Xiphisternum Pain · Xiphoid Process · London
The ECG was normal. The gastroscopy was normal. The pain is still there.
If you have xiphoid process syndrome, you have probably been through the cardiac pathway — ECG, possibly echocardiogram — and told your heart is fine. You may have been treated for acid reflux for months or years without much change. The pain is real and it’s located precisely at the tip of your breastbone. In many patients, a 30-second clinical examination of the xiphoid process reveals the diagnosis that years of investigations missed. If pressing firmly on the base of your sternum reproduces your exact pain — this page is probably relevant to you.
The diagnostic test you may not have had. The most useful clinical test for xiphodynia is direct palpation of the xiphoid process — firm pressure applied to the xiphoid tip reproduces the pain exactly. If pressing specifically on the tip of the sternum reproduces your pain and the pain resolves when pressure is released, xiphoid process syndrome is very likely. Many patients have had full cardiac workups, gastroscopies, and chest X-rays before anyone presses on their xiphoid.
Symptoms, diagnosis, and surgical treatment
- Pain at the lower end of the breastbone (xiphoid area)
- Pain reproduced by direct pressure on the xiphoid process
- Pain worsened by bending forward, lying down, or eating a large meal
- Pain radiating to the upper abdomen, lower chest, or shoulders
- Often described as sharp, stabbing, or aching
- History of previous negative cardiac and GI investigations
- Small incision directly over the xiphoid process (3–4 cm)
- Xiphoid process detached from the sternum and removed
- Day case or 1-night stay under general anaesthetic
- Return to normal activity within 2–4 weeks
- Small scar at the base of the sternum
- High success rate for pain relief when diagnosis is confirmed
Diagnosis is primarily clinical — based on the characteristic location of pain, the palpation test (reproduction of pain by direct pressure on the xiphoid), and exclusion of cardiac and gastrointestinal causes. A CT scan can identify an abnormally shaped, calcified, or deflected xiphoid process. Local anaesthetic injection into the xiphoid is sometimes used both diagnostically (relief of pain confirms the diagnosis) and therapeutically as a temporary measure before considering surgery.
For patients with a properly confirmed diagnosis of xiphoid syndrome — pain directly arising from the xiphoid, reproduced by palpation, having excluded other causes — surgical excision produces excellent pain relief in the majority of patients. The key is confirming the diagnosis before surgery. Patients in whom the xiphoid is not truly the primary pain source are unlikely to benefit from excision, which is why the pre-operative assessment is important.
The two conditions overlap in symptom pattern — both produce upper abdominal and lower chest pain that is worse after meals. Xiphoid syndrome specifically produces pain that is localised to the xiphoid tip and reproduced by pressing on it. If antacid treatment has not resolved your pain, and pressing on the base of your sternum reproduces your exact pain, xiphoid syndrome is worth properly investigating. A consultation will examine you specifically for this and clarify whether the diagnosis applies.
Years of investigations and still no answer?
A 5-minute clinical examination of the xiphoid process can confirm or exclude this diagnosis. Book a consultation and find out whether this is what’s been causing your pain.
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