Xiphoid Process: What Is It, Function, Injuries, and More

What Is It, Function, Injuries, and More

Author: Maria Giulia Boemi

Editor: Alyssa Haag

Editor: Ian Mannarino, MD, MBA

Editor: Kelsey LaFayette, DNP

Illustrator: Jessica Reynolds, MS

Modified: Mar 04, 2024

What is the xiphoid process?

The sternum is a bony structure at the midline of the anterior chest and consists of three parts: the manubrium, sternal body, and xiphoid process. The xiphoid process is a small, often triangular-shaped, bone that makes up the distal part of the sternum. The term xiphoid is derived from the Greek word “xiphos” meaning straight sword, which is used to describe the shape of this bone. It plays an important role in protecting underlying vital organs (e.g., the heart) and serves as an attachment point for muscles and ligaments.

Where is the xiphoid process located?

The xiphoid process is the smallest and most distal part of the sternum. It is typically located at the T9 or T10 vertebral level of the anterior thorax and is usually triangular. The base articulates with the sternal body forming the xiphisternal joint while the tip of the xiphoid points inferiorly. The length of the xiphoid process is typically between two and five centimeters. However, the size and shape of the xiphoid process may vary between individuals.

What is the function of the xiphoid process?

In general, the sternum protects the underlying mediastinal structures such as the heart; while also serving as an important attachment point for muscles (e.g., particularly those used in respiration) and ligaments. The anterior surface of the xiphoid process serves as an attachment site for the internal and external oblique muscles by way of their aponeuroses, or sheet-like structures of connective tissue that connect muscles to bones. The transversus abdominis and rectus abdominis muscles of the abdomen are also attached to the anterior surface of the xiphoid process. Together, these muscles help increase intraabdominal pressure for expiration. The anterior tip of the xiphoid process is where the linea alba, a fibrous midline structure running from the sternum to the pubic bone, is attached. The posterior surface of the xiphoid process serves as an attachment point for diaphragmatic slips, or muscular bundles of the diaphragm, that are responsible for contracting the diaphragm during respiration.

The xiphoid process also serves as an important landmark in determining hand placement for cardiopulmonary resuscitation (CPR). First, the lower part of the sternum is identified by locating the xiphoid process. Hands are then placed superiorly to the xiphoid process, at the middle part of the chest, to administer chest compressions. The xiphoid process is also a landmark for point-of-care ultrasounds such as the emergent Focused Assessment with Sonography for Trauma (FAST), which can quickly identify free intraperitoneal fluid or fluid within the pericardium (i.e., pericardial effusion or cardiac tamponade.) Additionally, the xiphoid process is an important landmark during cardiac surgery or during a pericardiocentesis, a procedure in which a needle is inserted inferiorly to the xiphoid process and into the pericardium to remove fluid.

Can the xiphoid process be injured?

Fortunately, injury to the xiphoid process is typically infrequent, however, the xiphoid process is a soft bone and is therefore susceptible to injury. Fractures usually occur in the context of trauma from motor vehicle accidents, sports injuries, or chest compressions during CPR. A fracture of the xiphoid process may lead to complications such as trauma to the underlying pericardium, heart, lungs, diaphragm, or liver. Fractures are often evaluated using a chest x-ray or CT scan of the chest and treatment typically consists of analgesics for pain and monitoring until spontaneous healing is achieved, which usually occurs over the course of ten weeks. If the bone is significantly displaced, surgical fixation may be performed to stabilize and join together the bone fragments.

Xiphoid syndrome, or xiphodynia, refers to pain in the xiphoid process, the xiphisternal joint, or any structure attached to the xiphoid process. Risk factors for xiphodynia include trauma or lifting heavy objects, gastroesophageal reflux disease, coronary artery disease, and angina pectoris. Xiphodynia may also occur in osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis as a result of inflammation of the xiphisternal joint. It typically presents as pain around the xiphoid process that may radiate to the chest, abdomen, throat, arms, or head and can often be mistaken for chest pain or upper abdominal pain. Physical examination may reveal tenderness with palpation around the xiphoid process. Due to its broad symptoms, it is often mistaken for other, more serious conditions (e.g., acute coronary syndrome, pericarditis, or GERD) and is therefore diagnosed commonly. There is limited evidence regarding the treatment of xiphodynia, though it is thought to be self-limiting and is generally treated with non-steroidal anti-inflammatories (i.e., NSAIDs) to reduce pain and inflammation. For persistent pain, injections of anesthetics or steroids have been used and in rare cases, a surgical procedure to remove the xiphoid process (i.e., xiphoidectomy) may be considered.

What are the most important facts to know about the xiphoid process?

The xiphoid process is a small, often triangular-shaped bone that makes up the distal part of the sternum. Its function is to protect underlying organs, serve as an attachment site for muscles that drive respiration, and provide a landmark for hand placement during CPR. Injury is typically infrequent but may result in a fracture of the xiphoid process or xiphodynia. Xiphoid fractures usually heal spontaneously. The treatment of xiphodynia typically consists of NSAID administration, though injections of anesthetics or steroids and surgery have also been proposed for severe or refractory cases.

Anderson BW, Holme MR, Alkhammash L, et al. Anatomy, Thorax, Xiphoid Process. [Updated 2023 Mar 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537076/

Bentley TP, Journey JD. Sternal Fracture. PubMed. Published 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507790/

Morton DA, Foreman K, Albertine KH, editors. Chapter 2. Anterior Thoracic Wall. In: The Big Picture: Gross Anatomy. McGraw Hill; 2011. Accessed July 30, 2023. Available from: https://accessmedicine-mhmedical-com.ezproxylocal.library.nova.edu/content.aspx?bookid=381§ionid=40140008

Kwon H, Kim Y, Kim K, et al. Where is the left ventricle during cardiopulmonary resuscitation based on chest computed tomography in the expiration with arms down position? PLoS One. 2018;13(2):e0193364. doi:10.1371/journal.pone.0193364

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Noor N, Amgalan A, Vij N, et al. Treatment and Management of Xiphoidalgia. Orthop Rev (Pavia). 2022;14(3):37070. doi:10.52965/001c.37070

Xiphoid Process

What Is It, Function, Injuries, and More

What is the xiphoid process?

Where is the xiphoid process located?

What is the function of the xiphoid process?

Can the xiphoid process be injured?

What are the most important facts to know about the xiphoid process?

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