Disabling pain in the coccyx, usually provoked by sitting or rising from sitting.
May be post-traumatic (e.g., after a fall or childbirth), nontraumatic, or idiopathic in origin.
More common in women.
Conservative management includes pressure-relieving cushions, local corticosteroid injections, and/or coccygeal manipulation.
Surgery (coccygectomy) is highly effective in recalcitrant post-traumatic coccygodynia.
It is important to rule out local pathology, such as tumors or infection.
A disabling pain in the coccyx exacerbated by sitting or rising from sitting. The pain is often pulling or lancinating in quality, may radiate to the sacrum or buttocks, and may coexist with lower back pain. It may be post-traumatic, nontraumatic, or idiopathic in origin and is more common in women. Also known as coccydynia or coccygeal neuralgia.
History and exam
Key diagnostic factors
- coccyx pain
- coccygeal tenderness
- spasm of pelvic floor musculature
- relief of symptoms after corticosteroid injection
Other diagnostic factors
- female sex
- history of trauma to the coccyx
1st investigations to order
- lateral sacrococcygeal x-ray
- dynamic lateral sacrococcygeal x-rays
Investigations to consider
- MRI lumbosacral spine with contrast
- CT lumbosacral spine
- WBC count
- erythrocyte sedimentation rate
new diagnosis: acute or chronic disease
symptoms ≥2 months and failed acute management
Rudolph J. Schrot, MD, MAS, FAANS
Sutter Medical Group
RJS declares that he has no competing interests.
Birender Balain, MBBS, FRCS, FRCS (Tr and Orth)
Robert Jones and Agnes Hunt Orthopaedic and District Hospital
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
SE is the author of a study referenced in this topic.
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