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It is a pointed cartilaginous extension attached to the sternum. It is the lowest and smallest part of the breastbone.
The xiphoid process, also known as xifisterno or metasternal, is initially a cartilage that ossifies, becomes hard and bony, in adults.
The xiphoid process is a small section of bone located at the base of the sternum at the 10th thoracic vertebra.
It is most commonly triangular in shape and may also have a small perforation within its structure.
In some cases, the xiphoid process will be bifurcated. This results in the development of the xiphoid process with two branches instead of a single point.
It is considered a normal variant in structure and is often found to follow family genetic lines.
Due to its physical form, the word xiphoid is derived from the Greek word xiphos, which means “straight sword.”
The xiphoid appendix is also known by other names, including:
- Ensiforme.
- Xiphoid process.
- Xiphoid appendix.
Anatomy of the xiphoid appendix
The xiphoid appendix extends from where the lower ribs join the sternum and ranges in size from tiny to several centimeters long.
The extension is marked by a small hole. It also has a sharp point that resembles that of a sword.
The part of the sternum located just above the xiphoid appendages is known as the manubrium. The xiphisternal joint is the immobile point between the two portions of the sternum. This process is sometimes naturally bifurcated and can also sometimes be perforated.
These morphological variations are not harmful to health. They just make the xiphoid process look different.
Development of the xiphoid appendages
This cartilaginous extension can be seen and felt in babies. At this stage, the xiphoid appendix is a lump located below the sternal notch.
It ossifies and fuses with the sternum as the individual grows. Cartilage becomes hard and bony at any time between 15 and 29 years of age.
This pattern of cartilage that ossifies with age is quite common in the human body.
Many other human bones, such as the growth plates of the limb bones, are also initially cartilage which is later replaced by bone.
Function of the xiphoid process
Initially made of flexible cartilage, the xiphoid appendix remains flexible from infancy to adulthood, before inevitably calcifying with age, through a process known as ossification.
Initial flexibility allows for adequate physical growth and development during childhood and adolescence while providing a level of protection for the development of certain internal organs, such as the heart and esophagus.
Sometimes the bulge is visible under the skin of babies and then it is not as visible.
Generally, the ossification of the xiphoid appendages is completed around the age of 40, resulting in the rigid structure that a person will maintain for the rest of a person’s life.
The xiphoid appendages do not have a particular function, but they function as an accessory and an anchor point for several important muscles, such as the transverse thoracic and rectus abdominis and especially the abdominal diaphragm, which is a sheet-shaped muscle necessary for breathing.
The xiphoid appendages and cardiopulmonary resuscitation
The xiphoid appendix can serve as a physical landmark for other parts of the human anatomy, such as the lower margin of the heart and the upper end of the liver.
This is used as a guide to ensure that medical professionals position themselves appropriately when performing CPR.
The framework is often used as a landmark in cardiopulmonary resuscitation, because this extension is easy to locate and can help to remember the location of the cardiac apex.
Care must be taken not to put pressure on the xiphoid process during cardiopulmonary resuscitation. It is an unsupported structure and can break under pressure.
Incorrect hand placement while CPR can fracture the xiphoid appendix and, in extreme cases, detach it from the rest of the sternum.
This presents a particular risk as the floating piece of bone can cause damage to other areas, including:
- The heart.
- The liver.
- Lungs.
A ruptured xiphoid appendix can damage various internal organs, it can also lead to a perforation in the diaphragm and cause severe pain and inflammation in the chest.
Sometimes the hand positions in CPR are unsafe as the hand extends beyond the base of the sternum in these positions and increases the risk of rupturing the xiphoid appendages.
Xiphoid appendage pain
Sometimes this structure can also bend to form a bulge that protrudes from an area around the chest. This lump generally does not cause any problems for the individual in the initial stage.
However, it can be very uncomfortable when the individual tries to lift weights or eats a heavy meal. This condition needs to be treated in the initial stage, otherwise it can cause serious problems.
Severe pain and inflammation may be experienced in the swollen xiphoid appendages. Sometimes this extension can break completely due to some accident or trauma.
It can cause various health problems, such as chest pain, breathing difficulties, and nausea. However, a protruding or ruptured xiphoid appendages generally does not cause the death of the victim.
When pain is felt in the area of the xiphoid appendages, it is known as xiphoid syndrome. The pain associated with xiphoidalgia is often characterized as sharp and deep.
In general, the associated pain worsens when the area is physically compressed, as well as with certain forms of movement, such as bending or twisting the torso. Also, the pain can radiate to other areas of the body.
Pain may be felt in the chest, back, or other chest areas. In some cases, pain in the arms or neck may also be experienced.
Depending on the areas affected by pain, the symptoms can mimic the pain symptoms commonly associated with a heart attack .
This can lead to the condition being undiagnosed due to more serious heart conditions being investigated.
In addition to heart disease, there are also similar symptoms present in the diagnosis of gallbladder disease and various forms of bone disease.
The intensity of the pain can vary. While some may find the pain tolerable, it can be excruciating for others.
In extreme cases, the severity of the pain experienced can lead to nausea sufferers.
Causes of pain
Pain can be caused by a variety of factors. While physical trauma is the most common source of pain, it is not the only known cause.
Some may experience xiphoid syndrome due to other inflammatory conditions, while others may be caused by a physical malformation of the structure.
Additionally, the inflammation and pain associated with xiphoid syndrome can occur spontaneously, without an easily identifiable underlying condition or injury.
Among the most common causes we have:
Injuries
The most common cause of pain in the xiphoid process region is the result of physical injury.
This can include compression caused by a collision with an object, such as the impact of a steering wheel in a car accident, or when the area is struck by a moving object, as can also occur in various sports activities.
Although the area is designed to allow some mobility to the body, high amounts of pressure can cause a fracture.
It is also possible to damage the area when a heavy object is lifted, or when the body is twisted.
This can occur when attempting a physical act that is not normally performed by the person, or within the scope of normal daily activity.
Injuries of this nature can also lead to localized swelling that can lead to additional sensitivity when the area is touched.
Tos
A cause of physical injury to the area can occur when you suffer from a cough.
The act of coughing can be somewhat traumatic, as a large number of thoracic muscles are used to help the lungs with the rapid expansion and contraction necessary to try to expel a foreign object or substance.
This type of injury is more common in conditions that cause long-term coughing, such as emphysema , although it can also occur during an acute respiratory illness .
Gastroesophageal reflux
Another common cause of pain around the xiphoid appendages is gastroesophageal reflux disease .
This is a disease that involves stomach acid flowing back through the esophagus, this disease can cause pain in the same regions as the xiphoid appendages. As the acid flows through the esophagus, it becomes irritated and inflamed.
This pain can be similar to xiphoid syndrome based on where the esophagus is located within the body.
Since the pains can be similarly localized, it can be easy to mistake the symptoms of one condition for the other.
It is also important to know that having one condition does not necessarily lead to the other, although it is possible to experience symptoms of both conditions simultaneously.
Changes in body weight
Some cases of xiphoid pain have been observed in people who have experienced significant weight loss. As a person gains weight, additional fat will be deposited in the abdomen.
This can cause the organs to change and the rib cage to expand, especially in cases of medical obesity .
This can result in additional outward pressure against the ribs and sternum, ultimately causing pain.
When the same person loses excess fat, the internal organs can change again.
The rib cage can continue to protrude even as the stomach area becomes smaller, leading to irritation around the xiphoid appendages.
Cancer
The protruding xiphoid appendages are often mistaken for a tumor, hernia, or even cancer.
However, the lump near the end of the breastbone is generally harmless although care must be taken so that it does not break completely.
Treatment
A doctor should be consulted immediately if pain is experienced in the lower parts of the sternum.
Usually various tests and examinations are performed, such as X-ray, the treatment is done based on the x-ray report.
Doctors generally recommend hot or cold compress therapy for this condition. There are also several medications that help decrease pain.
Patients are also advised to wear elastic bands to avoid further dislocation of the process. According to some people, the xiphoid appendages are not essential.
However, it works as an anchor for several important muscles. It can cause severe pain and health problems if the breastbone breaks.
The xiphoid appendages can be removed surgically. This surgical procedure is really complex and should be performed only by experts.
There are also other simpler surgeries to remove the extension. A cardio-thoracic surgeon should be consulted to decide the most appropriate surgery for an individual.
Surgery should only be considered after all other treatments to relieve xiphoid pain have failed .