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

By Adam Pick on February 24, 2015

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


Written by Adam Pick
- Patient & Website Founder

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.


Carol StJohn says on February 24th, 2015 at 6:08 pm

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..



Adam says on February 24th, 2015 at 6:24 pm

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 says on February 25th, 2015 at 11:50 am

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.



Adam says on February 25th, 2015 at 5:38 pm

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



Theresa Ramsburg Kinsey says on February 26th, 2015 at 11:02 am

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



Robert Crutchfield says on March 3rd, 2015 at 9:42 pm

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 says on March 15th, 2015 at 2:11 pm

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 says on March 28th, 2015 at 8:13 pm

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 says on June 16th, 2017 at 10:40 am

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”.



Mike Kleinsmith says on December 12th, 2018 at 9:47 am

Good Morning,
I had aortic valve replacement Feb 2018. I spent 3 days in hospital and sent home. Had I guess as normal pain. Started Cardiac rehab after 4 weeks and on day 1 had a pop in my chest and intense pain. Took a week off rehab per dr. Ever since I have had anywhere from discomfort to “DAMN that hurts pain”. I do very physically demanding work, Heavy Equipment operator,have not returned to work yet. I am 52 y/o. I still get the occasional popping in my chest. I have Long term disability thru work and they want me to go to social security disability. I have daily issues of discomfort to pain. Sometimes deep breathing hurts. They did a CT scan at 6mos and said it did not heal right and has separated at the top. He told me don’t lifted anything over 10 lbs.Now my surgeon was asked for medical records from disability and he wants me to return to work full duty ASAP. I know that I am not able to go back to what I do without having alot of pain. I already have a titanium plate. I rarely will take the hydrocodone for pain but occasionally I do. They want me to go to a pain clinic to ” Have the nerves deadened” in my sternum so stop the pain. I compare this to doing that in your finger and then hit it with a hammer. It doesn’t hurt but still causes damage. I am contemplating trying to go back to work, I do enjoy what I do.
Others say find a desk job. I have no office skills. I lift upwards to 100lbs daily at work and do it repeatedly. I have low grade to high grade pain daily. Some days hand over hand turning on steering wheel is painful.
Suggestions? Thoughts? do I disregard going back to work and living in extreme pain daily?
Stressed out and scared as hell to go back to work!


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