What can you do about it? Also called the metasternum, the xiphoid cartilage or if you want a tongue twister, the xiphisternum, the xiphoid process is a small extension of bone just below your ribcage.
That sort of explains the shape of the xiphoid as it looks like a very short sword, widest at the base and tapering off to a point heading off towards your stomach. It starts out as a structure made of cartilage at birth and then slowly hardens into the bone as you mature. What does the xiphoid do?
Well, nothing really active. For one, it serves as a landmark that indicates where chest compressions may be administered during cardiopulmonary resuscitation CPR. If you do, it may break off and puncture the lungs. The xiphoid also serves as an attachment point for organs and large muscles that make up the floor of the diaphragm.
It also plays a part in the abdominal muscles that compress and flex the abdomen. Even though the xiphoid is generally unobtrusive, it can be a source of pain, especially when it is inflamed. This pain is usually called xiphodynia, the xiphoid syndrome or even xiphoidalgia. The pain, which may be mild or far from mild, is generally felt in the lower part of the sternum, just above your abs.
Now, when there's a pain in the xiphoid process, there are many reasons why it may be so. This is a last resort procedure when other therapies fail.
To perform this surgery, a surgeon makes an incision along the base of the xiphoid process. Using electrosurgical dissection, the surgeon cuts and releases the exposed xiphoid process from the sternum, and then uses electrocoagulation electric currents to stop bleeding. You may have bruising after surgery and tenderness until the wound heals. Recovery times vary from person to person, but you may be able to resume normal activity within a few weeks. In one study, a year-old surfer was able to resume surfing 26 days after xiphoid process removal.
They can help you uncover the underlying cause and then discuss your treatment options. Somatic pain is constant and involves superficial injuries. Visceral pain is vague and often feels like a deep squeeze, pressure, or aching.
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COVID and anxiety can both lead to chest pain or tightness. However, there are many less serious causes of a tight…. Tietze syndrome involves a painful swelling or lump in or around the upper ribs. The symptoms are similar to costochondritis, but there are key….
Pain in your chest when swallowing food or drink can be alarming. If your chest hurts when you swallow, it could be due to a variety of conditions…. The area can feel tender for several weeks post-surgery until the wound has healed. Xiphoid process pain may produce discomfort, but is rarely a cause for concern. However, if anyone experiences a tight pain in the lower sternum for more than a week, they should seek medical attention.
Xiphoid process pain can be triggered by many different causes and is most commonly a result of acute chest trauma. Inflammation of the region can cause a lump to develop that may be mistaken for a more serious condition, such as a tumor or a hernia. Some fractures or breaks may require the xiphoid process to be surgically removed to prevent more serious internal damage.
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Learn more here, including when to seek…. He underwent routine laboratory tests with unremarkable results. Chest radiographs in two projections posteroanterior and lateral showed ventral deviation of the xiphoid process on the lateral view, explaining the mass-like protrusion palpated on the chest wall Figure 1. To exclude any bony lesion causing such symptoms, a CT scan of the thorax Siemens Somatom Spirit, multi-slice CT, Erlangen, Germany was performed and reformatted images in coronal, sagittal and axial planes were obtained.
On the sagittal images, the patient had a ventrally deviated xiphoid process confirming the lateral chest X-ray findings Figure 2. No other chest wall or upper abdominal mass was identified. Lateral X-ray shows hook-like anterior protrusion of the xiphoid process, which can be mistaken as a mass in the epigastric region on physical examination.
Thorax CT scan in the sagittal plane in reformatted image shows the hook-like anterior protrusion of the xiphoid process more clearly. This is considered an anatomic variation.
The xiphoid process was measured 4cm in the longitudinal dimension. No other pathologic condition was noted on the CT images. The patient was diagnosed as having the xiphoid syndrome according to the clinical and radiological findings.
Non-steroidal anti-inflammatory drugs were prescribed for 2 weeks and he was advised to avoid pressure on his xiphoid process while at work. The pain was relieved and his symptoms were reduced at follow-up after 3 weeks. At 3 months of follow-up, he mentioned that he used anti-inflammatory drugs only when he felt pain in his xiphoid region and that he had stopped using his anterior chest wall at work.
Trauma is an important factor in the aetiology of the xiphoid syndrome. Acceleration and deceleration injuries [ 1 ], blunt trauma to the chest [ 1 ], unaccustomed heavy lifting and aerobics have been known to precipitate xiphodynia [ 2 ], probably because of the muscular attachments to the xiphoid process. Cardiac or thoracic surgery also involves trauma to the chest wall, which may change the morphology of the sternum and cause xiphodynia. Enomoto et al.
They suggested that the xiphoid process was separated from the sternum and pulled down inferiorly by the rectus abdominis muscle and then reconnected to the sternum, so that it was elongated [ 3 ], a mechanism, which they suggested was similar to distraction osteogenesis in limb-lengthening operations [ 3 ].
Our patient had no history of any cardiac or thoracic surgery, but a history of repeated microtrauma to the sternum incurred during his work while leaning against wood and exerting force with his anterior chest wall. Microtraumas can result in stress fractures and may cause new bone formation.
New bone formation may also occur as a response to an insult such as tumour, infection, certain drugs, some arthritic conditions as well as trauma [ 4 ]. According to our observations, after the patient ceased using his chest wall while cutting wood, pain relief was established by the third week of the follow-up and anti-inflammatory drugs had helped to diminish the inflammation and resulting pain.
In conclusion, an occupational history as well as thorough clinical and radiological assessment can be import ant for correctly diagnosing and identifying the cause of rare conditions like the xiphoid syndrome. This disorder may be seen in people performing hard physical work who use their chest wall, such as the carpenter in our case.
Clinicians should be aware of this disorder and the diagnosis should be made by exclusion after careful examination and appropriate clinical investigation. Well-known causes such as acceleration and deceleration injuries and blunt trauma, unaccustomed heavy lifting and aerobics have been known to precipitate xiphodynia, the latter two because of the muscular attachments to the xiphoid process.
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