History

Most patients with coccygodynia (coccydynia) give a history of a fall or an antecedent childbirth. In 1950, Schapiro described this disorder as "television disease" because most of the patients had followed poor postural adaptation while watching television,^[19] and this poor adaptation was thought to be an important predisposing factor for coccygodynia. Prolonged sitting while using a computer likewise can be a harbinger of coccygodynia.

Patients usually complain of pain that is aggravated by sitting on hard surfaces. Some patients may complain of experiencing pain during defecation and sexual intercourse or while riding a bicycle or a motorbike.

From the 1930s through the late 1960s, George Thiele published several articles relating to coccyx pain,^[8] as a consequence of which coccygodynia is still sometimes referred to as Thiele syndrome. Thiele's description of the clinical features continues to hold true today. The main symptoms include pain in the lower sacrum or coccyx or in the adjacent muscles or soft tissues. The patient usually points to the coccyx as the site of pain.^[3] The severity of pain depends on the amount of time spent sitting.

Physical Examination

On examination, there is tenderness over the localized region.^[1]In fact, absence of local tenderness over the coccyx should lead the examiner to consider other diagnoses, such as lumbar disk disease or herniated disk. A rectal and pelvic examination also should be performed to check for any masses (tumors).

Differential Diagnoses

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Media Gallery

Coccyx is usually formed of 3-5 rudimentary vertebrae.
Coccyx as compared with cuckoo's beak.
Coccygeal configuration types I, II, III, and IV (from left to right). Type I: Coccyx is curved slightly forward, with its apex directed downward and caudally. Type II: Forward curvature is more marked, and apex extends straight forward. Type III: Coccyx most sharply angulates forward. Type IV: Coccyx is subluxated at sacrococcygeal joint or at intercoccygeal joint.
Dynamic radiographs obtained from patient with coccygodynia.

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Author

Deepak Gautam, MBBS, MS(Orth) Consultant Joint Replacement Surgeon and Director of Orthopaedic Disciplines, Bharati Vidyapeeth Medicover Hospitals, Navi Mumbai, India

Deepak Gautam, MBBS, MS(Orth) is a member of the following medical societies: Asia Pacific Orthopaedic Association, Indian Orthopedic Association, International Society of Orthopaedic Surgery and Traumatology, Orthopaedic Research Society, Spine Society Delhi Chapter

Disclosure: Received research grant from: Wellcome Trust/DBT India Alliance.

Coauthor(s)

Rajesh Malhotra, MBBS, MS Professor and Head, Department of Orthopedics, All India Institute of Medical Sciences; Chief, JPN Apex Trauma Centre, India

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Jeffrey A Goldstein, MD Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Director of Spine Service, Director of Spine Fellowship, Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, NYU Langone Medical Center

Jeffrey A Goldstein, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, AOSpine, Cervical Spine Research Society, International Society for the Advancement of Spine Surgery, International Society for the Study of the Lumbar Spine, Lumbar Spine Research Society, North American Spine Society, Scoliosis Research Society, Society of Lateral Access Surgery

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Globus, 3Spine<br/>Received income in an amount equal to or greater than $250 from: Globus, Nuvasive, Surgalign, 3Spine.

Additional Contributors

William O Shaffer, MD Former Orthopedic Spine Surgeon, Northwest Iowa Bone, Joint, and Sports Surgeons

William O Shaffer, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, International Society for the Study of the Lumbar Spine, Kentucky Medical Association, Kentucky Orthopaedic Society, North American Spine Society, Southern Medical Association, Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Coccygodynia Clinical Presentation

History

Physical Examination

References

Tables

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