Coccydynia
| Coccydynia | |
|---|---|
| Specialty | Rheumatology  |
Coccydynia is a medical term meaning pain in the coccyx or tailbone area, usually brought on by sitting too abruptly.
Synonyms
Coccydynia is also known as coccygodynia, coccygeal pain, coccyx pain, or coccalgia.
Diagnosis
A number of different conditions can cause pain in the general area of the coccyx, but not all involve the coccyx and the muscles attached to it. The first task of diagnosis is to determine whether the pain is related to the coccyx. Physical examination, high resolution x-rays and MRI scans can rule out various causes unrelated to the coccyx, such as Tarlov cysts and pain referred from higher up the spine. Note that, contrary to most anatomical textbooks, most coccyxes consist of several segments: 'fractured coccyx' is often diagnosed when the coccyx is in fact normal or just dislocated at an intercoccygeal joint.[1][2]
A simple test to determine whether the coccyx is involved is injection of local anesthetic into the area. If the pain relates to the coccyx, this should produce immediate relief.[3]
If the anesthetic test proves positive, then a dynamic (sit/stand) x-ray or MRI scan may show whether the coccyx dislocates when the patient sits.[4]
Use of dynamic x-rays on 208 patients who gave positive results with the anesthetic test showed:
- 22% Posterior luxation (partial dislocation of the coccyx backwards when sitting)
- 5% Anterior luxation (partial dislocation of the coccyx forwards when sitting)
- 27% Hypermobility (excessive flexing of the coccyx forwards and upwards when sitting)
- 14% Spicule (bony spur) on the coccyx
- 31% Not possible to identify the cause of pain
This study found that the pattern of lesions was different depending on the obesity of the patients: obese patients were most likely to have posterior luxation of the coccyx, while thin patients were most likely to have coccygeal spicules.
Causes
One way of classifying coccydynia is whether the onset was traumatic versus non-traumatic. In many cases the exact cause is not known (called idiopathic coccydynia).
Coccydynia is often reported following a fall or after childbirth. In some cases, persistent pressure from activities like bicycling may cause the onset of coccyx pain.[5] Coccydynia due to these causes usually is not permanent, but it may become very persistent and chronic if not controlled.
Also, coccydynia can be caused by sitting improperly, straining the coccyx.
Rarely, coccydynia is due to the undiagnosed presence of a sacrococcygeal teratoma or other tumor in the vicinity of the coccyx. In these cases, appropriate treatment usually involves surgery and/or chemotherapy.[citation needed]
Clinical features
Activities that put pressure on the affected area are bicycling, horseback riding, and other activities such as increased sitting that put direct stress on the coccyx. The medical condition is often characterized by pain that worsens with constipation and may be relieved with bowel movement. Rarely, even sexual intercourse can aggravate symptoms.
Non-surgical treatment
Since sitting on the affected area may aggravate the condition, a cushion with a cutout at the back under the coccyx is recommended (the donut cushion traditionally recommended by doctors is generally useless for this condition[citation needed]). If there is tailbone pain with bowel movements, then stool softeners and increased fiber in the diet may help. For prolonged cases, anti-inflammatory or pain-relieving drugs may be prescribed. The use of anti-depressants such as Elavil (amiltriptyline) may help alleviate constant pain. Local nerve blocks are often beneficial. Tailbone pain doctors specializing in Physical Medicine and Rehabilitation at New Jersey Medical School have published that sometimes even just a single local nerve block injection at the ganglion impar can give 100% relief of coccydynia when performed under fluoroscopic guidance.[5]
Surgical treatment
In rare cases, surgery to remove the coccyx (coccygectomy) may be required. Typically, surgery is reserved for patients with cancer (malignancy) or those whose tailbone pain has failed to respond to nonsurgical treatment (such as medications by mouth, use of seat cushions, and medications given by local injections done under fluoroscopic guidance, as noted above).[6]
See also
References
- ^ Postacchini F, Massobrio M (1983). "Idiopathic coccygodynia. Analysis of fifty-one operative cases and a radiographic study of the normal coccyx". J Bone Joint Surg Am. 65 (8): 1116–24. PMID 6226668.
{{cite journal}}: Unknown parameter|month=ignored (help) - ^ Kim NH, Suk KS (June 1999). "Clinical and radiological differences between traumatic and idiopathic coccygodynia". 40 (3). Yonsei Medical Journal: 215–20.
{{cite journal}}: Cite journal requires|journal=(help) - ^ Marx, Fred A. (1996). "Coccydynia/Levator Syndrome, A Therapeutic Test". Techniques in Coloproctology. 4 (1).
- ^ Maigne JY, Doursounian L, Chatellier G (2000). "Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma". Spine. 25 (23): 3072–9. doi:10.1097/00007632-200012010-00015. PMID 11145819.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ a b Foye P, Buttaci C, Stitik T, Yonclas P (2006). "Successful injection for coccyx pain". Am J Phys Med Rehabil. 85 (9): 783–4. doi:10.1097/01.phm.0000233174.86070.63. PMID 16924191.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Foye PM (2007). "Reasons to delay or avoid coccygectomy for coccyx pain". Injury. 38 (11): 1328. doi:10.1016/j.injury.2007.06.022. PMID 17884057.