Ribs / Chest Wall
Xiphoid Syndrome (Xiphodynia)
검상돌기 증후군
Localized pain/tenderness at the xiphoid process (anterior chest wall)
- How common
- Uncommon (underdiagnosed)
- Typical age
- Middle-aged adults
What is it?
Trauma, angulation, or attached muscle/tendon inflammation at xiphoid — may mimic GI or cardiac disease.
Commonly affected: Xiphoid process and its muscular/tendinous attachments
How it develops
- Load/TraumaRepeated cough, CPR, direct blow
- Attachment InflammationRectus abdominis/diaphragm attachments inflamed
- Xiphoid AngulationProminence or altered angulation
- Referred PainChest, epigastrium, and back referral
Symptoms
- Focal tendernessPalpation reproduces symptoms
- Pinpoint xiphoid painLocalized pain just above epigastrium
- Epigastric referralMimics esophageal/gastric disease
- Posture-related worseningWorse with bending, rotation, or post-meal
- Occasional nauseaAbdominal referral symptom
How it is examined
- Direct xiphoid palpationPalpation reproduces patient's pain — diagnostic
- Assess prominenceCheck for prominence or angulation
- Normal abdominal examNo hepatobiliary/GI findings
- Normal cardiopulmonary examExclude cardiac/pulmonary causes
Imaging
Lateral chest X-ray shows xiphoid angulation/prominence.
- Anterior xiphoid angulation
- Prominence visible
- Largely clinical diagnosis
CT confirms angulation and attachment changes; diagnosis is largely clinical.
- CT: angulation/swelling
- Attachment inflammation
- Exclude alternatives
Non-surgical care
- Reassurance/activity modificationAvoid triggers; reassure benign
- NSAIDsInflammation/pain control
- Heat/massageLocal heat and gentle massage
- Posture/diet correctionAvoid overeating; upright posture
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Refractory to conservative care
Procedures that may be discussed
- Local steroid/lidocaine injection
- Xiphoidectomy (rare)
Outlook
Most respond to conservative care; injection or xiphoidectomy for refractory cases.