Coccyx Pain Differential Diagnoses

  • Author: Patrick M Foye, MD; Chief Editor: Consuelo T Lorenzo, MD   more...
 
Updated: Jan 23, 2012
 
 

Diagnostic Considerations

Conditions to consider in the differential diagnosis of coccyx pain include the following:

  • Coccygeal fracture
  • Sacrococcygeal dislocation
  • Intracoccygeal dislocation (dislocation of one coccygeal segment from another)
  • Intrapelvic malignancy and/or metastatic lesions
  • Ischial bursitis
  • Sacroiliac joint pain
  • Ovarian cyst
  • Fibroid uterus
  • Pilonidal cyst
  • Sacral insufficiency fracture

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Patrick M Foye, MD  Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society

Disclosure: Nothing to disclose.

Coauthor(s)

Charles J Buttaci, DO, PT  Pain Management, Northeast Orthopedics

Charles J Buttaci, DO, PT is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Osteopathic College of Physical Medicine and Rehabilitation, and International Spine Intervention Society

Disclosure: Nothing to disclose.

Matthew Kirk Sorensen  University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Matthew Kirk Sorensen, is a member of the following medical societies: Society for Developmental Biology

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD  Physiatrist, Department of Physical Medicine and Rehabilitation, Alegent Health Immanuel Rehabilitation Center

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Additional Contributors

Michael T Andary, MD, MS Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists

Disclosure: Allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Robert L Sheridan, MD Assistant Chief of Staff, Chief of Burn Surgery, Shriners Burns Hospital; Associate Professor of Surgery, Department of Surgery, Division of Trauma and Burns, Massachusetts General Hospital and Harvard Medical School

Robert L Sheridan, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, and American College of Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Dev Sinha, MD Resident Physician, Department of Physical Medicine and Rehabilitation, University of Pennsylvania Health Systems

Disclosure: Nothing to disclose.

Acknowledgments

Dr. Foye acknowledges and appreciates the numerous patients with coccyx pain who have traveled—often substantial distances—to see him over the years. Much has been learned by listening to descriptions of their symptoms and to their stories, by discovering how suffering from coccyx pain impacts the quality of their lives, and by analyzing their favorable responses to nonsurgical treatment. Their substantial contributions to the coccydynia knowledge base have helped in the treatment of many subsequent patients with coccyx pain, not only in Dr. Foye's practice, but (through his publications in this area) elsewhere as well. Dr. Foye finds it to be a gratifying privilege to help so many of these patients find relief.

Evish Kamrava, 4th year medical student, St. George's University School of Medicine, Class of 2009, assisted with the 2008 revision of this manuscript.

References

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Lateral view of the pelvis and coccyx. The bracket shows the area of focus for radiographs that would provide a coned-down view of mainly the coccyx and distal sacrum. A more common lateral view would often also include larger bony structures, such as the lumbar spine and femur, all of which would make it difficult to optimize visualization of the small bones of the coccyx. In patients with coccyx pain, these coned-down, lateral views of the coccyx can provide important diagnostic information. Coned-down images obtained in the weight-bearing (seated) position can be compared with those obtained in a non–weight-bearing position (eg, side lying), thus allowing assessment for dynamic instability (eg, dislocations that occur only while seated).
Coccyx pain (coccydynia, or tailbone pain) is typically worse when the patient is sitting. Often, the pain is even worse when sitting leaning slightly backward, since this increases the weight bearing on the coccyx, as shown in this image. Dynamic radiographs of the coccyx involve obtaining coned-down (focused) views of the coccyx while the patient is seated (eg, in his or her most painful position). Often, this involves having the patient lean backward 0-40°, depending on the symptoms. Radiographs obtained in this position are compared with those obtained in a non–weight-bearing position (eg, side lying) to assess for instability or dislocations in the seated position.
Patients with a painful coccyx often find it more comfortable to sit leaning slightly forward, as shown in this image. This forward-leaning position minimizes any weight bearing on the coccyx itself and thus minimizes the exacerbation of coccyx pain. As shown, when a patient sits leaning forward, most of the weight bearing occurs bilaterally through the inferior ischial regions of the pelvis and the posterior thigh (femur) regions.
 
 
 
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