Is the xiphoid process tender?

From the Guidelines

Xiphoid process tenderness is typically managed with rest, ice, and over-the-counter anti-inflammatory medications like ibuprofen or naproxen for 7-10 days to reduce inflammation and pain. The xiphoid process tenderness is a common finding where the small cartilaginous extension at the bottom of the sternum is painful to touch. This condition, often called xiphoidalgia or xiphoid syndrome, typically results from direct trauma, repetitive strain, or inflammation 1.

Key Considerations

• The xiphoid process has limited blood supply and contains nerve endings that, when irritated, can cause significant discomfort despite the small size of this anatomical structure.
• Treatment includes applying ice for 15-20 minutes several times daily during acute pain, and taking over-the-counter anti-inflammatory medications like ibuprofen (400-600mg every 6-8 hours with food) or naproxen (220-440mg twice daily) for 7-10 days to reduce inflammation and pain.
• Avoid activities that worsen the pain, particularly those involving forward bending or pressure on the chest.
• Gentle stretching of the chest muscles may help relieve tension.
• If pain persists beyond 2-3 weeks, worsens significantly, or is accompanied by other symptoms like difficulty breathing or chest pain radiating elsewhere, medical evaluation is necessary to rule out other conditions. The provided evidence from studies 1 focuses on surgical techniques and ultrasound imaging criteria, which are not directly relevant to the management of xiphoid process tenderness.

Additional Recommendations

• It is essential to prioritize the patient's symptoms and medical history when evaluating xiphoid process tenderness.
• A thorough physical examination and medical evaluation should be performed to rule out other conditions that may be causing the tenderness.
• The patient should be advised to seek medical attention if the pain persists or worsens over time.

From the Research

Xiphoid Process Tender

• The xiphoid process is a part of the sternum that can be a source of pain, known as xiphodynia, which can radiate to the chest, abdomen, throat, and arms 2.
• Risk factors for developing secondary xiphoidalgia include GERD, gall-bladder disease, angina pectoris, and coronary-artery disease 2.
• The treatment of xiphodynia can range from conservative management to injections or a xiphoidectomy, depending on the patient's individual case and the degree of severity 2, 3.
• Anterior displacement of the xiphoid process may be the result of significant weight gain, repeated trauma, unaccustomed heavy lifting, exercise, and perichondritis, and can be a primary source of discomfort 3.
• Xiphoidectomy has been shown to be an effective treatment for xiphodynia, resulting in the disappearance of symptoms in some patients 3.
• The xiphoid process can exhibit significant interindividual variations, including ventral deviation, dorsal curving, and different shapes and endings, which can be evaluated using 64-row multidetector computed tomography (MDCT) 4.
• The anatomic evaluation of the xiphoid process using MDCT can facilitate the detection of variations and help in the diagnosis and treatment of xiphodynia 4.