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.
JS, a 25 year old female, presented to a chiropractic teaching clinic with a chief complaint of neck and upper back pain. Following the initial work-up, a diagnosis of neck pain of mechanical origin with an associated myofascial syndrome was made and a course of SMT, STT and exercises for the deep neck flexors undertaken. JS's symptoms were resolving well. During the course of a standard office visit it was noted that JS was being investigated for gastric ulcers because of a 3.5 year history of daily mild to severe and at times disabling abdominal pain with associated throat tightness. The pain would reach 8/10 in intensity and last for several hours. Repeated investigations including abdominal ultrasound, endoscopy, and tests for helicobacter pylori were all negative. JS's medical practitioner (GP) made a presumptive diagnosis of gastric ulcer disease and prescribed Cimetidine, then Lansoprazole and later Esomeprazole to no avail. JS was then advised by her GP to cease all medications and diagnosed functional dyspepsia. With persisting symptoms, the GP opted to prescribe an anti-depressant, Fluoxetine hydrochloride. JS's symptoms persisted and, in addition, she began to experience adverse effects to the Fluoxetine hydrochloride and so this was ceased. It was at this time that one of the authors (JKS) examined JS and discovered that both abdominal and throat symptoms were reproducible by direct pressure over the lateral aspect of her xiphoid process.\nA diagnosis of xiphodynia was established and a course of treatment involving 2 minutes of low-level laser therapy (LLLT) to an area of approximately 4 cm2 surrounding the xiphoid undertaken. A therapeutic trial of two laser treatments per week for up to four weeks was recommended. Progress was good. At the end of the third week JS reported significant decrease in frequency, duration and intensity of her abdominal pain. JS experienced days without any pain at all. In addition, the intensity of her pain was now reported as 3/10 maximum with duration of 30 minutes. Palpation of the xiphoid no longer reproduced abdominal pain although some throat tightness was still experienced. Two additional LLLT treatments were undertaken and JS was reviewed six weeks later at which time there was no tenderness over the xiphoid and JS reported infrequent very mild abdominal symptoms and no throat tightness. After reflecting upon her abdominal symptoms JS recalled that they began when she was working as a fruit-picker and had repeatedly performed awkward lifts of heavy crates. In order to lift and move the crates JS arched backward and used her abdomen to support the lift. This brought the edge of the crate into contact with her xiphoid process. The abdominal pain and throat tightness began the day following a particularly strenuous workday.