EpistemisCoccygodynia
Specialty: Musculoskeletal.
Why it occurs
- Direct trauma to the coccyx (fall from a sitting position, contusion or fracture)
- Repetitive microtrauma from prolonged sitting on hard surfaces
- Pathological hypermobility or hypomobility of the sacrococcygeal joint
- Spasm of the levator ani or coccygeus muscle
- Anatomical changes of the coccyx (bone spicules or subluxations)
- Sacral or coccygeal tumor (chordoma, osteosarcoma)
Initial workup
Dynamic coccyx x-ray (in standing and sitting positions to assess mobility and subluxation) | Magnetic resonance imaging of the pelvis focused on the sacro-coccyx | Transrectal ultrasound (if deep pelvic muscle mass or spasm is suspected).
red flags
Refractory progressive pain, worse at night, associated with a palpable presacral mass detected by rectal examination, rectal bleeding or involuntary weight loss (suspected pelvic or retroperitoneal neoplasia).
Standard management
- Naproxen — 500 mg every 12 hours orally; initial analgesic-anti-inflammatory
- Pregabalin — 75-150 mg/day in divided doses, useful in the local chronic neuropathic pain component
- Local infiltration of methylprednisolone (40 mg with 1% lidocaine into the sacrococcygeal joint under fluoroscopic or ultrasound guidance).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 6
- Treatment options
- 3