Last reviewed: 1 May 2023
Last updated: 31 Dec 2019
Summary
Definition
History and exam
Key diagnostic factors
- coccyx pain
- coccygeal tenderness
- spasm of pelvic floor musculature
- relief of symptoms after corticosteroid injection
More key diagnostic factors
Other diagnostic factors
- guarding
Other diagnostic factors
Risk factors
- female sex
- history of trauma to the coccyx
- obesity
More risk factors
Diagnostic investigations
1st investigations to order
- lateral sacrococcygeal x-ray
- dynamic lateral sacrococcygeal x-rays
More 1st investigations to order
Investigations to consider
- MRI lumbosacral spine with contrast
- CT lumbosacral spine
- WBC count
- erythrocyte sedimentation rate
More investigations to consider
Treatment algorithm
ACUTE
new diagnosis: acute or chronic disease
symptoms ≥2 months and failed acute management
Contributors
Authors
Rudolph J. Schrot, MD, MAS, FAANS

Neurosurgeon
Sutter Medical Group
Sacramento
CA
Disclosures
RJS declares that he has no competing interests.
Peer reviewers
Birender Balain, MBBS, FRCS, FRCS (Tr and Orth)
Specialist Registrar
Robert Jones and Agnes Hunt Orthopaedic and District Hospital
Oswestry
UK
Disclosures
BB is the author of some studies referenced in this topic.
Stephen Esses, MD
Professor of Orthopedics
Brodsky Chair of Spinal Surgery
Baylor College of Medicine
Houston
TX
Disclosures
SE is the author of a study referenced in this topic.
Differentials
- Lumbar spondylosis/disc herniation
- Proctalgia fugax
- Levator ani syndrome
More DifferentialsPatient leaflets
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