Diagnostic Considerations

The differential diagnosis can be broadly divided into the the following three major categories:

Nociceptive
Neuropathic
Visceral

The nociceptive aspect of the differential diagnosis includes conditions involving pain arising from the os coccygis,^[20] such as the following:

Levator ani syndrome, where the mobilization of the os coccygis is not painful
Osteomyelitis
Intraossal lipoma
Intraossal chondroma
Avascular necrosis
Precoccygeal cysts
Degenerative disease

The neuropathic aspect includes conditions in which the pain arises from the spine,^[21] such as the following:

Lumbar disk herniation, where the symptoms are not related to provocation by sitting
Neural tumors (eg, schwannoma, neurinoma, chordoma, arachnoid cysts of the cauda equina, sacrococcygeal meningeal cysts, and paragangliomas of the caudal end of the os coccygis)

Visceral pain is the result of pain referred from the visceral structures^[22] and may arise from the following:

Infections and tumors of the rectum, sigmoid colon. and urogenital system
Metastases

Workup

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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 Differential Diagnoses

Diagnostic Considerations

References

Tables

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