HWN Suggests

Sacrum and Coccyx Radiographs Have Limited Clinical Impact in the Emergency Department

The diagnosis of sacral and coccygeal fractures can be challenging, with missed or delayed diagnoses in 24–70% of cases. Factors that complicate radiographic interpretations include a combination of intrinsic sacral tilt, kyphotic curvature of the coccyx, overlying fecal material or bowel, variants in coccygeal anatomy, obesity, and poor technical quality...

Because of low yield and limited clinical impact in the ED, we recommend that sacrum and coccyx radiography be eliminated from ED practice in the setting of known or suspected trauma and that patients be treated conservatively or receive advanced imaging on the basis of clinical parameters.

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Articles of Interest

How to Find Relief from a Tailbone Injury

First, try sitting on a coccyx cushion or “donut pillow”. This takes pressure off of the tailbone while also cushioning the surrounding bones and muscles. If you don’t have a donut pillow, sitting on a regular small pillow and leaning slightly forward may provide some level of relief. If possible, try to take frequent breaks from sitting and walk around.

Fractures of coccyx and coccygodynia

The coccyx is usually formed of four rudimentary vertebras, the number may be increased to five or diminished to three. Its contour is normally the continuation of the curve of the lower sacrum. The first segment resembles the last sacral vertebra with large rudimentary articular processes called cornua.

Pain after fall on tailbone

A 21 year old female complains of pain after falling on her "tailbone". What's the diagnosis and management?

Sacral and coccyx radiographs may have limited diagnostic yield in detecting fractures

Sacral and coccygeal fractures are often associated with high-energy trauma, particularly in young adults. However, previous literature has demonstrated that sacral and coccygeal radiographs exhibit limited accuracy due to intrinsic anatomical variations, as well as overlying fecal material, and body habitus. Computed tomography is the current imaging standard in cases of high-energy trauma given its increased accuracy for traumatic bony abnormalities, calling into question the use of less sensitive sacral and coccygeal radiographs.

Resources

Coccyx pain

Coccyx pain is often due to to a dislocation at one of the coccyx joints, or stiffness of one of the joints, or a spasm of the muscles attached to the coccyx. It can follow after falls, childbirth, repetitive strain or surgery or for no obvious reason. The pain can disappear by itself or with treatment, or it can continue for years, and may get worse. It is five times more common in women than men, probably because the female pelvis leaves the coccyx more exposed.

Physiopedia

A fractured coccyx can be a very painful acute or chronic ordeal and may not resolve for a long duration. Furthermore, due to the nature of the coccyx structure, many tailbone fractures are not immediately diagnosed.

Radiopaedia

Coccygeal fractures are generally low-severity injuries, which nonetheless can be diagnostically challenging. Diagnosis may be delayed or missed due to coccygeal anatomy and patient/technical factors (e.g. obesity, overlying bowel gas/feces).