Editing Xiphoid process

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

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

===Development===
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===
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|url-access=subscription }}</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===
In birds, the xiphoid process is an elongated structure, often following the direction of the [[Keel (bird anatomy)|keel]].

==Function==
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==
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) 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 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>

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"/>

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]]

==Etymology==
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==
<gallery>
 File:Xiphoid process animation.gif|Position of xiphoid process (shown in red)
 File:Xiphoid process below2.png|Close up.
 File:Xiphoid_process_-_close-up_-_animation.gif|Shape of a xiphoid process (animation)
</gallery>

==References==
{{Reflist}}

==External links==
{{Anatomy-terms}}
{{Commons category|Xiphoid processes}}

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[[Category:Bones of the thorax]]