1 / 34

Coccydynia

Coccydynia. Pain in the vicinity of the coccygeal bone. Associated Symptoms. Dyspareunia Dyschezia Dysmenorrhea. Causes. Trauma from a vertical blow Difficult vaginal delivery. Pathologic features. Dislocated sacrococcygeal fracture Ligamentous damage

avital
Download Presentation

Coccydynia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Coccydynia Pain in the vicinity of the coccygeal bone

  2. Associated Symptoms • Dyspareunia • Dyschezia • Dysmenorrhea

  3. Causes • Trauma from a vertical blow • Difficult vaginal delivery

  4. Pathologic features • Dislocated sacrococcygeal fracture • Ligamentous damage • Most cases the tip of the coccyx is subluxed or hypermobile

  5. 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

  6. Anatomy • Levatorani and coccygeal muscles attach to and support the coccyx during childbirth and defecation • Gluteus maximus also attaches to the lateral coccyx

  7. Anatomy

  8. 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

  9. Symptoms • Pain • Dull and achy • Sensation of pressure • Increased pain with prolong sitting or sitting on hard surfaces

  10. Levatorani syndrome and proctalgiafugax are variants of coccydynia

  11. What is levatorani syndrome?

  12. LevatorAni Syndrome • Dull ache or pressure senation in the rectum • Worse during the day • Tenderness on palpation

  13. Pelvic Floor Muscles – Tension Myalgia

  14. ProctalgiaFugax

  15. ProctalgiaFugax • 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

  16. Physical exam • Tender over the coccyx • Pelvic symmetry • LE neuro exam • Rectal exam • Check lymph nodes

  17. Functional limitations • Driving • Avoid social situations • Equestrian • Sexual

  18. X-rays • Subluxation and fx

  19. Physiatric Prescription • Pain control measures?

  20. Pain relief • Ice • Warm sitz baths • Ultrasound • Galvanic stim

  21. Pain relief • Soft sitting surfaces – donut holes? • Pelvic floor relaxation exercises • Pelvic floor massage • Massage • Injections

  22. What is Thiele’s massage?

  23. Thieles Massage

  24. What is sacral sitting?

  25. Posture • Sitting

  26. Sacral Sitting

  27. Sacral Flexion

  28. Motion • Anti-lordotic exercises – Williams exercises • Hip extensor strengthening

  29. What is Williams Exercises?

  30. Williams Exercises

  31. Alignment/Adjustment – Muscle Energy • Sacral Flexion • Sacral extension • Sacro iliac • Unilateral or Bilateral

  32. Pelvic floor and gluteal relaxation

  33. Other measures • Botox • Prolotherapy • Surgery

  34. Activity modification • No prolong sitting • No sitting on hard surfaces

More Related