Coccydynia Pain in the vicinity of the coccygeal bone.
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Transcript of Coccydynia Pain in the vicinity of the coccygeal bone.
![Page 1: Coccydynia Pain in the vicinity of the coccygeal bone.](https://reader034.fdocuments.in/reader034/viewer/2022051515/551c379455034693488b4657/html5/thumbnails/1.jpg)
Coccydynia
Pain in the vicinity of the coccygeal bone
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Associated Symptoms
• Dyspareunia• Dyschezia• Dysmenorrhea
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Causes
• Trauma from a vertical blow
• Difficult vaginal delivery
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Pathologic features
• Dislocated sacrococcygeal fracture
• Ligamentous damage
• Most cases the tip of the coccyx is subluxed or hypermobile
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Anatomy
• Fibrous sacrococcygeal joint connects the sacrum to the one to four bone segments of the coccyx
• Joint is reinforced by sacrococcygeal ligaments which encloses the s5 nerve root
• S4,5 make the coccygeal plexus
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Anatomy
• Levator ani and coccygeal muscles attach to and support the coccyx during childbirth and defecation
• Gluteus maximus also attaches to the lateral coccyx
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Anatomy
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Prevalence
• 5x greater in women
• Female coccyx is more posterior in location and larger
• 3x more frequent in obese women, maybe be related to the decrease pelvic rotation during sitting
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Symptoms
• Pain
• Dull and achy
• Sensation of pressure
• Increased pain with prolong sitting or sitting on hard surfaces
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Levator ani syndrome and proctalgia fugax are
variants of coccydynia
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What is levator ani syndrome?
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Levator Ani Syndrome
• Dull ache or pressure senation in the rectum
• Worse during the day
• Tenderness on palpation
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Pelvic Floor Muscles – Tension Myalgia
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Proctalgia Fugax
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Proctalgia Fugax
• Sudden onset of anal pain that last a few minutes or seconds
• Spastic muscle contractions of the pelvic floor muscles
• Five times per year or more
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Physical exam
• Tender over the coccyx• Pelvic symmetry• LE neuro exam• Rectal exam• Check lymph nodes
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Functional limitations
• Driving
• Avoid social situations
• Equestrian
• Sexual
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X-rays
• Subluxation and fx
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Physiatric Prescription
• Pain control measures?
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Pain relief
• Ice• Warm sitz baths• Ultrasound• Galvanic stim
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Pain relief
• Soft sitting surfaces – donut holes?
• Pelvic floor relaxation exercises
• Pelvic floor massage• Massage• Injections
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What is Thiele’s massage?
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Thieles Massage
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What is sacral sitting?
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Posture
• Sitting
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Sacral Sitting
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Sacral Flexion
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Motion
• Anti-lordotic exercises – Williams exercises
• Hip extensor strengthening
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What is Williams Exercises?
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Williams Exercises
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Alignment/Adjustment – Muscle Energy
• Sacral Flexion• Sacral extension• Sacro iliac• Unilateral or Bilateral
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Pelvic floor and gluteal relaxation
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Other measures
• Botox• Prolotherapy• Surgery
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Activity modification
• No prolong sitting• No sitting on hard
surfaces