The most common causes of coccygodynia in 324 patients were anorectal infection, 45 per cent; chronic trauma involving poor sitting posture, 32 per cent; acute trauma, 20 per cent, and parturition, 4.4 per cent.
With the exception of cases of acute trauma, the coccyx is not tender and is not the source of the pain called coccygodynia; the pain originates in spasm of the levator ani and coccygeus (and, at times, in the medial fibers of the gluteus maximus) muscles, and is referred to the coccygeal area; and the size, shape and position of the coccyx bear no relationship to coccygodynia.8
X-ray examination is of diagnostic value only in cases of suspected fracture or dislocation.
Coccygectomy too often yields disappointing results, but is most likely to be of value in patients in whom coccygodynia was caused by acute severe trauma.3, 16, 21, 27
Gross and microscopic examination of coccyges removed in an attempt to relieve coccygodynia have failed to reveal any disease of the coccyx or contiguous ligaments and tendons.16
Relief obtained by injections of alcohol, or of various anesthetic agents, with or without cortisone, is accomplished through resultant relaxation of the spastic levator ani and coccygeus muscles.
Treatment by properly applied massage of the levator ani and coccygeus muscles, and at times, of the mesial fibers of the gluteus maximus muscle, cured or satisfactorily relieved 91.7 per cent of patients treated.
KeywordsMuscle Spasm Gluteus Maximus Acute Trauma Sacrospinous Ligament Piriformis Muscle
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- 1.Blount, W. P.: Osteomyelitis of the coccyx. J.A.M.A.91: 727, 1928.Google Scholar
- 2.Boland, F. K.: Osteitis of the coccyx. J.A.M.A.88: 1883, 1927.Google Scholar
- 3.Caldwell, G. A.: Minor injuries of the lumbar spine and coccyx. S. Clin. North America, October 1951, p. 1345.Google Scholar
- 4.Cooper, W. L.: Coccygodynia. J. Kentucky M. A.57: 178, 1959.Google Scholar
- 6.Dittrich, R. J.: Coccygodynia as referred pain. J. Bone & Joint Surg.33A: 715, 1951.Google Scholar
- 7.Dorland’s Illustrated Medical Dictionary, Ed. 23, Philadelphia, W. B. Saunders Company, 1957, p. 294; 1348.Google Scholar
- 8.Duncan, G. A.: Painful coccyx. Arch. Surg.34: 1088, 1937.Google Scholar
- 10.Ely, L. W.: Coccygodynia. J.A.M.A.54: 968, 1910.Google Scholar
- 11.Granet, E.: Proctalgias and allied non-inflammatory perianal dyscrasias: Coccygodynia, proctalgia fugax, neurogenic pruritus ani. Am. J. Digest. Dis.13: 330, 1946.Google Scholar
- 12.Gray, H.: Anatomy, Descriptive and Applied. Philadelphia, Lea & Febiger, 1913, p. 450.Google Scholar
- 13.Helwig, F. C.: Personal communication to the author.Google Scholar
- 14.Hirst, J. C. and C. Wachs: Labor injuries to the coccyx and their treatment. Am. J. Obst. & Gynec.7: 199, 1924.Google Scholar
- 15.Hobart, M. H.: Manipulative treatment of coccygodynia. S. Clin. North America17: 579, 1937.Google Scholar
- 16.Key, J. A.: Operative treatment of coccygodynia. J. Bone & Joint Surg. n.s.19: 759, 1937.Google Scholar
- 17.Kleckner, M. S.: Coccygodynia: The present day interpretation and treatment. Tr. Am. Proct. Soc. 1933, p. 100.Google Scholar
- 18.Laird, D.: Personal communication to the author.Google Scholar
- 19.Marmor, L.: How to treat inflammation of the coccyx. GP25: 110, 1962.Google Scholar
- 20.McCusker, H.: Injuries to the coccyx. Rhode Island M. J.17: 77, 1934.Google Scholar
- 21.Mentzer, C. G.: Coccygodynia: Report of one hundred and fifty cases. J. Florida M. A.36: 27, 1949.Google Scholar
- 23.Pyper, J. B.: Excision of the coccyx for coccygodynia: A study of the results in twenty-eight cases. J. Bone & Joint Surg.39B: 733, 1957.Google Scholar
- 25.Simpson, J. Y.: Clinical lectures on the diseases of women. Lecture XVII. On coccygodynia, and the diseases and deformities of the coccyx. M. Times & Gaz.40: 1, 1859.Google Scholar
- 28.Suermondt, W. F.: Die Behandlung der Coccygodyne. Arch. klin. Chir.167: 671, 1931.Google Scholar
- 29.Thiele, G. H.: Clinical manifestations of anorectal disease. J. Missouri M. A.33: 85, 1936.Google Scholar
- 30.Thiele, G. H.: Tonic spasm of the levator ani, coccygeus, and piriformis muscles: Its relationship to coccygodynia and pain in the region of the hip and down the leg. Tr. Am. Proct. Soc. 1936, p. 145.Google Scholar
- 31.Thiele, G. H.: Coccygodynia and pain in the superior gluteal region and down the back of the thigh: Causation by tonic spasm of the levator ani, coccygeus and piriformis muscles and relief by massage of these muscles. J.A.M.A.109: 1271, 1937.Google Scholar
- 34.Travell, Janet and S. H. Rinzler: The myofascial genesis of pain. Pestgrad. Med.11: 425, 1952.Google Scholar
- 35.Waters, E. G.: A consideration of the types and treatment of coccygodynia. Am. J. Obst. & Gynec.33: 531, 1937.Google Scholar
- 37.Wilkinson, W. R.: Coccygodynia: Review of the literature and presentation of cases. South. Surgeon13: 280, 1947.Google Scholar
- 38.Yeomans, F. C.: Coccygodynia: A new method of treatment by injections of alcohol. Tr. Am. Proct. Soc. 1914, p. 67.Google Scholar
- 39.Yeomans, F. C.: Coccygodynia: Further experience with injections of alcohol in its treatment. Surg., Gynec. & Obst.29: 612, 1919.Google Scholar