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{{Short description|Small bony extension of the lower part of the sternum}}
{{Infobox bone
{{Infobox bone
| Name = Xiphoid process
| Name = Xiphoid process
| Latin = processus xiphoideus
| Latin = processus xiphoideus
| Image = Xiphoid process frontal.png
| Image = Xiphoid process frontal.png
| Caption = Position of the xiphoid process (shown in red).
| Caption = Position of the xiphoid process (shown in red)
| Image2 = Gray116.png
| Image2 = Gray116.png
| Caption2 = Posterior surface of sternum. (Xiphoid process labeled at bottom.)
| Caption2 = Posterior surface of sternum. (Xiphoid process labeled at bottom.)
}}
}}


The '''xiphoid process''' {{IPAc-en|ˈ|z|aɪ|f|ɔɪ|d}}, or '''xiphisternum''' or '''metasternum''', is a small [[Cartilage|cartilaginous]] [[Process (anatomy)|process]] (extension) of the inferior (lower) part of the [[Human sternum|sternum]], which is usually [[Ossification|ossified]] in the adult human.<ref>{{cite book|last1=Muscolino|first1=Joseph E.|title=The Muscle and Bone Palpation Manual with Trigger Points, Referral Patterns and Stretching|date=2008|publisher=Elsevier Health Sciences|isbn=978-0323051712|page=104|url=https://books.google.com/books?id=k-C07_fNiYsC&q=Xiphoid+process}}</ref> It may also be referred to as the ensiform process. Both the Greek-derived ''xiphoid'' and its Latin equivalent ''ensiform'' mean 'swordlike' or 'sword-shaped'
The '''xiphoid process''' ({{IPAc-en|ˈ|z|ɪ|f|ɔɪ|d}}), also referred to as the '''ensiform process''', '''xiphisternum''', or '''metasternum''', constitutes a small [[Cartilage|cartilaginous]] [[Process (anatomy)|process]] (extension) located in the inferior segment of the [[sternum]], typically [[Ossification|ossified]] in adult humans.<ref>{{cite book|last1=Muscolino|first1=Joseph E.|title=The Muscle and ''Bone Palpation Manual with Trigger Points, Referral Patterns and Stretching|date=2008|publisher=Elsevier Health Sciences|isbn=978-0323051712|page=104|url=https://books.google.com/books?id=k-C07_fNiYsC&q=Xiphoid+process}}</ref> Both the Greek-derived term ''xiphoid'' and its Latin equivalent, ''ensiform'', connote a "swordlike" or "sword-shaped" morphology.


==Structure==
==Structure==
The xiphoid process is considered to be at the level of the 9th [[thoracic vertebrae|thoracic vertebra]] and the T7 [[Dermatome (anatomy)|dermatome]].
The xiphoid process is anatomically situated at the level of the 9th [[thoracic vertebra]] (T9) and corresponds to the T7 [[Dermatome (anatomy)|dermatome]].


===Development===
===Development===
In newborns and young (especially slender) infants, the tip of the xiphoid process may be both seen and felt as a lump just below the sternal notch. By age 15 to 29, the xiphoid usually fuses to the body of the sternum with a [[fibrous joint]]. Unlike the [[synovial joint|synovial articulation]] of major joints, this is non-movable. Ossification of the xiphoid process occurs around age 40.<ref name="Moore Clinically Oriented Anatomy">{{cite book|last1=Moore|first1=Keith L.|title=Moore Clinically Oriented Anatomy|date=13 February 2013|publisher=LWW|isbn=9781451119459|page=84|edition=7}}</ref>
In neonates and young infants, particularly smaller infants, the tip of the xiphoid process may be seen as a palpable lump situated just below the sternal notch. Between the ages of 15 and 29, the xiphoid process typically undergoes fusion with the body of the sternum through a [[fibrous joint]]. Unlike the [[synovial joint|synovial articulation]] of major joints, this joint does not permit movement. Ossification of the xiphoid process typically occurs around the age of 40.<ref name="Moore Clinically Oriented Anatomy">{{cite book|last1=Moore|first1=Keith L.|title=Moore Clinically Oriented Anatomy|date=13 February 2013|publisher=LWW|isbn=9781451119459|page=84|edition=7}}</ref>


===Variation===
===Variation===
The xiphoid process can be naturally [[wikt:bifurcation|bifurcated]] or sometimes perforated (xiphoidal foramen).<ref>{{Cite journal |last=Yekeler |first=Ensar |last2=Tunaci |first2=Mehtap |last3=Tunaci |first3=Atadan |last4=Dursun |first4=Memduh |last5=Acunas |first5=Gulden |date=2006 |title=Frequency of Sternal Variations and Anomalies Evaluated by MDCT |url=http://www.ajronline.org/doi/10.2214/AJR.04.1779 |journal=American Journal of Roentgenology |language=en |volume=186 |issue=4 |pages=956–960 |doi=10.2214/AJR.04.1779 |issn=0361-803X}}</ref> These variances in morphology are inheritable{{Citation needed|date=April 2022}}, which can help group family members together when dealing with burial remains. These morphological differences pose no health risk, and are simply a difference in form.
The xiphoid process may exhibit natural [[wikt:bifurcation|bifurcation]] or, in some instances, perforation (referred to as a xiphoidal foramen).<ref>{{Cite journal |last1=Yekeler |first1=Ensar |last2=Tunaci |first2=Mehtap |last3=Tunaci |first3=Atadan |last4=Dursun |first4=Memduh |last5=Acunas |first5=Gulden |date=2006 |title=Frequency of Sternal Variations and Anomalies Evaluated by MDCT |url=http://www.ajronline.org/doi/10.2214/AJR.04.1779 |journal=American Journal of Roentgenology |language=en |volume=186 |issue=4 |pages=956–960 |doi=10.2214/AJR.04.1779 |pmid=16554563 |issn=0361-803X}}</ref> These morphological variations are [[Heredity|hereditary]],{{Citation needed|date=April 2022}} which can facilitate the categorization of family members when addressing burial remains. These morphological differences carry no health implications; they simply represent variances in form.


===Other animals===
===Other animals===
In birds, the xiphoid process is a long structure, often following the direction of the [[Keel (bird anatomy)|keel]].
In birds, the xiphoid process is an elongated structure, often following the direction of the [[Keel (bird anatomy)|keel]].


==Function==
==Function==
Much the way the first seven [[ribs]] articulate with the sternum, the cartilage in the [[celiac plexus]] joins on the xiphoid process, reinforcing it, and indirectly attaches the [[costal cartilage]] to the sternum. The xiphoid process is involved in the attachment of many muscles, including the abdominal diaphragm, a muscle necessary for normal breathing. It also anchors the rectus abdominis muscles ("abs").
Similar to how the first seven [[ribs]] articulate with the sternum, the cartilage within the [[celiac plexus]] attaches to the xiphoid process, reinforcing it, and indirectly connecting the [[costal cartilage]] to the sternum. The xiphoid process plays a role in the attachment of many muscles, including the [[abdominal diaphragm]], a muscle necessary for normal breathing. Additionally, it serves as an attachment point for the [[Rectus abdominis muscle|rectus abdominis muscles]], commonly known as the "abs."


==Clinical significance==
==Clinical significance==
Pressure on the xiphoid process should be avoided when administering chest compressions in [[cardiopulmonary resuscitation]] (CPR), as this can cause the xiphoid process to break and detach, resulting in punctures or lacerations of the [[Thoracic diaphragm|diaphragm]]. Additionally, the liver may be punctured, resulting in deadly internal [[hemorrhaging|bleeding]].
During chest compressions in [[cardiopulmonary resuscitation]] (CPR), it is possible to fracture or dislodge the xiphoid process, potentially leading to punctures or lacerations of the [[Thoracic diaphragm|diaphragm]]. Furthermore, inadvertent liver puncture resulting in life-threatening internal bleeding can occur.


[[Xiphodynia|Xiphoidalgia]] (Xiphodynia) is a syndrome distinguishable by pain and tenderness to the sternum. While some sources describe this disorder as rare, others suggest it is relatively common but overlooked by physicians. This is a musculoskeletal disorder that has the ability to produce a constellation of symptoms that can mimic a number of common abdominal and thoracic disorders and diseases.<ref>{{cite web |url= https://medlicker.com/984-xiphoid-process-pain|title=Xiphoid process pain (Xiphoidalgia): the ultimate guide | website= medlicker.com| publisher= }}</ref>
[[Xiphodynia|Xiphoidalgia]] (xiphodynia) represents a distinctive [[syndrome]] characterized by sternum-related pain and tenderness. While some sources categorize this disorder as uncommon, others suggest it may be relatively prevalent but overlooked by medical professionals. Xiphoidalgia is a musculoskeletal ailment capable of producing an array of symptoms that may mimic various common abdominal and thoracic disorders and diseases.<ref>{{cite web |url= https://medlicker.com/984-xiphoid-process-pain|title=Xiphoid process pain (Xiphoidalgia): the ultimate guide | website= medlicker.com| publisher= }}</ref>


Symptoms can include abdominal pain, chest pain, [[nausea]] and radiating pain to the back, neck, and shoulders. Lifting heavy objects or trauma to the chest may be the cause of this musculoskeletal disorder and pain may be heightened by bending or twisting. Anesthetic and steroid injections are commonly employed to treat this medical condition.<ref>{{cite web| url= http://cmbi.bjmu.edu.cn/uptodate/coronary%20heart%20disease/evaluation/major%20causes%20of%20musculoskeletal%20chest%20pain.htm | title= Major causes of musculoskeletal chest pain | website= cmbi.bjmu.edu.cn |publisher= |archiveurl= https://web.archive.org/web/20101213025042/http://cmbi.bjmu.edu.cn/uptodate/coronary%20heart%20disease/evaluation/major%20causes%20of%20musculoskeletal%20chest%20pain.htm |archivedate=December 13, 2010 }}</ref> The earliest known case of this was noted in 1712.<ref name="PMC2045657">{{cite journal| pmc= 2045657 | pmid=17868466 | doi= 10.1186/1746-1340-15-13 | volume=15 | title= Xiphodynia: a diagnostic conundrum | journal=Chiropr Osteopat | page=13 | last1 = Simpson | first1 = JK | last2 = Hawken | first2 = E| year=2007 }}</ref>
Symptoms associated with xiphoidalgia may include abdominal pain, chest discomfort, nausea, and radiating pain extending to the back, neck, and shoulders. Activities such as lifting heavy objects or chest trauma may precipitate this musculoskeletal ailment, and symptoms may intensify with bending or twisting. Common therapeutic approaches include anesthetic and steroid injections.<ref>{{cite web| url= http://cmbi.bjmu.edu.cn/uptodate/coronary%20heart%20disease/evaluation/major%20causes%20of%20musculoskeletal%20chest%20pain.htm | title= Major causes of musculoskeletal chest pain | website= cmbi.bjmu.edu.cn |publisher= |archiveurl= https://web.archive.org/web/20101213025042/http://cmbi.bjmu.edu.cn/uptodate/coronary%20heart%20disease/evaluation/major%20causes%20of%20musculoskeletal%20chest%20pain.htm |archivedate=December 13, 2010 }}</ref> The earliest documented case dates back to 1712.<ref name="PMC2045657">{{cite journal| pmc= 2045657 | pmid=17868466 | doi= 10.1186/1746-1340-15-13 | volume=15 | title= Xiphodynia: a diagnostic conundrum | journal=Chiropr Osteopat | page=13 | last1 = Simpson | first1 = JK | last2 = Hawken | first2 = E| year=2007 | doi-access=free }}</ref>


After age 40, a person may become aware of their partially [[ossified]] xiphoid process and mistake it for an abnormality.<ref name="Moore Clinically Oriented Anatomy"/>
Beyond age 40, individuals may become aware of their partially ossified xiphoid process and potentially misinterpret it as an abnormality.<ref name="Moore Clinically Oriented Anatomy"/>


[[Pericardiocentesis]], the procedure whereby fluid is aspirated from the [[pericardium]], often uses the xiphoid process as an anatomical landmark by which this procedure is carried out.<ref>{{cite book |last= Sam |first= Amir H. |author2=James T.H. Teo |title= Rapid Medicine |publisher= [[Wiley-Blackwell]] |date= September 2010 |isbn= 978-1-4051-8323-9}}</ref>
In the context of [[pericardiocentesis]], a medical procedure involving the aspiration of fluid from the [[pericardium]] of the heart, the xiphoid process often serves as an [[anatomical landmark]] for guiding the procedure.<ref>{{cite book |last= Sam |first= Amir H. |author2=James T.H. Teo |title= Rapid Medicine |publisher= [[Wiley-Blackwell]] |date= September 2010 |isbn= 978-1-4051-8323-9}}</ref>[[File:Final CD.jpg|85px|thumb|right|[[Sternum|Substernal]] fossa as superficial pendant of xiphoid process]]
[[File:Final CD.jpg|85px|thumb|right|[[Sternum|Substernal]] fossa as superficial pendant of xiphoid process]]


==Etymology==
==Etymology==
The word ''xiphoid'' derives from the [[Greek language|Greek]] word ''[[xiphos]]'' for straight sword, the tip of which the process somewhat resembles. The ''xiphoid process'' is a translation of Latin ''processus xiphoides''.<ref name="Siebenhaar1850">Siebenhaar, F.J. (1850). ''Terminologisches Wörterbuch der medicinischen Wissenschaften.'' (Zweite Auflage). Leipzig: Arnoldische Buchhandlung.</ref><ref name="Triepel1910b">Triepel, H. (1910). ''Die anatomischen Namen. Ihre Ableitung und Aussprache. Mit einem Anhang: Biographische Notizen.''(Dritte Auflage). Wiesbaden: Verlag J.F. Bergmann.</ref> The writings of the Greek [[physician]] [[Galen]]<ref name="Liddell & Scott">Liddell, H.G. & Scott, R. (1940). ''A Greek-English Lexicon. revised and augmented throughout by Sir Henry Stuart Jones. with the assistance of. Roderick McKenzie.'' Oxford: Clarendon Press.</ref> refer to ''Os xyphoides'' a translation of ξιφοειδές ὀστοῦν.<ref name="Liddell & Scott"/> Classical Latin ''os'' and Ancient Greek ὀστοῦν both mean bone, while ξιφοειδές means sword-shaped.<ref name="Liddell & Scott"/>
The term ''xiphoid'' originates from the Greek word ''[[xiphos]]'', which means 'straight sword', bearing a resemblance to the process's tip. The Latin equivalent, ''processus xiphoides'', translates to the xiphoid process.<ref name="Siebenhaar1850">Siebenhaar, F.J. (1850). ''Terminologisches Wörterbuch der medicinischen Wissenschaften.'' (Zweite Auflage). Leipzig: Arnoldische Buchhandlung.</ref><ref name="Triepel1910b">Triepel, H. (1910). ''Die anatomischen Namen. Ihre Ableitung und Aussprache. Mit einem Anhang: Biographische Notizen.''(Dritte Auflage). Wiesbaden: Verlag J.F. Bergmann.</ref> The writings of the Greek physician [[Galen]] refer to ''Os xyphoides'', a translation of the Greek phrase ξιφοειδές ὀστοῦν.<ref name="Liddell & Scott">Liddell, H.G. & Scott, R. (1940). ''A Greek-English Lexicon. revised and augmented throughout by Sir Henry Stuart Jones. with the assistance of. Roderick McKenzie.'' Oxford: Clarendon Press.</ref> In this context, ''os'' in [[Classical Latin]] and ὀστοῦν in [[Ancient Greek]] both denote 'bone', while ξιφοειδές signifies 'sword-shaped'.<ref name="Liddell & Scott"/>


==Additional images==
==Additional images==

Latest revision as of 16:05, 2 April 2024

Xiphoid process
Position of the xiphoid process (shown in red)
Posterior surface of sternum. (Xiphoid process labeled at bottom.)
Details
Identifiers
Latinprocessus xiphoideus
MeSHD014989
TA98A02.3.03.007
TA21135
FMA7488
Anatomical terms of bone

The xiphoid process (/ˈzɪfɔɪd/), also referred to as the ensiform process, xiphisternum, or metasternum, constitutes a small cartilaginous process (extension) located in the inferior segment of the sternum, typically ossified in adult humans.[1] Both the Greek-derived term xiphoid and its Latin equivalent, ensiform, connote a "swordlike" or "sword-shaped" morphology.

Structure[edit]

The xiphoid process is anatomically situated at the level of the 9th thoracic vertebra (T9) and corresponds to the T7 dermatome.

Development[edit]

In neonates and young infants, particularly smaller infants, the tip of the xiphoid process may be seen as a palpable lump situated just below the sternal notch. Between the ages of 15 and 29, the xiphoid process typically undergoes fusion with the body of the sternum through a fibrous joint. Unlike the synovial articulation of major joints, this joint does not permit movement. Ossification of the xiphoid process typically occurs around the age of 40.[2]

Variation[edit]

The xiphoid process may exhibit natural bifurcation or, in some instances, perforation (referred to as a xiphoidal foramen).[3] These morphological variations are hereditary,[citation needed] which can facilitate the categorization of family members when addressing burial remains. These morphological differences carry no health implications; they simply represent variances in form.

Other animals[edit]

In birds, the xiphoid process is an elongated structure, often following the direction of the keel.

Function[edit]

Similar to how the first seven ribs articulate with the sternum, the cartilage within the celiac plexus attaches to the xiphoid process, reinforcing it, and indirectly connecting the costal cartilage to the sternum. The xiphoid process plays a role in the attachment of many muscles, including the abdominal diaphragm, a muscle necessary for normal breathing. Additionally, it serves as an attachment point for the rectus abdominis muscles, commonly known as the "abs."

Clinical significance[edit]

During chest compressions in cardiopulmonary resuscitation (CPR), it is possible to fracture or dislodge the xiphoid process, potentially leading to punctures or lacerations of the diaphragm. Furthermore, inadvertent liver puncture resulting in life-threatening internal bleeding can occur.

Xiphoidalgia (xiphodynia) represents a distinctive syndrome characterized by sternum-related pain and tenderness. While some sources categorize this disorder as uncommon, others suggest it may be relatively prevalent but overlooked by medical professionals. Xiphoidalgia is a musculoskeletal ailment capable of producing an array of symptoms that may mimic various common abdominal and thoracic disorders and diseases.[4]

Symptoms associated with xiphoidalgia may include abdominal pain, chest discomfort, nausea, and radiating pain extending to the back, neck, and shoulders. Activities such as lifting heavy objects or chest trauma may precipitate this musculoskeletal ailment, and symptoms may intensify with bending or twisting. Common therapeutic approaches include anesthetic and steroid injections.[5] The earliest documented case dates back to 1712.[6]

Beyond age 40, individuals may become aware of their partially ossified xiphoid process and potentially misinterpret it as an abnormality.[2]

In the context of pericardiocentesis, a medical procedure involving the aspiration of fluid from the pericardium of the heart, the xiphoid process often serves as an anatomical landmark for guiding the procedure.[7]

Substernal fossa as superficial pendant of xiphoid process

Etymology[edit]

The term xiphoid originates from the Greek word xiphos, which means 'straight sword', bearing a resemblance to the process's tip. The Latin equivalent, processus xiphoides, translates to the xiphoid process.[8][9] The writings of the Greek physician Galen refer to Os xyphoides, a translation of the Greek phrase ξιφοειδές ὀστοῦν.[10] In this context, os in Classical Latin and ὀστοῦν in Ancient Greek both denote 'bone', while ξιφοειδές signifies 'sword-shaped'.[10]

Additional images[edit]

  • Position of xiphoid process (shown in red)
    Position of xiphoid process (shown in red)
  • Close up.
    Close up.
  • Shape of a xiphoid process (animation)
    Shape of a xiphoid process (animation)

References[edit]

  1. ^ Muscolino, Joseph E. (2008). The Muscle and Bone Palpation Manual with Trigger Points, Referral Patterns and Stretching. Elsevier Health Sciences. p. 104. ISBN 978-0323051712.
  2. ^ a b Moore, Keith L. (13 February 2013). Moore Clinically Oriented Anatomy (7 ed.). LWW. p. 84. ISBN 9781451119459.
  3. ^ Yekeler, Ensar; Tunaci, Mehtap; Tunaci, Atadan; Dursun, Memduh; Acunas, Gulden (2006). "Frequency of Sternal Variations and Anomalies Evaluated by MDCT". American Journal of Roentgenology. 186 (4): 956–960. doi:10.2214/AJR.04.1779. ISSN 0361-803X. PMID 16554563.
  4. ^ "Xiphoid process pain (Xiphoidalgia): the ultimate guide". medlicker.com.
  5. ^ "Major causes of musculoskeletal chest pain". cmbi.bjmu.edu.cn. Archived from the original on December 13, 2010.
  6. ^ Simpson, JK; Hawken, E (2007). "Xiphodynia: a diagnostic conundrum". Chiropr Osteopat. 15: 13. doi:10.1186/1746-1340-15-13. PMC 2045657. PMID 17868466.
  7. ^ Sam, Amir H.; James T.H. Teo (September 2010). Rapid Medicine. Wiley-Blackwell. ISBN 978-1-4051-8323-9.
  8. ^ Siebenhaar, F.J. (1850). Terminologisches Wörterbuch der medicinischen Wissenschaften. (Zweite Auflage). Leipzig: Arnoldische Buchhandlung.
  9. ^ Triepel, H. (1910). Die anatomischen Namen. Ihre Ableitung und Aussprache. Mit einem Anhang: Biographische Notizen.(Dritte Auflage). Wiesbaden: Verlag J.F. Bergmann.
  10. ^ a b Liddell, H.G. & Scott, R. (1940). A Greek-English Lexicon. revised and augmented throughout by Sir Henry Stuart Jones. with the assistance of. Roderick McKenzie. Oxford: Clarendon Press.

External links[edit]

This article uses anatomical terminology.
Wikimedia Commons has media related to Xiphoid processes.
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