How is coccydynia diagnosed?

Updated: Jan 07, 2021
  • Author: Patrick M Foye, MD; Chief Editor: Consuelo T Lorenzo, MD  more...
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Answer

The patient's response to injection of local anesthetic agents, with or without corticosteroids, can provide helpful information regarding whether the patient's pain generator has been accurately identified. However, the injection response may not be considered truly diagnostic of whether the pain generator is a specific anatomic structure unless the injection is performed with the guidance of fluoroscopy or other imaging aids. Similarly, if large volumes of fluid are injected, extravasation from the targeted site decreases the diagnostic specificity.

Plain radiographs are typically the initial imaging study of choice for patients with coccydynia, especially in cases of focal sacrococcygeal trauma. Plain radiographs may reveal fractures, abnormal sacrococcygeal curvature, osteophytes, or dislocations of the sacrococcygeal junction or intracoccygeal segments. [6, 7]

Lumbosacral magnetic resonance imaging (MRI) would be most helpful in cases in which the coccygeal pain is suspected to be referred from anatomic structures located more superiorly within the spine (ie, at the lumbar or sacral regions).

Computed tomography (CT) scanning and/or MRI of the pelvis can be helpful in cases in which intrapelvic pathology (ovarian, cervical, colon, testicular, or prostate cancer or their associated metastases) is suspected. [8]


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