Xiphoidalgia

Xiphoidalgia, also called xiphodynia, is pain localized to the xiphoid process, the small cartilaginous extension at the inferior end of the sternum. The pain is typically in the lower sternum and may be sharp, dull, or achy. It is often reproducible on palpation of the xiphoid area and can be worsened by bending forward, lifting, deep breathing, coughing, or activity. Onset can follow chest trauma, heavy coughing, prior sternotomy, or prolonged strain, but may occur without a trigger.

Common causes include musculoskeletal strain, costoxiphoid or sternoxiphoid joint arthropathy, inflammation of the xiphoid cartilage, and post-traumatic changes. Less commonly, referred pain from abdominal or esophageal conditions, or cardiac etiologies, may be mistaken for xiphoidalgia. The key clinical distinction is tenderness and reproducibility with palpation of the xiphoid process, absence of systemic symptoms, and a normal cardiac exam when indicated.

Diagnosis is clinical. If red flags such as persistent severe chest pain, dyspnea, syncope, fever, or signs of systemic illness are present, further workup is indicated. Imaging is not routinely required but may include chest radiography to exclude other pathology; ultrasound or CT can help evaluate the xiphoid region; ECG is used to assess cardiac causes; laboratory tests may be ordered if inflammatory or infectious etiologies are suspected.

Management is mainly conservative: patient education, avoidance of known triggers, NSAIDs or acetaminophen for pain, topical heat or cold, and gradual return to activity. Physical therapy focusing on posture and chest wall mechanics can help. If pain persists, local anesthetic or corticosteroid injections into the xiphisternal joints may be tried. In refractory cases, surgical removal of the xiphoid process (xiphoidectomy) has been described, but is uncommon.

Prognosis is typically favorable, with most patients improving with conservative measures within weeks to months. Chronic or recurrent cases require reassessment to exclude alternative diagnoses.