Xiphoid syndrome: an uncommon occupational disorder

Abstract

We report a case of a 45-year-old man, complaining of swelling and pain in his epigastric region for the last 3 years. According to his medical history, he had undergone various investigations and treatments for gastro-oesophageal reflux, without relief. He had had a history of chronic repeated microtraumas to his sternum during 9 years of working as a carpenter, as a result of placing wood against his anterior chest wall and pushing the former into a plank cutting machine. On examination, a tender swelling was palpable as an immobile, hard mass showing minimal protrusion under the skin on the xiphoid process. He was diagnosed as having xiphoid syndrome. We prescribed anti-inflammatory medication and advised him to avoid pressure on his anterior chest wall, especially on the sternum, while cutting wood. At follow-up, the symptoms were relieved. Xiphoid syndrome may be seen in people performing hard physical work who incur sustained pressure or friction on their anterior chest wall. The case emphasizes the importance of the occupational history as well as clinical and radiological investigation of unusual conditions as mentioned above.

MDCT evaluation of sternal variations: Pictorial essay

“…Xiphoid variations are usually of no clinical significance. However, review of literature shows elongated and ventrally deviated xiphoid process can be mistaken for an epigastric mass and cause pain[ 29 30 ] [ Figure 23 ].…”

Xiphoidectomy: A Surgical Intervention for an Underdocumented Disorder

“…Over the years many possible causes for xiphodynia have been suggested in the literature, although still very little is known about the etiology [2–4]. Some publications suggest that inflammation due to (repeated) mechanical injury might contribute to the cause [2].…”

“…Some publications suggest that inflammation due to (repeated) mechanical injury might contribute to the cause [2]. Others suggest that anterior displacement of the xiphisternal angle is a cause for prominence of the xiphoid process and therefore prone to mechanical injury and subsequent inflammation [3].…”

Xiphoidectomy for xiphoid process-induced pain in a surfer

“…Two similar cases of pain due to occupational causes have been reported. 3,4 Both patients had a history of chronic repeated microtrauma to the anterior chest wall associated with work. Their symptoms were relieved by analgesics and avoiding trauma.…”