The Journal of Pain
Volume 5, Issue 3, Supplement 1 , April 2004, Page S135
A. Smolenski, J. Fine
Denver Health Medical Center, Denver, CO
In this case report, the patient was a 67 year old female with a five year history of rectal and sacral pain. This is a patient with chronic, progressive rectal and sacral pain which began after a fall. Previous work-up had included an MRI of the lumbar spine and pelvis and were unrevealing. The patient was admitted to an inpatient Rehabilitation unit due to failure of pain control as an outpatient. Initial evaluation revealed significant pain with rectal exam as well as a hypermobile coccyx.
The patient was sent for stress views of the coccyx using the Maigne protocol which demonstrated hypermobility on flexion views. A few days later, the patient had a diagnostic injection to the sacrococcygeal disc space as well as between the first and second coccygeal space.
Post-procedure, the patient reported complete relief of pain and was pain free with mobilization of the coccyx on repeat rectal exam.
Coccygodynia represents only one percent of low back pain but can be extremely debilitating. Up to 1/3 of coccygodynia cases are idiopathic but many cases are thought to arise from disruption of the sacrococcygeal joint ligaments. In these cases, a hypermobile coccyx will likely be present on exam and with stress views on plain film. Pain relief with lidocaine/steroid injection will further confirm the diagnosis and may be therapeutic. In evaluating a patient with chronic rectal and sacral pain, coccygodynia secondary to hypermobile coccyx should be considered in the differential diagnosis and thoroughly evaluated with rectal exam, plain films with stress views, and if necessary local injection with anesthetic and steroid.