Treatment options for coccygodynia

Abstract

To this day, patients with coccyx problems are the most frequently underestimated patient population in orthopedic practices. The clinical picture of coccygodynia was first described in 1859. Nevertheless, discussions about the importance of coccyx problems remain atiresome topic. All patients have in common that they have gone through along ordeal with many therapists, examinations and therapeutic approaches without having received areal diagnosis. The main symptom of coccygodynia is the pain directly on the lowest segment of the coccyx, which often only occurs when sitting and is intensified by the change in position, usually from asitting to astanding position. Trauma can only be described as the trigger in 50% of cases. Women are four times more likely to be affected than men. The gold standard for imaging should be viewed from standing and seated dynamic lateral radiographs of the coccyx. After the diagnosis has been made, conservative treatment should first be started with oral NSAIDs, relief with acoccyx cushion with arecess and, if necessary, physiotherapy to strengthen or loosen the pelvic floor. Local infiltrations with aglucocorticoid and local anesthetic directly in the painful area are also often promising. If the symptoms persist for more than 6months, surgical treatment in the sense of removing the coccyx can be discussed with the patient. The literature shows asuccess rate of 80-90% if the indication was correct.