title: Chronic poststernotomy pain after cardiac surgery: correlation of computed tomography findings on sternal healing with postoperative chest pain.
abstract: BACKGROUND
  The aim of this study was to correlate CT findings on sternal healing to late postoperative chest pain after median sternotomy.
  
  
  METHODS
  71 patients with a mean age of 69 ± 8.4 years were examined by CT-scan for normal or imperfect sternal healing at a mean follow-up time of 1.4 ± 1.6 years. Patients completed a questionnaire for chest and shoulder pain using a multidimensional pain score and visual analog scale.
  
  
  RESULTS
  Total 48 patients showed complete and 23 incomplete sternal healing. Although pain incidence was insignificantly higher after incomplete then after complete sternal healing (56.5% vs. 43%) pain intensity in the regions of chest and shoulder was almost equal between the two groups. Yet patients with a dehiscence over 3 mm in width had a significant higher chest pain intensity (17.5 ± 20 mm) compared with patients with a minor dehiscence (3.7 ± 8, mm p = 0.04) and those with normal sternal healing (8.1 ± 16 mm, p = 0.05). Furthermore, a dehiscence in more than one sternal segment led to a significantly higher pain intensity (chest: 18.8 ± 26 mm, shoulder: 23 ± 24 mm) compared with a dehiscence localized in only one segment (chest: 8.1 ± 18 mm, p = 0.04, shoulder: 4.6 ± 8.7 mm, p = 0.037).
  
  
  CONCLUSIONS
  In general, there is only a weak correlation between late postoperative chest pain and quality of sternal reunion. However, with an extent of failed sternal reunion over a width of 3 mm and the presence of imperfect ossification in more than one segment of the sternum, a significant increase of pain intensity in the regions of chest and shoulder was observed.
authors: Department of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University, Frankfurt am Main, Germany. npaps_@hotmail.com
authors: Nestoras
authors: N
authors: Papadopoulos
authors: Meltem
authors: M
authors: Hacibaramoglu
authors: Canan
authors: C
authors: Kati
authors: Dominik
authors: D
authors: Muller
authors: Julius
authors: J
authors: Flöter
authors: Anton
authors: A
authors: Moritz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D059350:Chronic Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D056346:Sternotomy / Q000009:adverse effects; D013249:Sternum / Q000000981:diagnostic imaging / Q000601:surgery*; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014945:Wound Healing