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Condition/Disorder Synonym

  • Coccygodynia

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

Key Features

Description

  • Tailbone pain

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

General Considerations

  • 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

Demographics

  • Five times more common in women than in men5

  • Mean age of onset is 40 years5

  • Three times more common in obese patients5

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 coccyx

Functional Implications

  • Difficulty sitting, impacting ability to perform work and daily activities

  • Difficulty or pain with defecation

Possible Contributing Causes

  • 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

Differential Diagnosis

  • Sacral chordoma

  • Tarlov cyst

  • Pilonidal cyst

  • Sacroiliac (SI) joint pain

Means of Confirmation or Diagnosis

Imaging

  • Dynamic radiograph of coccyx position

  • Dynamic radiography (stand vs. sit)

Diagnostic Procedures

  • Joint injection at coccyx-sacral junction to determine relief

  • Physical examination

  • Diagnostic joint injection

Treatment

Medications

  • Muscle relaxants

  • Oral analgesics

  • Oral corticosteroids

Medical Procedures

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