| Coccydynia or Coccygodynia Classification and external resources |
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| 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. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings M00-M99 - Diseases of the Musculoskeletal system and Connective tissue (M00-M25 Arthropathies (M00-M03 Infectious arthropathies The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors The coccyx (pronounced kok -siks (Latin os coccygis) commonly referred to as the tailbone, is the final segment of the human vertebral column
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Synonyms
Coccydynia is also known as coccygodynia, coccygeal pain, coccyx pain, coccaglia or (in layperson's terms) buttache. The term " layman " originated from the use of the term Laity, but over the centuries changed definition to mean a person who is a non-expert in a given field of
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. This article is about the skeletal structure See also Spicule (solar physics and Spicule (glass manufacture.
Natural History
In many cases the exact cause is not known.
Coccydynia is often reported following a fall or after childbirth. Childbirth (also called labour, birth, partus or parturition) is the culmination of a Human Pregnancy or 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. See also Teratoma Sacrococcygeal teratoma (SCT is a Teratoma (a kind of tumor located at the base of the Coccyx (tailbone See also Cancer A tumor or tumour is the name for a swelling or lesion formed by an abnormal growth of cells (termed neoplastic In these cases, appropriate treatment usually involves surgery and/or chemotherapy. Chemotherapy, in its most general sense refers to treatment of disease by chemicals that kill cells specifically those of micro-organisms or Cancer.
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. Anti-inflammatory refers to the property of a substance or treatment that reduces Inflammation. 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. Physical medicine and rehabilitation (PM&R or physiatry, is a branch of Medicine dealing with functional restoration of a person affected by physical disability Reference Foye 2006
Surgical Treatment
In rare cases, surgery to remove the coccyx (coccygectomy) may be required. Coccygectomy is Surgery to remove the Coccyx. In Humans coccygectomy is the treatment of last resort for Coccydynia, but a required treatment
See also
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; 65(8): 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). The pelvic portion of each Sympathetic trunk is situated in front of the Sacrum, medial to the Anterior sacral foramina. The coccyx (pronounced kok -siks (Latin os coccygis) commonly referred to as the tailbone, is the final segment of the human vertebral column "Successful injection for coccyx pain. ". Am J Phys Med Rehabil 85 (9): 783-4. doi:. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 16924191.
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