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Michael L. Ramsey, MD et al ABSTRACT The term coccyx is Greek for the
word meaning cuckoo, as the bone resembles the beak of the bird.
Usually, the coccyx is made up of 4 fused segments, with the first
being the largest and having two transverse processes, but no spinous
process or pedicles. The
sacrococcygeal joint is a symphysis joint and there exists a moderate
amount of motion. The other 3
joints are fibrous and have minimal motion, and often fuse by middle age.
In elderly persons, the coccyx may fuse to the sacrum, and the
coccyx is supported by long superficial and short deep sacrococcygeal
ligaments. The ratio of coccygodynia is 9:1
for female: male. This is
because the ischial tuberosities are more spread apart in women, placing
the coccyx at risk of injury. In
addition, the coccyx in women is smaller, lower and more posterior in the
pelvis than in men. The cause
of coccygodynia is not known, but there appears to be incidences of
osteoarthritis of the sacrococcygeal joint, nonunion, subluxation, lumbar
athology, childbirth injury, and functional neurosis.
Treatment may include doughnut cushions, ice, heat, local
injections, and manipulation. This study reviewed two groups of
persons with at least two months of coccygodynia. The first group received local injections into the
sacrococcygeal joint with marcaine and a corticosteroid.
Manipulation was performed by having one finger in the rectum and
the other on the outer surface, while the coccyx was taken throughout its
ROM. The surgical group
received removal of the segments, occasionally leaving the last segment. For the conservative treatment of
manipulation and injection, 78% reported success, while 22% did not.
Of the successful patients, 56% required more than one injection,
and none required more than three. The
surgical group reported a satisfactory result 87% of the time, and only
two reported continued problems, and both were the only worker’s
compensation patients. All
patients receiving surgery had already failed conservative treatment.
The wound complication rate was a high 26% for the surgical group. COMMENTS Coccygodynia, or coccygea, is not
that uncommon, and often underreported either due to the patients
reluctance to have that area treated, or the medical communities
reluctance to address that area. The authors indicate that at times
it may be the soft tissue that is contributing to the problem, as opposed
to the sacrococcygeal joint, which I agree with.
Usually, patients I see have pain and tenderness at the tip, as the
soft tissue branches out off the coccyx.
Often, there exists sacral hypomobility or even lumbar
hypomobility, resulting in increased coccygeal movement and pain. There is also a high rate of problems due to some form of
direct trauma. My method of treatment usually
consists of ultrasound, soft tissue massage in a transverse pattern
perpendicular to the tissues as they branch off the coccyx, sacral
mobilization, coccygeal manipulation and mobilization when necessary, and
iontophoresis with ice. I
would have to say I never had a patient who did not improve over 80% with
this treatment method. It may
be awkward at times, but just be a medical professional and treat
accordingly. For the doughnut cushion, I usually send the patient to a
local fabric store that sells replacement sofa cushions. They can pick up a cheap piece of foam, cut out the relief
where needed, and provide some pressure relief. This article has faults, including
no control group and no method to find out if there is a placebo effect
from the injections. It does
provide a platform for future study of PT in this area, as the authors
indicate there is little in the literature.
If the local medical community does not hear of the things we can
do and the problems we can treat, they will not refer to us.
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