Xiphodynia

Xiphodynia: Definition, Description, Causes and Risk Factors

Pain of a neuralgic character, in the region of the xiphoid cartilage.Xiphodynia is a condition involving referral of pain to the chest, abdomen, throat, arms and head from an irritated xiphoid process. The literature over a 60 year period reveals 12 citations relating to the terms xiphodynia and xiphoidalgia, with only 5 of these in English. The papers published between 1979 and 1998 present 10 cases of xiphodynia, all treated by localized injection. They reported on 24 cases observed over a seven year period where gentle pressure on a hypersensitive xiphoid reproduced all or most of the patients' presenting pain.xiphodynia MedigooThere are no clear data relating to the incidence or prevalence of xiphodynia. Most authors say that it is an uncommon disorder while researchers found the syndrome present in about 2 percent of the population of a general-hospital ward and stated that it is "far more common than is generally appreciated." They went so far as to suggest that examination of the xiphoid should be part of the routine examination of any patient presenting with upper-abdominal or chest pain.The xiphoid process is the smallest of the three sections of the sternum. It is a thin and elongated, cartilaginous in structure in youth, but becomes ossified at its upper part in the adult. The xiphoid may be broad and thin, pointed, bifid, perforated, curved, and may deviate laterally. The xiphoid forms a synchondrosis with the body of the sternum. On the front of each superior angle, there is a facet for part of the seventh costal cartilage.While xiphodynia is frequently insidious in onset, trauma may precipitate the syndrome. Acceleration/deceleration injuries, blunt trauma to the chest, unaccustomed heavy lifting and aerobics have been known to precipitate xiphodynia likely because of the muscular attachments. The cases presented here all gave a history of 'trauma' which appeared to be associated with the onset of symptoms.

Symptoms:

Xiphodynia is a musculoskeletal disorder capable of producing a constellation of symptoms that mimic several common abdominal and thoracic diseases including:
  • Cardiac chest pain.
  • Epigastric pain.
  • Nausea, vomiting and diarrhea.
  • Radiating pain into the back, neck, shoulders, arms and chest wall.

Diagnosis:

The diagnosis of xiphodynia is dependent upon the reproduction of the patient's symptoms completely or in part by moderate pressure on the xiphoid process and its adjacent structures.Even though xiphodynia often exists in the absence of any other medical condition, it has been demonstrated in conjunction with life-threatening disease such as cardiac disease including angina pectoris, myocardial infarction, and pericarditis. It is therefore imperative that any patient presenting to a primary health care provider with acute chest or abdominal pain be carefully investigated to establish a diagnosis and treatment plan where appropriate, emergency medical care must be rendered. In cases where a clear medical diagnosis cannot be established, a simple provocative test may uncover a symptomatic xiphoid process and establish the diagnosis of xiphodynia. In those patients who receive treatment for an established 'medical condition' in whom symptoms persist, consideration might be given to examining for xiphodynia.

Xiphodynia Treatment:

The 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. It is clear from these and other reported cases that xiphodynia may not be self-limiting. The medical 'treatment of choice' is an injection of local anaesthetic and steroid. Xiphoid injection, while often curative, is not without risk of complications including pleural or peritoneal perforation, pneumothorax, or infection.Conservative physical therapies are worth a trial, however no evidence exists for their effectiveness with xiphodynia.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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