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Coccygodynia

Last reviewed: 1 Apr 2025
Last updated: 11 Apr 2024

Summary

Definition

History and exam

Key diagnostic factors

  • coccyx pain
  • coccygeal tenderness
  • spasm of pelvic floor musculature
  • relief of symptoms after corticosteroid injection
Full details

Other diagnostic factors

  • guarding
Full details

Risk factors

  • female sex
  • history of trauma to the coccyx
  • obesity
Full details

Diagnostic tests

1st tests to order

  • lateral sacrococcygeal x-ray
  • dynamic lateral sacrococcygeal x-rays
Full details

Tests to consider

  • MRI of the sacrum and coccyx
  • CT lumbosacral spine
  • WBC count
  • erythrocyte sedimentation rate
Full details

Treatment algorithm

ACUTE

new diagnosis: acute or chronic disease

symptoms ≥2 months and failed acute management

Contributors

Authors

Rudolph J. Schrot, MD, MAS, FAANS
Rudolph J. Schrot

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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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.

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