Coccydynia

• Coccygodynia

• 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

• 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

• 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

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

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

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

Medications

• Muscle relaxants
• Oral analgesics
• Oral corticosteroids

Medical Procedures

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

• To physician/interventional radiologist for trigger point injections

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