – cardiologist says go to the surgeon is a never ending battle and he’s about ready to give up any suggestions what this might mean? Btw: he’s 47 yrs old and never had heart issues, cannot go back to work yet and had over 20 blockages and an extra veins in heart. Please help us- this is depressing and with no insurance we cannot just go to any doctor.

  • Mindy Pfeiffer

    I have recently developed something that sounds like a squeak in my chest. It happened after I tripped over a signpost that had fallen onto the sidewalk. Because it took me by surprise, I fell very hard, right on my sternum. (I have had 2 mitral valve replacements, last one 11 years ago) So far, my cardiologist can’t figure out what it is, and he wants me to do a CAT scan. Anyone ever experience anything like this? it sounds a bit like the sternal nounion described above.

  • William Elbogen

    I had aortic valve replacement three months ago (turned 60 in May). Being an avid swimmer, I was told I could go back to the pool after two months. I went in the water at 8 weeks and while it was a slow go at first, with sternal pain, I persevered, lasted my usual hour, and kept swimming almost every day. Now, 4 weeks later, I’m much stronger, however, I still have moderate pain in the sternum – not so much during the swim, rather, later in the day – but it’s usually gone by the next morning. My cardiologist thinks I should give it a rest because he’s worried about non-union. I’ve not had any clicking or feelings of shifting in the stenum, and my surgeon’s NP does not think there’s any cause for concern. Now I’m torn between my cardiologist’s concerns and my desire to continue swimming. Sure, I can schedule a CT Scan to verify but I’m im-“patient”.

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