The xiphoid process is the inferior tip of the sternum, the smallest and most variable segment of the sternum. It begins as cartilage, ossifies progressively in adulthood, and fuses to the sternal body variably, sometimes by the fourth decade, occasionally remaining cartilaginous well into old age. Its shape is highly variable (pointed, bifid, curved, perforated) and it may not be palpable in obese individuals.
| Articulations |
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|---|---|
| Landmarks |
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| Ossification | Begins to ossify between ages 5 and 18 from a single centre, fusing to the sternal body by the fourth decade in most people but remaining separate in some individuals throughout life. |
The xiphoid process can be palpated and is occasionally painful from xiphoidalgia, tenderness of the xiphoid process from trauma, pressure, or referred pain from gastrointestinal pathology. Xiphoid fractures from CPR chest compressions occur during resuscitation but do not affect CPR efficacy. The xiphoid is a landmark for the subxiphoid pericardiocentesis approach and for upper abdominal laparotomy incision planning.
Follow the sternum down the midline of the chest to the point where the two costal margins meet. Just below this junction, press gently to feel a small, sometimes bent or mobile tip; this is the xiphoid process. Avoid firm pressure over it, and in CPR place the hands on the lower half of the sternum above it.
Pain and tenderness at the xiphoid that can mimic cardiac or abdominal pain, often after trauma or overuse.
Direct trauma or chest compressions during CPR can fracture the xiphoid process.
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