Question
Hello Dr. Leatherman,

I have been having problems with my xiphoid process for about 4 months now, (I had a similar problem about 4 years ago, but it ended up simply going away after a few months). My Orthopedic M.D. has never x-rayed the area, (infact he has never touched the area), states that this is a tough condition to treat since everything I do basically affects the area. He has treated me with local injections directly into the sternum area, and is now trying a "schock-wave" therapy of related area. I also suffer from mild gastritis and GERD, but he states this has nothing to do with the condition. The pain is generally a dull, uncomfortable feeling which forces my abdominal muscles often to cramp up when sitting and i find that the xiphoid itself is hard and sensitive to touch or press upon. I am 46, and have recently undergone just about every test one can go through. All of the results state that I must be in great shape and yet this problem is a true "pain" literally speaking. If it is something I have to live with, well then I will have to deal with it.

Answer
Dear Thomas,

Pain in the immediate location of the xiphoid process is usually due to a direct trauma resulting in fracture or cartilage injury.  If there was no trauma then you could have irritated the connective tissue due due muscular strain or the articulation between the xiphoid and the sternum can be irritated.  This is often called Xiphodynia which describes an uncommon syndrome with a constellation of symptoms ranging from upper abdominal pain, chest pain, sometimes throat and arm symptoms which are referred from the xiphisternal joint or the structures attached to the xiphoid process.

Either way, your MD is correct that these issues are difficult to treat.  If there was no trauma it is understandable that the MD did not order an x-ray to look at the structure.  However, I am not surprised that he never even touched the area...this is often the case unfortunately, but in his defense, there are no specific orthopedic tests designed to test the xiphoid process either.  Did he actually give you a diagnosis of what he thinks the problem is?  

Most clinical literature suggests that xiphodynia is a self-limiting disorder to be treated with reassurance or with analgesics, topical heat and cold, and an elastic rib belt. The medical 'treatment of choice' is an injection of local anaesthetic and steroid often clestone.

The first thing I would recommend you do is examine your daily activities to see if there are repetitive motions that place stress or pressure on the xiphoid...either directly or through pectoralis or abdominal musculature contractions. However, conservative physical therapies are also worth a trial...the clinical use of pulsed therapeutic ultrasound, or low level laser therapy is worth exploring due to the fact that they have both been found to reduce inflammation and improve healing of tissue.  If the above does not help, prolotherapy is also worth exploring if the cartilagenous junctions are expected to be the original source of the pain.

Good luck Thomas, hope this helps.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net