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What Are the Most Common Causes of Damage to the Xiphoid Process?

The xiphoid process lies at the base of the sternum.
CPR carries a high risk of injury to the xiphoid process.
The xiphoid process can be damaged by contact with a helmet in football.
A baseball pitcher is at risk of suffering a damaged xiphoid process from a line drive.
Rugby sometimes involves direct blows to a player's chest.
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  • Written By: Shelby Miller
  • Edited By: W. Everett
  • Last Modified Date: 12 October 2014
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The xiphoid process is the lowermost portion of the sternum, or breastbone. It is the small, tapered piece of bone that projects downward from the point where the two sides of the ribcage meet in the middle. Since it is so exposed, this bone is susceptible to fractures, in which it breaks off from the body of the sternum. Damage can be caused by any blunt trauma, such as a blow to the chest as occurs during contact sports or in a vehicle accident, or during cardiopulmonary resuscitation (CPR), when the caregiver uses improper technique when delivering chest compressions.

Situated in the very center of the chest, the xiphoid process can be located shortly below the nipple line in the space where the bottommost ribs meet. As it descends a short distance into this middle space and therefore is unprotected by the rib cage, and also because it lies so close to the skin, a blow to the chest can easily damage the process or break it off all together. The latter injury is considered very dangerous, not because of this bone’s function — it serves as an attachment site for the diaphragm muscle and for the rectus abdominus muscle in the abdomen — but because the broken piece of bone can easily puncture the heart, which lies immediately behind the sternum.

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Blunt trauma is the most common cause of damage to the bone, with contact sports a frequent arena in which this injury is seen. In American football, for instance, the bone can be damaged when a player drives his helmet into another player’s chest. Rugby and boxing are two other sports in which athletes may apply direct blows to each other’s chests. Other causes of bodily trauma that may damage it include car accidents in which the body is thrown into the steering column, or being struck in the chest with a blunt object, such as a baseball pitcher being hit with the ball.

Another activity with a high risk of damage to the xiphoid process is CPR. Kneeling on the floor alongside an unconscious person who is lying face-up, the rescuer places the heel of his hands, on atop the other, on the middle of the chest at the nipple line and rapidly presses down and up on the sternum in hopes of pumping the heart muscle behind it. If the rescuer places the heels of his hands too low, he risks snapping off the bone during the delivery of compressions and therefore endangering the heart even more.

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anon317961
Post 9

@dautsun: If someone is suffering from an FBOA (foreign body obstructed airway) to the extent where abdominal thrusts (a.k.a. heimlich maneuver)are applicable, then they won't "..end up with bigger problems.." They will die if definitive action is not taken promptly. Damage to the xiphoid process is avoidable but is a potential undesirable side effect in an emergency scenario.

I would rather have a temporary xiphoid process injury than permanent death.

@JaneAir, similar to above: if someone is in genuine need of CPR, it is not possible to do "more harm than good."

So long as your hand placement is on the central chest, then that is good enough. Too many lives are lost because first-aiders are unnecessarily scared by idiotic instructors into thinking that they can somehow make a non-breathing person worse and when faced with a real life scenario, they freeze!

You can't get worse than dead. Any damage received during the administration of CPR will heal.

I know because I teach this stuff. What I refuse to do is teach people to be too scared to save someone's life.

Perdido
Post 8

@seag47 - I know what you mean. I worry about my daughter every time that she gets into a vehicle.

My sister fractured her xiphoid process in a car wreck a few years ago. She was in a lot of pain, but the doctor thought it best that they let it heal on its own. It wasn't hurting her heart function at all, and he just told her to take it easy and gave her a bunch of pain pills.

I would hate to see my daughter in that much pain. I know it isn't very likely that this would happen, but things like this just scar a person's mind. I will forever relate automobiles with painful injuries.

seag47
Post 7

I worry a lot about my son getting injured playing football. I have heard of other players getting xiphoid process injuries during particularly violent games, and I'm afraid every time he steps onto the field.

My husband and I argued a lot over whether we should let him play. Of course, since my husband had been a football player in high school and in college, he was determined that our son should be, too. Since my son wanted this so badly, I couldn't stop him.

kylee07drg
Post 6

Some people have a protruding xiphoid process, but this doesn't always mean that there has been damage to it. Some people are just built that way.

I knew a guy who worked out a lot, and he often went without a shirt at the gym. I could see a weird protrusion near his sternum, and it wasn't a muscle.

He said that he had always had that. It wasn't tender or anything, and he had gotten used to it.

StarJo
Post 5

Reflux disease can cause xiphoid process pain. My brother has had this problem for years.

He says that the pain starts at the xiphoid process and goes up to his neck. He often regurgitates stomach acid, so he knows to look out for this once he feels tenderness around this bone.

LoriCharlie
Post 4

@ceilingcat - Well, to be fair, there are a lot of possible way you can injure any part of your body, not just the xiphoid process. It's just that most of your bones won't end up embedded in your heart if you hurt them.

Still, I don't think there's any reason to worry too much about the xiphoid process (more than anything else.) I've never personally heard of someone dying from an injured xiphoid process, so I can't imagine that it happens too often. You're probably more likely to get hit by lightning or something!

ceilingcat
Post 3

I had no clue that damaging the xiphoid process could be so dangerous! That is really scary! Imagine getting into a car accident or having a simple sports injury and ending up with one of your bones puncturing your heart. It sounds horrible.

JaneAir
Post 2

@dautsun - That's true. When I took a CPR class, we also learned how to do the Heimlich maneuver. And we talked about the xiphoid process in the context of both things, because you can damage the xiphoid process during either procedure.

Usually if you're doing the Heimlich maneuver or CPR on someone, they're in immediate medical danger. So it can be really easy to lose your head and forget what you're doing. However, you have to try to keep a clear head and pay attention to where you're placing your hands, so you don't end up doing more harm than good.

dautsun
Post 1

You can also damage the xiphoid process by accident while doing the Heimlich maneuver on someone who is choking. Since you're supposed to put quick pressure on the abdomen right under the xiphoid process, it would be really easy to make a mistake in the heat of the moment, and push on the xiphoid process instead.

Then you might end up with bigger problems than just choking!

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