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119: COCCYDYNIA

Elizabeth R. Northrop, DPT, PT; Cynthia E. Neville, DPT, PT, WCS

CONDITION/DISORDER SYNONYM

  • Coccydynia

ICD-9-CM CODES

  • 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

ICD-10-CM CODES

  • 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

PREFERRED PRACTICE PATTERNS1

  • 4B: Impaired Posture

  • 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

  • 4G: Impaired Joint Mobility, Muscle Performance, and Range of Motion Associated with Fracture

PATIENT PRESENTATION

A 25-year-old woman delivered her first baby vaginally. She had epidural anesthesia during the delivery. During the delivery, she heard a loud “pop” noise. After the epidural wore off, she felt a severe pain in her rear end. She was unable to sit on the edge of the hospital bed and had severe pain when she attempted to sit in a chair.

KEY FEATURES

Description

  • Tailbone pain

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

FIGURE 119-1

Arteries and nerves of the perineum. (From DeCherney AH, Nathan L, Goodwin TM, Laufer N, Roman AS. Current Diagnosis & Treatment: Obstetrics & Gynecology. 11th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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FIGURE 119-2

Pelvic muscles. (From DeCherney AH, Nathan L. Current Diagnosis & Treatment: Obstetrics & Gynecology. 10th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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General Considerations

  • Consider sacroiliac (SI) joint as potential cause of pain

  • Ask patient about the history of falls; distant history can contribute to coccydynia

  • Occupations requiring prolonged sitting may contribute to coccydynia

  • Pain may be referred from muscles, including the obturator internus, levator ani, and gluteus maximus

Demographics

  • Five times more common in women than in men

  • Mean age of onset is 40 years

  • Three times more common in obese patients

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • 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 the coccyx

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