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  • Coccygodynia

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  • 724.7 Disorders of coccyx
  • 724.70 Unspecified disorder of coccyx
  • 724.71 Hypermobility of coccyx
  • 724.79 Other disorders of coccyx
  • 839.41 Closed dislocation, coccyx
  • 839.42 Closed dislocation, sacrum
  • 847.3 Sprain of sacrum
  • 847.4 Sprain of coccyx

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  • M53.2X8 Spinal instabilities, sacral and sacrococcygeal region
  • M53.3 Sacrococcygeal disorders, not elsewhere classified
  • S33.2XXA Dislocation of sacroiliac and sacrococcygeal joint, initial encounter
  • S33.8XXA Sprain of other parts of lumbar spine and pelvis, initial encounter

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Description

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  • Tailbone pain
  • Pain often increases with sitting, defecation, transitional movements, and palpation of coccyx

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General Considerations

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  • Consider sacroiliac (SI) joint as potential cause of pain
  • Ask patient about history of falls; distant history can contribute to coccydynia
  • Occupations requiring prolonged sitting may contribute to coccydynia
  • Pain may be referred from muscles, including obturator internus, levator ani, and gluteus maximus

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Demographics

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  • Five times more common in women than in men5
  • Mean age of onset is 40 years5
  • Three times more common in obese patients5

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Signs and Symptoms

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  • Pain in sitting position
  • Pain with transition from sitting to standing
  • Pain with standing, walking, forward flexion
  • Pain with defecation, coughing
  • Increased pain during menstruation
  • Inflammation
  • Poor sitting posture
  • Frequent shifts in sitting position, sitting down carefully
  • Luxation, hypermobility, hypomobility of coccyx

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Functional Implications

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  • Difficulty sitting, impacting ability to perform work and daily activities
  • Difficulty or pain with defecation

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Possible Contributing Causes

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  • Vaginal delivery
  • Postpartum
  • Direct trauma from fracture, fall, childbirth
  • Poor sitting posture
  • Prolonged sitting
  • Anorectal infection
  • Levator ani spasm
  • Trigger points of obturator internus, levator ani, or gluteus maximus
  • Overuse of levator ani
  • Neoplasm
  • Pelvic asymmetry
  • Stretch or rupture of sacrococcygeal ligaments
  • Soft-tissue damage

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Differential Diagnosis

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  • Sacral chordoma
  • Tarlov cyst
  • Pilonidal cyst
  • Sacroiliac (SI) joint pain

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Imaging

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  • Dynamic radiograph of coccyx position
  • Dynamic radiography (stand vs. sit)

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Diagnostic Procedures

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  • Joint injection at coccyx-sacral junction to determine relief
  • Physical examination
  • Diagnostic joint injection

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Medications

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  • Muscle relaxants
  • Oral analgesics
  • Oral corticosteroids

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Medical Procedures

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  • Trigger point injections
  • Corticosteroid injection
  • Local anesthetic injection
  • Coccygectomy

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  • To physician/interventional radiologist for trigger point injections

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  • Pain
  • Overactive pelvic floor muscles
  • Poor posture
  • Limited joint mobility
  • Obstructed defecation

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  • Palpation and mobility of coccyx
    • Palpate coccyx externally with single ...

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