During routine dissection of a fresh-frozen cadaveric specimen, a 44-year-old at death Caucasian male was found to have an elongated and hook-shaped xiphoid process that protruded dorsally (). Measurements were taken using a digital microcaliper (Mitutoyo, Kanagaw, Japan). The measured length, width, and thickness of the xiphoid process were 54.2 mm, 17.1 mm, and 4.6 mm, respectively. Sternal body and manubrium lengths were 83.5 mm and 60.0 mm, respectively. The angle from the sternal body to xiphoid process was 167°. The attachments of the muscles to the sternum, including the xiphoid process, were normal. During extraction of the sternum from the rib cage, the manubrium was slightly fractured but no other anatomical variations were identified.
DM, a 33 year old female presented to a chiropractic clinic with a chief complaint of neck pain and headaches following a motor vehicle accident and a secondary complaint of mid-dorsal pain. DM's primary complaint was diagnosed as Whiplash Associated Disorder (Grade II) (WAD II) and resolved following a course of spinal manipulative therapy (SMT), soft-tissue treatment (STT) and neck exercises. The onset of DM's second complaint of mid-dorsal pain was five years previously, following the difficult delivery of her first child. The pain had worsened following the birth of her second child, four years later. It was present every day, rated 7–8/10 at its worst and 3–4/10 at best. The mid-dorsal pain disturbed DM's sleep and physical activity aggravated the pain. Minor relief was obtained by application of moist heat over the painful thoracic area and stretching of the mid-back. Of note, DM had undergone a laparoscopic cholecystectomy between the pregnancies after which her mid-dorsal pain had completely abated for three weeks but then recurred. Aside from local tenderness in the mid-dorsal spine, physical examination was unremarkable. A course of manipulation and ultrasound to the mid-dorsal area was undertaken. Even though DM reported a feeling of increased mobility in her dorsal spine, the symptom of mid-back pain persisted. Because of the refractory nature of DM's mid-dorsal pain, re-assessment was performed. The reassessment included an abdominal examination because of the resolution of her symptoms following laparoscopic cholecystectomy. Examination revealed an exquisitely tender xiphoid process and reproduction of DM's mid-dorsal pain when pressure was applied to the left aspect of the xiphoid. A diagnosis of xiphodynia was established and a course of ultrasound (4 minutes, 2 watts/cm2, pulsed) undertaken over a two week period. Following five treatments DM's symptoms were significantly diminished but for unknown reasons, in the week between the fifth and sixth treatment, there was a relapse in mid-dorsal pain. At this point it was determined to refer her for an opinion from a Rheumatologist who performed a single injection of lidocaine and Celestone ™ to the spot found to be most tender to palpation in the xiphisternal area. DM's mid-dorsal pain resolved completely and has not returned in the intervening 9 years.