Causes Trauma from a vertical blow Difficult vaginal delivery
Pathologic features Dislocated sacrococcygeal fracture Ligamentous damage Most cases the tip of the coccyx is subluxed or hypermobile
Anatomy Fibrous sacrococcygeal joint connects the sacrum to the one to four bone segments of the coccyx Joint is reinforced by sacrococcygeal ligaments which encloses the s5 nerve root S4,5 make the coccygeal plexus
Anatomy Levator ani and coccygeal muscles attach to and support the coccyx during childbirth and defecation Gluteus maximus also attaches to the lateral coccyx
Prevalence 5x greater in women Female coccyx is more posterior in location and larger 3x more frequent in obese women, maybe be related to the decrease pelvic rotation during sitting
Symptoms Pain Dull and achy Sensation of pressure Increased pain with prolong sitting or sitting on hard surfaces
Levator ani syndrome and proctalgia fugax are variants of coccydynia
What is levator ani syndrome?
Levator Ani Syndrome Dull ache or pressure senation in the rectum Worse during the day Tenderness on palpation
Pelvic Floor Muscles – Tension Myalgia
Sudden onset of anal pain that last a few minutes or seconds Spastic muscle contractions of the pelvic floor muscles Five times per year or more
Physical exam Tender over the coccyx Pelvic symmetry LE neuro exam Rectal exam Check lymph nodes
Functional limitations Driving Avoid social situations Equestrian Sexual
X-rays Subluxation and fx
Physiatric Prescription Pain control measures?
Pain relief Ice Warm sitz baths Ultrasound Galvanic stim