Pain in the middle of the chest when turning over may be caused by aseptic inflammation of the soft tissues of the chest or by injury. If injury is caused, there is usually a clear history of trauma, such as being hit or crushed in the chest, resulting in localized soft tissue damage in the middle of the chest, usually with localized swelling, and if there is bleeding of the capillaries underneath the skin, localized bruising may also be seen. Bruising and swelling can also be seen if there is subcutaneous hemorrhage of capillaries. Pain may be present during thoracic activity, such as deep breathing, or forceful lifting, or may be aggravated on top of the original pain. There is also localized aseptic inflammation, most commonly thoracic costochondritis, where there is aseptic inflammation of the cartilage between the sternum and the ribs. If the inflammation is severe, there will be localized flushing of the skin, increased skin temperature, and even localized redness, swelling and heat pain.