- Patrick M Foye, MD
Patrick M Foye, MD
- Professor and Interim Chair of Physical Medicine and Rehabilitation
- Rutgers University New Jersey Medical School
- Section Editors
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health & Science University
- Mark D Aronson, MD
Mark D Aronson, MD
- Editor-in-Chief — Primary Care (Adult); Hospital Medicine
- Section Editor — General Medicine
- Professor of Medicine
- Harvard Medical School
Coccydynia is pain at the coccyx. It is also referred to as coccygodynia or tailbone pain. Though coccydynia resolves with supportive care in the majority of patients, symptoms can persists for months and years. Intractable coccydynia is relatively uncommon, but when it occurs, it can dramatically decrease a patient's quality of life. This topic will provide an overview of coccydynia, including diagnosis and management.
The coccyx is the lowest region of the vertebral spine, located inferior to the sacrum (figure 1). Typically, the lower coccyx curves anteriorly, into the pelvis (figure 2 and figure 3). The coccyx, along with the two ischial tuberosities, bears weight when a person is sitting, with an increased weight load on the coccyx when a person leans back, partly reclining, in the sitting position (figure 4).
The coccyx typically has three to five vertebral segments, with fibrocartilaginous joints between the sacrum and coccyx and between coccygeal segments. These joints are comparable with those seen in higher intervertebral spaces, but may be fused in the coccyx. Muscles and ligaments that insert on the sacrum and coccyx (including the levator ani and its component parts) support the pelvic floor and participate in voluntary control of the bowel.
PREVALENCE AND RISK FACTORS
Coccydynia is five times more prevalent in women than men [1,3]. The higher prevalence is thought to be due to injuries that occur during childbirth and the coccyx being located more posteriorly in women (figure 3), and thus more susceptible to external trauma .
- Lirette LS, Chaiban G, Tolba R, Eissa H. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J 2014; 14:84.
- Maigne JY, Pigeau I, Aguer N, et al. Chronic coccydynia in adolescents. A series of 53 patients. Eur J Phys Rehabil Med 2011; 47:245.
- Fogel GR, Cunningham PY 3rd, Esses SI. Coccygodynia: evaluation and management. J Am Acad Orthop Surg 2004; 12:49.
- De Andrés J, Chaves S. Coccygodynia: a proposal for an algorithm for treatment. J Pain 2003; 4:257.
- Maigne JY, Doursounian L, Chatellier G. Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma. Spine (Phila Pa 1976) 2000; 25:3072.
- Patel R, Appannagari A, Whang PG. Coccydynia. Curr Rev Musculoskelet Med 2008; 1:223.
- Nathan ST, Fisher BE, Roberts CS. Coccydynia: a review of pathoanatomy, aetiology, treatment and outcome. J Bone Joint Surg Br 2010; 92:1622.
- Ryder I, Alexander J. Coccydynia: a woman's tail. Midwifery 2000; 16:155.
- Maigne JY, Rusakiewicz F, Diouf M. Postpartum coccydynia: a case series study of 57 women. Eur J Phys Rehabil Med 2012; 48:387.
- Moon SG, Kim NR, Choi JW, Yi JG. Acute coccydynia related to precoccygeal calcific tendinitis. Skeletal Radiol 2012; 41:473.
- Kim HS, Yang SH, Park HJ, et al. Glomus tumor as a cause of coccydynia. Skeletal Radiol 2013; 42:1471.
- Blocker O, Hill S, Woodacre T. Persistent coccydynia--the importance of a differential diagnosis. BMJ Case Rep 2011; 2011.
- Cockbain AJ, Morrison CP, Davies JB. Coccydynia secondary to a large pelvic tumor of anorectal origin. Spine J 2011; 11:683.
- Foye PM, Shupper P, Wendel I. Coccyx fractures treated with intranasal calcitonin. Pain Physician 2014; 17:E229.
- Maigne JY, Tamalet B. Standardized radiologic protocol for the study of common coccygodynia and characteristics of the lesions observed in the sitting position. Clinical elements differentiating luxation, hypermobility, and normal mobility. Spine (Phila Pa 1976) 1996; 21:2588.
- Mitra R, Cheung L, Perry P. Efficacy of fluoroscopically guided steroid injections in the management of coccydynia. Pain Physician 2007; 10:775.
- Foye PM. Ganglion impar injection techniques for coccydynia (coccyx pain) and pelvic pain. Anesthesiology 2007; 106:1062.
- Foye PM, Buttaci CJ, Stitik TP, Yonclas PP. Successful injection for coccyx pain. Am J Phys Med Rehabil 2006; 85:783.
- Buttaci CJ, Foye PM, Stitik TP. Coccydynia successfully treated with ganglion impar blocks: A case series. Am J Phys Med Rehabil 2005; 84:218.
- Balain B, Eisenstein SM, Alo GO, et al. Coccygectomy for coccydynia: case series and review of literature. Spine (Phila Pa 1976) 2006; 31:E414.
- Gunduz OH, Sencan S, Kenis-Coskun O. Pain Relief due to Transsacrococcygeal Ganglion Impar Block in Chronic Coccygodynia: A Pilot Study. Pain Med 2015; 16:1278.
- Maigne JY, Chatellier G. Comparison of three manual coccydynia treatments: a pilot study. Spine (Phila Pa 1976) 2001; 26:E479.
- Maigne JY, Chatellier G, Faou ML, Archambeau M. The treatment of chronic coccydynia with intrarectal manipulation: a randomized controlled study. Spine (Phila Pa 1976) 2006; 31:E621.
- Maigne JY, Lagauche D, Doursounian L. Instability of the coccyx in coccydynia. J Bone Joint Surg Br 2000; 82:1038.
- Perkins R, Schofferman J, Reynolds J. Coccygectomy for severe refractory sacrococcygeal joint pain. J Spinal Disord Tech 2003; 16:100.
- Trollegaard AM, Aarby NS, Hellberg S. Coccygectomy: an effective treatment option for chronic coccydynia: retrospective results in 41 consecutive patients. J Bone Joint Surg Br 2010; 92:242.
- Haddad B, Prasad V, Khan W, et al. Favourable outcomes of coccygectomy for refractory coccygodynia. Ann R Coll Surg Engl 2014; 96:136.
- Karadimas EJ, Trypsiannis G, Giannoudis PV. Surgical treatment of coccygodynia: an analytic review of the literature. Eur Spine J 2011; 20:698.
- Kerr EE, Benson D, Schrot RJ. Coccygectomy for chronic refractory coccygodynia: clinical case series and literature review. J Neurosurg Spine 2011; 14:654.
- Hanley EN, Ode G, Jackson Iii BJ, Seymour R. Coccygectomy for patients with chronic coccydynia: a prospective, observational study of 98 patients. Bone Joint J 2016; 98-B:526.
- PREVALENCE AND RISK FACTORS
- CLINICAL FEATURES
- Clinical diagnosis
- Additional evaluation
- DIFFERENTIAL DIAGNOSIS
- Initial management
- Persistent symptoms
- - Imaging
- - Local injection
- - Other treatments
- Intractable coccydynia
- SUMMARY AND RECOMMENDATIONS