A Family Doctor's Tale - COCCYX INJURIES

DOC I HAVE A COCCYX INJURY

Coccygeal Injuries consist of Dislocation and fractures.

Dislocation of the coccyx is the dislocation of the coccyx bone forward following falls on the coccyx or repetitive injury to the coccyx.

The coccyx is the tail end of the spine and consists of 3-5 segments which angulates forward to a variable degree.

Fractures of the coccyx may occur as a result of traumatic separation of the segments of the coccyx due to injury.

The cause of Coccygeal Dislocation and fractures is due to:

1.Injury or trauma to the coccygeal bone from falls on the buttocks

2.Repetitive pressure on the coccyx during delivery of the baby during chuildbirths. Fibrosis and stiffness of the coccyx may result from the pressure on the coccyx.

3.Sitting in a slumping position may cause the tip of the coccyx to press upwards giving rise to pain.

The symptoms and signs of Coccygeal Injuries are:

Onset is usually gradual unless due to acute injury

Symptoms:

1.Pain on sitting on the coccyx

2.pain is aggravated by slumping or sitting on a hard seat
 
3.pain is also aggravated by constipation

4. the symptoms are more common in women.

Signs:

1.local tenderness on palpation of the coccyx bone and the side soft tissues

2.deformity of the cocygeal bone

3.rectal examination often reveal pain on sacrococcygeal movements
 
4.X-rays may show dislocation of the coccygeal bone inwards or bony ankylosis with the sacral bone.
Sometimes fractures of the tip of the coccygeal bone may be present.
Osteoarthritis may be noted at the sacrococcygeal joint.

The complications of Coccygeal Injuries are:
Fibrosis and inflammation of the coccyx bone.

The Treatment of Coccygeal injuries is:
Conservative treatment:
1.reduction of the dislocation or fractures of the coccyx bone can be done under local anesthesia

2.Pain can be relieved by sitting a warm sitz bath and a soft doughnut shaped pillow

3.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) are given for pain

4.Muscle relaxant to relax muscles

5.local injection of local anesthetic and long acting steroid can be given for chronic strain or osteoarthritis.

6.constipation should be avoided

All acute injuries of the coccyx are treated conservatively for at least 6 months even with significant angulation of the coccyx bone.

Surgery :

Surgical excision of the coccyx is done only if there is severe pain or in patients who do respond to conservative treatment.

The prognosis of Coccygeal Dislocation is:

Prognosis is usually good although recurrence may occur.

The prevention of Coccygeal Injuries are:
1. Avoid any falls on buttocks

2. sitting in a slumping position.