Overview
What is the anatomy of the coccyx relative to coccydynia?
What is the anatomy of muscles and ligaments relative to coccyx pain?
What are the biomechanics relative to coccydynia?
What is the prevalence of coccydynia?
What is the prognosis of coccydynia?
Where are patient education resources about coccyx pain found?
Presentation
What is the focus of the clinical history to evaluate coccyx pain?
What is the role of palpitation in the evaluation of coccyx pain?
What is included in the physical exam to evaluate coccyx pain?
DDX
Which conditions are included in the differential diagnoses of coccyx pain?
What are the differential diagnoses for Coccyx Pain?
Workup
What should be included in the workup of coccyx pain?
What is the role of EMG and NCS in the workup of coccyx pain?
What is the role of anesthetic injections in the workup of coccyx pain?
Which histologic findings are characteristic of coccyx pain?
What is the role of lab tests in the workup of coccyx pain?
What is the role of radiography in the workup of coccyx pain?
Which lateral view radiographic findings are characteristic of coccyx pain?
Which anteroposterior (AP) view radiographic findings are characteristic of coccyx pain?
Which coned-down (focused) view radiographic findings are characteristic of coccyx pain?
What is the role of lumbosacral MRI in the workup of coccyx pain?
What is the role of bone and CT scans in the workup of coccyx pain?
What is the role of pelvis imaging in the workup of coccyx pain?
Treatment
When is malignancy screen indicated in the workup of coccyx pain?
What is the role of physical therapy (PT) in the treatment of coccyx pain?
Which activity modifications are used in the treatment of coccyx pain?
Which specialist consultations are beneficial to patients with coccyx pain?
What is the role of surgery in the treatment of coccyx pain?
What is the role of ganglion impar nerve blocks in the treatment of coccyx pain?
How are ganglion impar nerve blocks administered in the treatment of coccyx pain?
What is the role of sacrococcygeal joint injections in the treatment of coccyx pain?
What is the role of epidural steroid injections in the treatment of coccyx pain?
What is the role of ischial bursa injection in the treatment of coccyx pain?
What is the role of nerve ablation in the treatment of coccyx pain?
What is the role of osteopathic/chiropractic manipulation in the treatment of coccyx pain?
Medications
What is the role of medications in the treatment of coccyx pain?
Which medications in the drug class Anticonvulsants, Other are used in the treatment of Coccyx Pain?
Which medications in the drug class Analgesics, Other are used in the treatment of Coccyx Pain?
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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).
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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.
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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.