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Coccygodynia 724.79

synonyms: coccygodynia, coccydynia,

Coccygodynia ICD-9

  • 724.79 (coccygodynia)

Coccygodynia Etiology / Epidemiology / Natural History

  • Definition: pain inthe region of the coccyx.
  • Women>men, 5:1
  • Mean age = 40
  • May be caused by trauma such as difficult vaginal delivery.
  • May be related to hypermobile or subluxatation tip of the coccyx. Patients with an immobile coccyx may have burisitis of the adventia at the coccygeal tip.
  • Associated with obesity, antecedent trauma, childbirth.

Coccygodynia Anatomy

Coccygodynia Clinical Evaluation

  • Pain around the coccyx which may be exacerbated by sitting or arising from sitting.
  • Evaluate for low back pain / radiculopathy.
  • May feel frequent need to defecate or have pain with defecation.
  • Ask about blood in stool, or any vaginal disorders.
  • Evaluate surrounding skin for pilondial cysts/fistula.
  • Rectal examination: feel for bony spicules, palpable masses, pain with coccygeal motion.
  • Stool guaiac for occult blood.

Coccygodynia Xray / Diagnositc Tests

  • Dynamic xrays: standing and sitting lateral views of the coccyx may demonstrate anterior hypermobility >25°, subluxation or posterior displacement when seated, or a spicule of the distal tip.
  • Bone scan: may show inflammation in a subluxated or hypermobile segement but is not diagnostic.
  • MRI: may demonstrate edema around coccyx but is not diagnositic. Aids in ruling out tumor etc.
  • Local injection: releaf of symptoms with local anesthetic injection around the coccyx adds in diagnosis.

Coccygodynia Classification / Treatment

  • NSAIDs, rest, hot baths, coccygeal cushion, stool softener. Physical therapy with diatherm and ultrasound.
  • Steriod/local anesthetic injection (59% successful), Injection with manipulation under anesthesia (85% successful) (Wray CC, JBJS 1991;73Br:335).
  • Coccyectomy: 88% excellent to good results (Postacchini F, JBJS 1983;65A:1116)

Associated Injuries / Differential Diagnosis

  • Low back pain.
  • Lumbar degenerative disk disease.
  • Arachnoiditis of the lower sacral nerve roots.
  • Coccyx/sacral tumor.
  • Pilonidal cysts/sinuses.
  • Perirectal abscesses.

Coccygectomy Complications

  • Perineal contamination of the wound (bowel prep indicated pre-operatively).
  • Continued pain.

Coccygodynia Follow-up Care

  • Post-Op: avoid any pressure on surgical incision.
  • 7-10 days: wound check, remove sutures if healing has occur. Continue weekly follow-up until wound is well healed. Avoid prolonged pressure on coccyx.
  • 6 Weeks: gradually resume activites. No sports.
  • 3 Months: resume full activities if symptom free.

Coccygodynia Review References

  • Fogel GR, JAAOS 2004;12:49
 

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