Summary
Definition
History and exam
Key diagnostic factors
- coccyx pain
- coccygeal tenderness
- spasm of pelvic floor musculature
- relief of symptoms after corticosteroid injection
Other diagnostic factors
- guarding
Risk factors
- female sex
- history of trauma to the coccyx
- obesity
Diagnostic tests
1st tests to order
- lateral sacrococcygeal x-ray
- dynamic lateral sacrococcygeal x-rays
Tests to consider
- MRI of the sacrum and coccyx
- CT lumbosacral spine
- WBC count
- erythrocyte sedimentation rate
Treatment algorithm
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 has been an expert witness for personal injury defense, is a primary investigator on two industry sponsored studies, and has given medical lectures.
Peer reviewers
Patrick M. Foye, MD
Professor and Director of the Coccyx Pain Center
Rutgers New Jersey Medical School
Newark
NJ
Disclosures
PMF is the author of references cited in this topic.
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.
References
Key articles
Skalski MR, Matcuk GR, Patel DB, et al. Imaging coccygeal trauma and coccydynia. Radiographics. 2020 Jul-Aug;40(4):1090-106.Full text Abstract
Fogel GR, Cunningham PY, Esses, SL. Coccygodynia: evaluation and management. J Am Acad Orthop Surg. 2004;12:49-54. Abstract
Wray CC, Easom S, Hoskinson J. Coccydynia. Aetiology and treatment. J Bone Joint Surg (Br). 1991;73-B:335-338.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Lumbar spondylosis/disk herniation
- Proctalgia fugax
- Levator ani syndrome
More DifferentialsPatient information
Back pain (lower back)
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