Archives of Physical Medicine and Rehabilitation
Volume 84, Issue 9 , September 2003, Page E15
Grant Cooper MD, Mike S. Lee MD and Gregory E. Lutz MD
Hospital For Special Surgery, New York, NY, USA
Setting: Academic outpatient physiatric spine practice.
Patient: A 32-year-old woman.
Case Description: The patient was referred for evaluation of coccygeal pain. Her pain began 3 months prior during a spontaneous vacuum-assisted vaginal delivery of a healthy 8lb boy. The fetus was not in breech, however, his head was turned to the side, making passage difficult. After 21/2h in the active stage, a vacuum was used to assist with the delivery. The patient felt and heard a "snap" in her coccyx.
Assessment/Results: She reported the pain was sharp and rated its intensity as 10 out of 10. Magnetic resonance imaging (MRI) revealed an edematous pattern surrounding her coccyx. Her pain was most pronounced when sitting and was alleviated with standing. She underwent trials of physical therapy and internal mobilization, which aggravated her pain. She was prescribed a nonsteroidal anti-inflammatory drug and nasal calcitonin, but was unable to tolerate these medications due to side effects. Her physical examination was unremarkable except for a pulling sensation in the sacral region on flexion. A repeat MRI confirmed a fractured coccyx with persistent edematous pattern. There was no associated soft tissue injury or mass lesion in the area. We diagnosed her with coccygodynia secondary to coccygeal fracture and prescribed 6 weeks of conservative management. Her pain progressively improved and she did not require further treatment.
Discussion: Postpartum coccygodynia is most commonly seen secondary to hormonal changes, which occur during the third trimester of pregnancy. These changes induce a softening of the synchrondrosis between the sacrum and coccyx, increasing mobility of the ligaments and surrounding muscles, causing inflammation. However, this is only the second reported case of a coccygeal fracture causing postpartum coccygodynia.
Conclusion: Childbirth may result in a coccygeal fracture. This etiology should be included in the differential diagnosis of postpartum coccygodynia.