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20-September-2008 10:21:22 - Coccydynia Coccydynia or Coccygodynia Classification and external resources ICD-10 M53.3 ICD-9 724.79 eMedicine pmr/242 Coccydynia is a medical term meaning pain in the coccyx or tailbone area, usually brought on by sitting. Contents 1 Synonyms 2 Diagnosis 3 Natural History 4 Clinical Features 5 Non-Surgical Treatment 6 Surgical Treatment 7 See also 8 External links 9 References Synonyms Coccydynia is also known as coccygodynia, coccygeal pain, coccyx pain, coccaglia or in layperson's terms buttache. Diagnosis A number of different conditions can cause pain in the general area of the coccyx, but not all involve the coccyx and the muscles attached to it. The first task of diagnosis is to determine whether the pain is related to the coccyx. Physical examination, high resolution x-rays and MRI scans can rule out various causes unrelated to the coccyx, such as Tarlov cysts and pain referred from higher up the spine. Note that, contrary to most anatomical textbooks, most coccyxes consist of several segments: 'fractured coccyx' is often diagnosed when the coccyx is in fact normal or just dislocated at an intercoccygeal joint 1 2. A simple test to determine whether the coccyx is involved is injection of local anesthetic into the area. If the pain relates to the coccyx, this should produce immediate relief 3. If the anesthetic test proves positive, then a dynamic sit/stand x-ray or MRI scan may show whether the coccyx dislocates when the patient sits 4. Use of dynamic x-rays on 208 patients who gave positive results with the anesthetic test showed: 22% Posterior luxation partial dislocation of the coccyx backwards when sitting 5% Anterior luxation partial dislocation of the coccyx forwards when sitting 27% Hypermobility excessive flexing of the coccyx forwards and upwards when sitting 14% Spicule bony spur on the coccyx 31% Not possible to identify the cause of pain This study found that the pattern of lesions was different depending on the obesity of the patients: obese patients were most likely to have posterior luxation of the coccyx, while thin patients were most likely to have coccygeal spicules. Natural History In many cases the exact cause is not known. Coccydynia is often reported following a fall or after childbirth. In some cases, persistent pressure from activities like bicycling may cause the onset of coccyx pain. 5 Coccydynia due to these causes usually is not permanent, but it may become very persistent and chronic if not controlled. Rarely, coccydynia is due to the undiagnosed presence of a sacrococcygeal teratoma or other tumor in the vicinity of the coccyx. In these cases, appropriate treatment usually involves surgery and/or chemotherapy. Clinical Features Activities that put pressure on the affected area are bicycling, horseback riding, and other activities such as increased sitting that put direct stress on the coccyx. The medical condition is often characterized by pain that worsens with constipation and may be relieved with bowel movement. Rarely, even sexual intercourse can aggravate symptoms. Non-Surgical Treatment Since sitting on the affected area may aggravate the condition, a cushion with a cutout at the back under the coccyx is recommended the donut cushion traditionally recommended by doctors is generally useless for this condition. If there is tailbone pain with bowel movements, then stool softeners and increased fiber in the diet may help. For prolonged cases, anti-inflammatory or pain-relieving drugs may be prescribed. The use of anti-depressants such as Elavil amiltriptyline may help alleviate constant pain. Local nerve blocks are often beneficial. Tailbone pain doctors specializing in Physical Medicine and Rehabilitation at New Jersey Medical School have published that sometimes even just a single local nerve block injection at the ganglion impar can give 100% relief of coccydynia when performed under fluoroscopic guidance. Reference Foye 2006 Surgical Treatment In rare cases, surgery to remove the coccyx coccygectomy may be required. See also Ganglion impar Coccyx tailbone External links www.coccyx.org, website about coccydynia causes, treatments and coping with the condition Coccyx pain, tailbone pain, coccydynia Peer-reviewed medical chapter, available free online at eMedicine References ^ Idiopathic coccygodynia. Analysis of fifty-one operative cases and a radiographic study of the normal coccyx. The Journal of bone and joint surgery. American volume. 1983 Oct; 658: 1116-1124. Postacchini F, Massobrio M ^ Clinical and radiological differences between traumatic and idiopathic coccygodynia. Yonsei Medical Journal, 1999 Jun, 40:3, 215-20. Kim NH; Suk KS ^ Coccydynia/Levator Syndrome, A Therapeutic Test. Techniques In Coloproctology, Volume 4 - No.1 - 1996. Fred A. Marx ^ Causes and Mechanisms of Common Coccydynia: Role of Body Mass Index and Coccygeal Trauma. Spine, volume 25, number 23, 2000, 3072-3079. Maigne, J-Y, Doursounian, L, and Chatellier, G. ^ Foye P, Buttaci C, Stitik T, Yonclas P 2006. Successful injection for coccyx pain. Am J Phys Med Rehabil 85 9: 783-4. doi:10.1097/01.phm.0000233174.86070.63. PMID 16924191. v d e Diseases of the musculoskeletal system and connective tissue M, 710-739 Arthropathies Arthritis Septic arthritis - Reactive arthritis - Rheumatoid arthritis - Psoriatic arthritis - Felty syndrome - Juvenile idiopathic arthritis - Still's disease - crystal Gout, Chondrocalcinosis - Osteoarthritis Heberden's node, Bouchard's nodes - Monoarthritis/Polyarthritis Specific joints shoulder Winged scapula - elbow Cubitus valgus, Cubitus varus - hand Wrist drop, Boutonniere deformity, Swan neck deformity hip Protrusio acetabuli, Coxa valga, Coxa vara - leg Foot drop, Flat feet, Club foot, Unequal leg length - patella Luxating patella, Chondromalacia patellae - foot Bunion/hallux valgus, Hallux varus, Hallux rigidus, Hammer toe general terms Valgus deformity, Varus deformity Other Hemarthrosis - Arthralgia - Osteophyte - Hypermobility Systemic CT disorders vasculitis: Arteritis Polyarteritis nodosa, Takayasu's arteritis, Temporal arteritis - arterioles/capillaries Wegener's granulomatosis, Kawasaki disease, Churg-Strauss syndrome, Microscopic polyangiitis hypersensitivity/autoimmune: Hypersensitivity vasculitis - Goodpasture's syndrome - Systemic lupus erythematosus Drug-induced - Dermatomyositis Juvenile dermatomyositis - Polymyositis - Scleroderma - Sjögren's syndrome - Behçet's disease - Polymyalgia rheumatica - Eosinophilic fasciitis Dorsopathies spinal curvature Kyphosis, Lordosis, Scoliosis - Scheuermann's disease - Spondylolysis - Torticollis - Spondylolisthesis Spondylopathies Ankylosing spondylitis, Spondylosis, Spinal stenosis - Schmorl's nodes - Degenerative disc disease - Coccydynia - Back pain Radiculopathy, Neck pain, Sciatica, Low back pain Soft tissue disorders Muscle Myositis Pyomyositis - Myositis ossificans Fibrodysplasia ossificans progressiva Synovium and tendon Synovitis/Tenosynovitis Calcific tendinitis, Stenosing tenosynovitis, Trigger finger, DeQuervain's syndrome - Irritable hip - Ganglion cyst Bursa Bursitis Olecranon, Prepatellar, Trochanteric - Baker's cyst Fascia/fibroblastic Fasciitis Plantar fasciitis, Nodular fasciitis, Necrotizing fasciitis - Dupuytren's contracture - Fibromatosis Shoulder lesions Adhesive capsulitis - Rotator cuff tear - Subacromial bursitis Enthesis Enthesopathies Iliotibial band syndrome, Achilles tendinitis, Patellar tendinitis, Golfer's elbow, Tennis elbow, Metatarsalgia, Bone spur, Tendinitis Other, NEC Muscle weakness - Rheumatism - Myalgia - Neuralgia - Neuritis - Panniculitis - Fibromyalgia Osteopathies disorders of bone density and structure: Osteoporosis - Osteomalacia - continuity of bone Pseudarthrosis, Stress fracture - Monostotic fibrous dysplasia - Skeletal fluorosis - Aneurysmal bone cyst - Hyperostosis - Osteosclerosis Osteomyelitis - Avascular necrosis - Paget's disease of bone - Algoneurodystrophy - Osteolysis - Infantile cortical hyperostosis Chondropathies Juvenile osteochondrosis Legg-Calvé-Perthes syndrome, Osgood-Schlatter disease, Köhler disease, Sever's disease - Osteochondritis - Tietze's syndrome - Relapsing polychondritis See also congenital Retrieved from http://en..org/wiki/Coccydynia Categories: Injuries Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Nederlands This page was last modified on 1 July 2008, at 19:19
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