ConditionBones, joints & muscles
Xiphoidalgia (Xiphoid Process Pain)
Xiphoidalgia is pain and tenderness at the xiphoid process, the small, pointed piece of cartilage and bone at the bottom tip of the breastbone. The pain is felt just below the center of the chest or in the upper belly, worsens when pressing on the spot, bending, twisting or after large meals, and may spread to the chest, back or shoulders. Causes include injury, overuse, inflammation and reflux. It is harmless but can mimic heart or stomach problems, so those should be ruled out first.
Also called: Xiphoid syndrome, xiphodynia, xiphoid process pain, hypersensitive xiphoid syndrome
At a glance
- What it is
- Pain arising from the xiphoid process at the lower tip of the sternum.
- Feels like
- Sharp or aching pain below the center of the chest, tender to press, worse with bending or after meals.
- Causes
- Injury (including CPR), heavy lifting, repetitive strain, inflammation, reflux, sometimes no cause.
- Look-alikes
- Heart pain, reflux, ulcers, gallbladder disease, costochondritis, hernias.
- Diagnosis
- Reproducing pain by pressing the xiphoid; tests to exclude other causes.
- Treatment
- Rest, ice or heat, NSAIDs, posture changes, steroid injection; rarely surgical removal.
When to get help
Call 911 or go to the ER
- Chest pressure, squeezing or pain spreading to the arm, jaw or back, with shortness of breath, sweating or nausea: call 911
- Severe upper belly pain with vomiting blood, black stools or a rigid belly
- Pain after a major chest injury with difficulty breathing
See a doctor within a day or two
- Upper belly pain with fever, yellow skin or eyes, or pain under the right ribs after meals
- A new, rapidly growing or hard lump at the bottom of the breastbone
Book a routine appointment
- Pain or tenderness at the bottom tip of the breastbone lasting more than 2 weeks
- A small bony lump at the tip of the sternum that is new to you or painful
- Pain that worsens after meals with heartburn
Usually safe to manage at home
- Mild tenderness at the xiphoid after lifting, a cough, or an awkward movement that eases with rest
What and where the xiphoid process is
The breastbone (sternum) has three parts: the manubrium at the top, the body in the middle, and the xiphoid process at the bottom. The xiphoid is cartilage in childhood and gradually turns to bone, often fully by middle age. Several muscles and ligaments attach to it, including parts of the diaphragm and abdominal muscles.
Many people suddenly notice a small, firm lump at the bottom of their breastbone and worry it is a tumor. Usually this is simply the normal xiphoid, which can be more prominent in thin people, after weight loss, or if it angles outward.
Symptoms
- pain or tenderness right at the bottom tip of the breastbone
- pain that may spread to the chest, upper belly, back, throat or shoulders
- worse with pressing on the xiphoid, bending forward, twisting, lifting or after large meals
- a feeling of fullness or pressure in the upper belly
- sometimes nausea
- a visible or palpable lump at the tip of the sternum
Causes
- trauma: a blow to the chest, car accident seat belt injury, or CPR chest compressions
- repetitive strain: heavy lifting, intense core exercises, coughing
- inflammation: of the cartilage and attachments, sometimes alongside costochondritis
- gastroesophageal reflux disease: reflux can irritate nearby nerves and cause referred pain
- gallbladder and stomach conditions: can cause referred pain to the area
- xiphoid variations: a forked, bent or elongated xiphoid
- unknown cause in many people
Conditions that can feel similar
| Condition | Clues |
|---|---|
| Heart attack or angina | Pressure, spreading to arm or jaw, breathlessness, sweating; not tender to touch |
| Reflux and heartburn | Burning behind the breastbone, sour taste, worse lying down |
| Peptic ulcer | Gnawing upper belly pain, relation to meals |
| Gallstones | Pain under the right ribs after fatty meals |
| Costochondritis or Tietze syndrome | Tenderness where ribs join the sternum higher up; Tietze has swelling |
| Epigastric hernia | Soft bulge in the midline below the sternum, worse with straining |
| Slipping rib syndrome | Pain at the lower rib margin with clicking |
Diagnosis
A doctor examines the chest and belly and presses on the xiphoid. If pressing reproduces the familiar pain, xiphoidalgia is likely. Depending on symptoms and risk factors, they may order:
- an ECG and sometimes heart tests to exclude cardiac causes
- X-ray, CT or ultrasound to look at the xiphoid, check for fractures, hernias or masses
- upper endoscopy or reflux testing if digestive symptoms are prominent
- blood tests or abdominal ultrasound for gallbladder disease
A diagnostic injection of local anesthetic at the xiphoid that relieves the pain confirms the diagnosis.
Treatment
- rest from activities that aggravate the pain, such as heavy lifting or intense core training
- ice in the first few days after injury, then heat
- NSAIDs such as ibuprofen or naproxen at the label dose, if safe for you
- posture changes: avoid slouching and prolonged bending
- smaller meals and reflux treatment if pain follows eating
- steroid and local anesthetic injection for persistent pain
- surgical removal of the xiphoid (xiphoidectomy): rarely, for severe pain that does not respond to other treatments; generally effective in carefully selected patients
Most people improve within weeks to a few months with conservative care.
Frequently asked questions
What is xiphoidalgia?
Xiphoidalgia is pain and tenderness at the xiphoid process, the small pointed tip at the bottom of the breastbone. The pain can spread to the chest, upper belly or back and is often worse with pressure, bending or eating.
Why do I have a lump at the bottom of my sternum?
Most often, the lump is the normal xiphoid process, which can become noticeable after weight loss or if it angles outward. Less often it may be an epigastric hernia, swelling from injury or, rarely, a tumor. See a doctor if it is new, painful, growing or hard.
Can xiphoid pain be a heart problem?
Xiphoidalgia itself is not a heart problem, but heart pain can be felt in the same area. Pain that feels like pressure, spreads to the arm or jaw, or comes with breathlessness or sweating needs emergency evaluation. Xiphoid pain is usually tender to the touch.
Why does my xiphoid process hurt after eating?
A full stomach presses on the area beneath the xiphoid, which can trigger pain if the xiphoid or its attachments are irritated. Reflux, ulcers and gallbladder problems can also cause pain after meals in this area and may need evaluation.
How long does xiphoidalgia last?
Many cases improve within a few weeks to a few months with rest, anti-inflammatory medicine and avoiding aggravating activities. Persistent pain may respond to an injection. Surgery is rarely needed.
Sources
This guide was written from current patient and clinical guidance, including:
- StatPearls (NCBI Bookshelf): Xiphoid syndrome; Anatomy, thorax, xiphoid process
- American Academy of Family Physicians (AAFP): Chest wall pain
- Cleveland Clinic: Xiphoid process pain
- MedlinePlus: Chest pain
- American Heart Association: Warning signs of a heart attack