Lump on xiphoid process

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What you need to know about the xiphoid process

The xiphoid process is a small extension of bone just below the sternum. Discomfort in the xiphoid process can be painful as it can affect the lower ribcage, breastbone, and several major muscles located around the abdomen and diaphragm.

The name xiphoid derives from the Greek word for “straight sword” as the structure has a sharp tip, resembling a sword. It is also known by other names including the metasternum, xiphisternum, and xiphoid cartilage.

In this article, we discuss symptoms, causes, and treatment options for xiphoid process pain.

What is the xiphoid process?

The xiphoid process is a tiny bone structure located at the center of the chest, just below the lower part of the sternum.

At birth, the xiphoid process is formed from cartilage that eventually develops into bone.

During a person’s early life, the xiphoid process rarely causes any discomfort given its soft cartilage structure. However, as it hardens, it can cause some discomfort in later life for many reasons.

Symptoms of xiphoid process pain

Discomfort can range from mild to severe. A person may feel pain in muscle groups connected to the xiphoid process around the abdomen and chest.

Symptoms tend to come and go, making it a challenge to diagnose. It is also possible for the area to become inflamed, causing a lump to develop around the lower sternum.

This lump is a result of inflammation but can often be mistaken for a more serious medical condition, such as a tumor.

Causes of xiphoid process pain

A common cause of xiphoid process pain is acute chest trauma that has damaged the structure.

The xiphoid process is not protected or supported by surrounding structures, making it vulnerable to damage. This damage can occur during cardiopulmonary resuscitation (CPR) when a person applies too much pressure to the lower sternum.

Less common causes of xiphoid process pain can include:

  • overeating
  • acid reflux
  • lifting heavy objects or weights
  • repetitive strain on the torso


People who have felt pain in their lower sternum for more than 1 week should see a doctor for assessment.

Diagnosing xiphoid process pain can be challenging given the transient nature of symptoms and its proximity to several major organs and bone structures. For example, it can be initially mistaken for a broken rib.

The presence of inflammation forming a lump can also be mistaken for a tumor or a hernia.

Given the difficulty in confirming xiphoid process pain, doctors may recommend an X-ray, magnetic resonance imaging (MRI), or computerized tomography (CT) scan.

With the help of these images, it is possible to assess any damage to the structure and the extent of any inflammation.


Treatment for xiphoid process pain depends on its cause.

A doctor may prescribe anti-inflammatory drugs to reduce pain.

They may also recommend that a person experiencing pain from xiphoid process avoids high-intensity exercise or activities that put a strain on the area.

Damage to the xiphoid process itself is not severe.

However, if the xiphoid process breaks or fractures, it is possible for bone fragments to cause damage surrounding vital organs.

For example, it is possible for a bone fragment to puncture the lungs, which can be life-threatening.


In such cases, surgical interventions may be a necessary precaution against internal damage.

The xiphoid process can be removed using an electrosurgical dissection of the lower sternum. The procedure is considered safe, with a low risk of complications. 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.


Is My Chest Pain Caused by the Xiphoid Process?


The xiphoid process is the smallest region of the sternum, or breastbone. It’s made up of cartilage at birth but develops into bone in adulthood. It’s located where the lower ribs attach to the breastbone. The tip of the xiphoid process resembles a sword.

Although the xiphoid process is small, it serves as an attachment point for organs and large muscles that make the floor of the diaphragm.

What are the symptoms of xiphoid process pain?

Pain caused by the xiphoid process is called xiphoidalgia. Xiphoid process pain occurs for varying reasons. Pain — which can be mild, moderate, or severe — is typically felt in the lower part of the sternum. The sternum is the bone that makes up the middle front of your ribcage.

Pain is described as pressure or tightness, and you may have other symptoms like upper abdominal pain, chest pain, and back pain. Some people also notice a lump or swelling in this area.

Causes of pain in the xiphoid process

Xiphoid process pain has several possible explanations. Pain can occur after an accident that causes chest trauma. This damages the structure of the xiphoid process, causing it to bend or break off. Damage can also occur from incorrect cardiopulmonary resuscitation (CPR) or resuscitation with too much force. A broken xiphoid process increases inflammation, which leads to pain and tenderness in the chest.

You may also experience xiphoid process pain with acid reflux. This is when stomach acid backs up into the esophagus. Acid reflux can irritate the lining of the esophagus, and since the esophagus is located behind the breastbone, xiphoid process pain can develop along with reflux symptoms.

Other factors that contribute to xiphoid process pain include:

  • heart disease
  • overeating
  • lifting weights

Diagnosing xiphoid process pain

Xiphoid process pain caused by minor trauma may resolve itself. See a doctor if pain doesn’t improve after a couple of weeks or gets worse. A doctor may be able to diagnose problems with your xiphoid process based on your symptoms and the presence of a lump near your breastbone. Your doctor may ask about recent traumas and other symptoms you’re having, such as chest pain and coughing.

A lump near your xiphoid process can be mistaken for a tumor or hernia. For an accurate diagnosis, your doctor may schedule an imaging test of the lower part of your breastbone. An X-ray can reveal damage to the xiphoid process. If X-ray results are inconclusive, your doctor may recommend further testing. Additional diagnostic tools include an MRI and CT scan. These tests can take pictures of the inside of your body and help identify masses, inflammation, and other abnormalities.

Treatment for xiphoid process pain

Treatment for xiphoid process pain depends on the underlying cause and the severity of your symptoms. If symptoms occur after a recent trauma, your doctor may prescribe a prescription anti-inflammatory to relieve pain, or recommend alternating between hot and cold therapy throughout the day. Your doctor may also suggest limiting certain activities until the injury heals.

Modifying eating habits can treat xiphoid process pain associated with acid reflux disease. Eat smaller meals five to six times a day and avoid certain trigger foods (e.g., alcohol, chocolate, peppermint, and tomatoes). Acid reflux is also controllable with over-the-counter and prescription medications that reduce stomach acid and promote healing of the esophagus.

Surgical removal of the xiphoid process

Although the xiphoid process has a specific role in anatomy, a broken xiphoid process can cause serious problems, such as puncturing internal organs. Your doctor may recommend surgical removal for breaks or fractures. 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.

The takeaway

If you develop pain, a lump, or swelling in the xiphoid process that doesn’t resolve in a few weeks, you should speak with your doctor. They can help you uncover the underlying cause and then discuss your treatment options.

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A Case of Lymphoma Simulating Primary Sternal Tumour

APSP J Case Rep. Jan-Apr; 5(1): 2.

Published online Apr 1.

Atalay Sahin

Dicle University Hospital, Thoracic Surgery, Diyarbakir, Turkey

Find articles by Atalay Sahin

Fatih Meteroglu

Dicle University Hospital, Thoracic Surgery, Diyarbakir, Turkey

Find articles by Fatih Meteroglu

Sevval Eren

Medeniyet University, Medical School, Thoracic Surgery, Istanbul, Turkey

Find articles by Sevval Eren

Ayse Nur Keles

Dicle University Hospital, Pathology, Diyarbakir,Turkey

Find articles by Ayse Nur Keles

Author informationArticle notesCopyright and License informationDisclaimer

Atalay Sahin, Dicle University Hospital, Thoracic Surgery, Diyarbakir, Turkey;

Contributor Information.

corresponding authorCorresponding author.

Address for Correspondence:Dr Atalay Sahin,Dicle University Hospital, Thoracic Surgery, Kampus, Diyarbakir, Turkey [email protected]

Received Aug 22; Accepted Sep

Copyright © Sahin et al

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC.


Any mass on the chest wall may not always be the primary local pathology. A case of lymphoma with an aggressive course may involve the sternum through local invasion and can mimic a chest wall tumour. A year-old boy with mediastinal lymphoma presented with a sternal mass. Partial sternectomy with replacement by methyl methacrylate prosthesis was performed.

Keywords: Lymphoma, Sternum, Prosthesis


Majority of sternal tumours are malignant regardless of being primary or secondary. A slowly enlarging lump of the sternum may mimic as a primary pathology. A CT scan can also support it as sternal tumour spread to the adjacent tissues.[1,2] We managed a patient with a suspected primary sternal tumour; it was later found to be an extension of mediastinal lymphoma.


A year-old boy was referred to thoracic surgery clinic with a slowly growing non-tender mass on the anterior chest wall for 2 months. It was initially considered as a subcutaneous abscess because of slow growth and fluctuation on palpation. Ultrasound of the lesion reported as subcutaneous abscess. Needle aspiration of the lesion did not reveal any pus thus infection was ruled out. At the one-month follow-up, the overlying skin of the mass became whitish and its periphery turned reddish and inflamed. Patient also developed pain and tenderness locally. The size of the mass increased from 2x2 cm to 5x5 cm and involved the middle part of the sternum.

Laboratory tests were within the normal range. CT scan revealed a mass of 8x5 cm occupying the anterior mediastinum, eroding the sternum, extending subcutaneously as an expanding necrotic area. A thymic tissue of 4x2 cm and conglomerated lymph nodes without definite borders were also noted (Fig. 1). The second percutaneous needle biopsy of the lesion gave no aspirate. Pathological examination of the trucut needle biopsy could not prove malignancy. The patient was considered as having a sternal mass. For both the diagnosis and treatment, the anterior mediastinum was explored. Frozen section examination showed malignancy. Skin flaps were elevated over the tumour mass. The pectoral muscles were dissected from the chest wall laterally and superiorly. Total gross excision of the lesion was performed. The resection included the two thirds of sternal body, the anterior aspects of the third to sixth ribs bilaterally to the costochondral junctions. A discrete mediastinal mass of 8x10 cm and the attached thymus were also excised. The resultant bony defect of the anterior chest wall (about 10 cm) was covered with sandwich prosthesis with propylene mesh and methyl methacrylate. Medial compression of the chest from either side enabled the graft to be sutured without tension. The pectoral muscles were then re-approximated in the midline. Chest drain was left. The postoperative recovery was uneventful.

Pathological examination of the specimen revealed primary mediastinal B-cell lymphoma invading thymus, sternum and skin. Immunohistochemically, the malignant cells were positive for CD20, Bcl-2, LCA, CD43, EMA and negative for CD3, CD10, SMA, desmin, myoglobin, suggestive of B-cell lymphoma. Following surgery and adjuvant chemotherapy, the patient was clinically without evidence of recurrent disease and had an acceptable cosmetic appearance.


Tumours of the sternum are uncommon lesions. They present with localized pain. The masses in anterior mediastinum are more malignant compared to the other locations. These include thymoma, germ cell tumours, and lymphomas. Primary mediastinal lymphomas compose % of primary mediastinal tumours.[] Primary non-Hodgkin disease in the sternum hardly occurs and believed as an extension of the disease from the anterior mediastinal lymph nodes. The cortex and sponges were not intact in our case. The disease, however, involved both the mediastinal and anterior layers of the periosteum and exhibited marked reactive membranous bone formation. The disease involved the anterior mediastinal and parasternal nodes first, and then secondarily invaded the sternum by extension through the peristernal lymphatics, which were connected to the sternal periosteum and intramedullary spaces.[5]

The index case was an example of localized lymphoma. The exploration was done to determine resectability of a primary sternal tumour. The treatment of choice for a primary sternal tumour is total sternectomy when the deeper anterior mediastinal nodes are uninvolved. Even some localized lymphomas are amenable to aggressive surgical therapy.

To conclude, anterior mediastinal lymphomas may mimic as primary sternal mass. Fine needle aspiration and trucut biopsy were non-contributory to the final diagnosis. Sternectomy with complete apparent surgical resection of the tumour and adjuvant chemotherapy worked well for our patient.


Source of Support: Nil

Conflict of Interest: None declared

Contributor Information

Atalay Sahin, Dicle University Hospital, Thoracic Surgery, Diyarbakir, Turkey.

Fatih Meteroglu, Dicle University Hospital, Thoracic Surgery, Diyarbakir, Turkey.

Sevval Eren, Medeniyet University, Medical School, Thoracic Surgery, Istanbul, Turkey.

Ayse Nur Keles, Dicle University Hospital, Pathology, Diyarbakir,Turkey.


1. Zareifar S, Bordbar MR, Karim M. T-cell lymphoblastic lymphoma of the sternum. J Clin Oncol. ;e [PubMed] [Google Scholar]

2. Haspolat K, Söker M. Çocukluk ça&#x; lenfomalar&#x; ve kemik etkilenmesi. Dicle Med J. ; (Turkish) [Google Scholar]

3. Sekiguchi N, Nishimoto J, Tanimoto K, Kusumoto S, Onishi Y, Watanabe T. Primary mediastinal large B-cell lymphoma: a single-institution clinical study in Japan. Int J Hematol. ; [PubMed] [Google Scholar]

4. Kerry J. Savage primary mediastinal large B-cell lymphoma. Oncologist. ; [PubMed] [Google Scholar]

5. Faries PL, D'Ayala M, Santos GH. Primary immunoblast&#x;c B-cell lymphoma of the sternum. J Thorac Cardiovasc Surg. ; [PubMed] [Google Scholar]

Articles from APSP Journal of Case Reports are provided here courtesy of The Association of Paediatric Surgeons of Pakistan

Xiphoid Process and Breathing
Portia1&#;s picture
26 Aug

Found a hard lump on the bone of my sternum- concerned?

26 Aug

I’m a 22 year old female and today I noticed for the first time a small lump (about the size of a pea) near the centre of my chest. It feels like bone and is on my sternum. It’s only on one side and I’m certain it wasn’t there before (at least not since a few weeks ago). 

I’ve never had any serious physical health conditions but cancer does run strongly in my family.

Should I be worried and get it checked out, or is it likely just a weird bit of bone growth?

reet75&#;s picture
27 Aug

Found a hard lump on the bone of my sternum- concerned?

27 Aug in response to Portia1

Hi Portia

I had & still have a quite large lump om my sternum had it checked out at the hospital.Result nothing to worry about.piece of cartlige protruding.

But do go to your GP & get it checked out better safe than sorry.

Best wishes x

natasha1&#;s picture
6 Dec

Found a hard lump on the bone of my sternum- concerned?

6 Dec in response to reet75

Hey i have a large lump on one side of my sternum feels like bone i have been to my GP and today recieved an app with the breast clinic. did your GP refer you to the clinic too? im quite nervous

thanks x

Portia1&#;s picture
4 Nov

Found a hard lump on the bone of my sternum- concerned?

4 Nov in response to Portia1


its over a year later. I never went to the dr about this and I'm completely fine. Please don't take this as "it's also probably nothing for me, I'll be fine"- please go see your doctor if you're ever concerned! In my case I think I just have a bit of a boney sternum which I'd never noticed 

taylorpt&#;s picture
31 Jan

Found a hard lump on the bone of my sternum- concerned?

31 Jan in response to Portia1


I found lump on right side more on like my chest I don't know if this is the sternum? Cancer runs in my family but I spend so much time at the doctors that I feel like they think I just go for the sake of it! Trying to avoid doctors but I don't know if I should treat it as urgent or not? 

LTay&#;s picture
7 Feb

Found a hard lump on the bone of my sternum- concerned?

7 Feb in response to taylorpt


I also have a hard lump in the middle of my sternum. My GP sent me for an ultrasound scan which I went to today. I have been told it's a bony prominence and that I may also need an X-ray. He said it's nothing to worry about but to contact my GP for the results of the scan in a week. It's worth getting yourself checked out though to put your mind at rest. Let me know how you get on.

DHin&#;s picture
2 May

Found a hard lump on the bone of my sternum- concerned?

2 May in response to LTay

It is hard to describe but my right breast bone at the top feels more swollen than the left and its quite tender. So it isn't like a significant lump as in pea size. I think I am worrying myself but I do think that on Monday I may have to go visit the Doctor to get checked even though been at the Doctors not the best right now is it x Good luck everyone x

ktktkt&#;s picture
2 May

Found a hard lump on the bone of my sternum- concerned?

2 May in response to DHin

Hello, sounds like what I experienced a couple of years ago. I had an x-ray, conclusion was a bit of arthritis (a surprise as I was only 48 at the time). A course of naproxen helped with the tenderness, and if it flares up, over the counter painkillers help. No further treatment required. Hopefully yours is nothing serious too.


Recent discussions in Pre-Diagnosis, Signs & Symptoms


Xiphoid process on lump

What Causes a Lump on the Sternum?

A hernia may cause a body mass on the sternum and may require surgery.

Unexplained lumps in any area of the body are a cause of concern for many individuals. One such common complaint is the presence of a lump on the sternum in the chest. Although individuals may fear a tumor or some other serious cause, in a large percentage of cases the most probable explanation for a sternum lump is found in a normal body part: the xiphoid process. Other issues such as hernias or tumors may be responsible in some cases, however.

The cartilaginous xiphoid process may resemble a protrusion or lump.

The sternum is one of the primary bone structures in the chest. This structure runs vertically through the middle of the upper body. Its primary function lays in anchoring and connecting the ribs. The sternum begins with a dip at the base of the throat called the sternal notch. The resulting V-shape may feel like one or two knots. These lumps are normal.

In rare cases, a lump on the sternum may result from a tumor.

Around roughly the center of the chest, the sternum ends in a bone and cartilage protrusion. The protrusion is known as the xiphoid process or xiphisternum, and different individuals have varying sizes and shapes of the structure. In some individuals, the xiphoid process is more prominent and sticks out away from the chest. This anatomical feature may feel like a hard lump on the sternum, especially if an individual is in a reclining position. Weight loss may also cause the xiphoid process to become more noticeable.

Any type of tumor on the sternum may cause chest pain.

The xiphoid process is the likeliest explanation for many concerns regarding a sternum lump or sternum knot, but on occasion a medical issue may facilitate a lump on the sternum. Hernias are another common cause for body masses. These conditions result when part of an organ pushes against or even through the internal barrier that houses it. In the case of a lump on the sternum, protrusion of the stomach or the intestines may create the sensation. This type of hernia may be soft or hard and have associated pain, and it may be caused by a birth defect or by overexertion of the related bodily area.

A lump on the sternum may occur as a result of trauma sustained during an accident.

In rare cases, a lump on the sternum may result from a tumor. Such masses found in the sternum are often benign or non-cancerous. A cancerous tumor around the sternum usually occurs due to a malignancy’s spread from a neighboring structure like the lungs. Either tumor type may or may not feature chest pain and fever as additional symptoms, depending on the size and precise location of the mass. Sternum tumors are one of the least common types of cancer.

Is that lump a Sarcoma?

Xiphoid syndrome: an uncommon occupational disorder


We report a case of a year-old man, complaining of swelling and pain in his epigastric region for the last 3 years. According to his medical history, he had undergone various investigations and treatments for gastro-oesophageal reflux, without relief. He had had a history of chronic repeated microtraumas to his sternum during 9 years of working as a carpenter, as a result of placing wood against his anterior chest wall and pushing the former into a plank cutting machine. On examination, a tender swelling was palpable as an immobile, hard mass showing minimal protrusion under the skin on the xiphoid process. He was diagnosed as having xiphoid syndrome. We prescribed anti-inflammatory medication and advised him to avoid pressure on his anterior chest wall, especially on the sternum, while cutting wood. At follow-up, the symptoms were relieved. Xiphoid syndrome may be seen in people performing hard physical work who incur sustained pressure or friction on their anterior chest wall. The case emphasizes the importance of the occupational history as well as clinical and radiological investigation of unusual conditions as mentioned above.

Chest pain, xiphodynia, xiphoid syndrome.


Xiphoid syndrome involves painful swelling and discomfort of the xiphoid process of the sternum [1]. Inflammation of the xiphoid process, causing xiphodynia, arises from mechanical injury to that anatomic region. The prevalence of xiphoid syndrome is not well known as there is limited literature on this rare condition. In this article, we describe a case of xiphoid syndrome, occurring as a result of an occupational injury, drawing attention to this painful condition that can be mistaken for other causes of chest and upper abdominal pain.

Case report

A year-old male was referred to our clinic with swelling and pain in the xiphoid region. He complained of chest pain and discomfort when lying in the prone position or when light pressure was applied to his chest (for example, during hugging someone or taking a deep breath). Over the preceding 3 years, he had previously undergone extensive physical examination and laboratory and radiological investigations such as computerized tomography (CT) of the thorax and none of them had revealed any significant abnormality. He had used anti-inflammatory medication intermittently and yet had no complete relief. He had also undergone gastric endoscopy the previous year because of a provisional diagnosis of an ulcer as a result of pain and swelling in the epigastric region. Finally, his symptoms were attributed to gastro-oesophageal reflux and he used anti-reflux treatment for 14 months without pain relief.

On physical examination, an immobile, mass-like protrusion was palpated in the xiphoid region. The patient had a history of chronic repeated microtraumas to his sternum, as he had worked as a carpenter for 9 years. He mentioned that in his work, he placed pieces of wood against his anterior chest wall and pushed them forward into a plank cutting machine. We concluded that in using his anterior chest wall repeatedly in this way he had caused chronic damage to the xiphoid process.

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.

Figure 1.

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.

Figure 1.

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.

Figure 2.

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.

Figure 2.

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. [3] observed that in a patient with a history of mitral valve replacement, the xiphoid process was elongated by 6cm and protruded anteriorly, 1 year after the operation. 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.

Key points

  • 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.

  • Repeated microtraumas to the bony parts of the body during heavy physical activity can result in stress fractures and resulting new bone formation.

  • People performing hard physical work who use their chest wall to exert force may be predisposed to the xiphoid syndrome.

Conflicts of interest

None declared.


© The Author Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: [email protected]


You will also be interested:

X = The Xiphoid process. Everything you need to know.

Everything you need to know about the xiphoid process

Even though it sounds like some complex medical procedure, the xiphoid process is nothing more than a bone (or bony cartilage depending on how old you are) right at the base of your sternum.

Ordinarily, your xiphoid will give you no cause for worry over the cause of your lifetime. Since it is not a stress carrying bone, nor exactly movable, it pretty much just sits in the middle of your chest doing nothing, or next to nothing.

But in some situations, you may have issues with your unobtrusive xiphoid process. How do you know the pain you feel is from your xiphoid? What can you do about it?

We’ve provided answers to all these questions and more within this article.

What is the xiphoid process and what does it do?

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.

The name of the bone itself, xiphoid, derives from a Greek that basically means “straight sword”. 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.

The xiphoid doesn’t start out as a bone though. It starts out as a structure made of cartilage at birth and then slowly hardens into the bone as you mature. It takes a long time to harden though and will not entirely become bone until your early 40’s.

So if you’re less than 21, that bump you notice just below your sternum is unlikely to be your xiphoid. You’ll need to look elsewhere.

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). Just a caution here though: If you’re doing CPR, don’t lean on the xiphoid. If you do, it may break off and puncture the lungs. That’ll be serious.

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.

So, it doesn’t really do anything active and if you were suddenly to lose your xiphoid, you probably won’t miss it very much.

Pain and inflammation in the xiphoid process

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. They include pain from:

  • An accident that causes chest trauma
  • CPR went wrong
  • Acid reflux
  • Heart disease
  • Overeating (which may contribute to acid reflux)
  • Stress in the xiphoid due to weight lifting
  • If the lump you feel around your xiphoid is painless, then there may be a more natural explanation. The xiphoid is generally inverted. This means that for the majority of people, the xiphoid faces inward so there’s no lump on their chests.

    However, about 5% of people have what is called a “protruding” xiphoid process. For these people, the xiphoid protrudes out of the chest, forming a lump that may look like a tumour. It’s totally harmless though and a perfectly natural phenomenon.

    What is the treatment for damage to the xiphoid process?

    damage to the xiphoid process

    Well, before thinking about treatment, you need to visit your doctor first and confirm that what you do have is xiphodynia. Generally, if you have felt this pain for more than one week, then you should see a doctor for assessment.

    There may be some difficulty with the diagnosis due to the fact that the xiphoid could be mistaken for a lump or a hernia. Also, because of its proximity to several bone structures, it could be mistaken for a broken rib, especially where the pain is severe.

    Magnetic resonance imaging (MRI) or a computerized tomography (CT) scan will take care of the diagnosis nicely though. These tests can An x-ray can reveal damage to the xiphoid. If the x-ray results are inconclusive, your doctor may recommend further testing.

    The treatment for xiphodynia depends on its cause. Generally, and especially in the case of an accident, a doctor may prescribe anti-inflammatory drugs to reduce the pain. If it is caused by weight lifting, the doctor may also recommend that you avoid intense exercise or activities that put a strain on your xiphoid.

    Pain caused by acid reflux would ordinarily include recommendations to avoid foods that could trigger a reflux such as chocolates, peppermint and tomatoes.

    Surgery may be considered as a last resort in the event of severe damage to the xiphoid such as its breaking. If left that way, it may be very dangerous as there’s a risk that it will puncture the lungs.

    How do you hide the bump on your sternum?

    hide xiphoid bump future fit

    As mentioned earlier, if what you have is a painless bump, you may have no cause to worry. The bump, in this case, is most probably caused by a protruding xiphoid process, an entirely natural phenomenon.

    There’s no danger to you here. But some people are very self-conscious about what they fear may be perceived as a defect. So it’s normal for you to ask how you can hide the bump on your sternum.

    You may have heard (or may think) that doing some more exercise around your pecs and abs will hide the bump or make it less noticeable. Nothing can be further from the truth.

    When you exercise your pecs, only the muscles to either side of the sternum develop and get filled out. The area along your sternum will maintain its depression so what you have after exercising that area may be a more prominent bump.

    The best thing to do is leave it alone. The bump is entirely natural and hardly anyone will notice it. Unless, of course, if you keep directing their attention to it by being overly self-conscious.

    If you are intentional about getting rid of the bump, you can approach your doctor to explore the possibility of getting a surgery. You should think this over carefully though.


    As you have seen from this article, there are many reasons why you could be experiencing the pain below your sternum. But you need to take it slow and consult your doctor before taking any other steps.


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