Winner of CoW 21 August 2016
COCCYDYNIA
Findings
Tiny dorsal bony spicule in the 2nd coccygeal vertebra. Soft tissue edema in the retro-coccygeal bursa without abnormal bone marrow STIR hyperintensities in the coccyx - Suggestive of retro-coccygeal bursitis – Likely cause of coccydynia. Type 2 coccyx with four coccygeal vertebrae noted
Discussion
Coccydynia was earlier considered as a "psychological" or somatization pain. Now, it is accepted that it is arising from various etiologic structures. Coccydynia is related to coccygeal instability in many cases and these can be documented by dynamic X-rays of Coccyx. The diagnosis should be documented with dynamic X-ray films to look for evidence of luxations and hypermobility. If the dynamic X-rays are normal, the cause of pain may be intradiscal inflammation, bursitis due to rigid coccyx or pain could be located at the sacral insertion of the sacrotuberous ligament. MRI is invaluable to diagnose an inflammatory reaction around a disc or the peri-coccygeal soft tissue or bone oedema. Four types of coccyx have been described type I: the coccyx is curved slightly forward, with its apex pointing caudally (~70%) type II: the coccyx is curved more markedly anteriorly, with its apex pointing straight forward (~15%) type III: the coccyx is sharply angulated forward between the first and second or the second and third segments (~5%) type IV: the coccyx is subluxed anteriorly at the level of the sacrococcygeal joint or at the level of the first or second intercoccygeal joints (~10%) Commonly described features of coccydynia are: rigid coccyx with a spicule or spur at its tip bursa along the dorsal surface of the coccyx presence of fluid collection within the sacrococcygeal synchondrosis large draining vein on the ventral coccyx any inflammation or soft tissue abnormalities around the coccyx Soft tissue edema or draining abutting tip of coccyx is most commonly related to a rigid coccyx, while uncommon in a flexible coccyx.
Ref: Eur Spine J. 2012 Oct; 21(10): 2097–2104. Magnetic resonance imaging findings in the painful adult coccyx Jean-Yves Maigne,1 Isabelle Pigeau,2
Findings
Tiny dorsal bony spicule in the 2nd coccygeal vertebra. Soft tissue edema in the retro-coccygeal bursa without abnormal bone marrow STIR hyperintensities in the coccyx - Suggestive of retro-coccygeal bursitis – Likely cause of coccydynia. Type 2 coccyx with four coccygeal vertebrae noted
Discussion
Coccydynia was earlier considered as a "psychological" or somatization pain. Now, it is accepted that it is arising from various etiologic structures. Coccydynia is related to coccygeal instability in many cases and these can be documented by dynamic X-rays of Coccyx. The diagnosis should be documented with dynamic X-ray films to look for evidence of luxations and hypermobility. If the dynamic X-rays are normal, the cause of pain may be intradiscal inflammation, bursitis due to rigid coccyx or pain could be located at the sacral insertion of the sacrotuberous ligament. MRI is invaluable to diagnose an inflammatory reaction around a disc or the peri-coccygeal soft tissue or bone oedema. Four types of coccyx have been described type I: the coccyx is curved slightly forward, with its apex pointing caudally (~70%) type II: the coccyx is curved more markedly anteriorly, with its apex pointing straight forward (~15%) type III: the coccyx is sharply angulated forward between the first and second or the second and third segments (~5%) type IV: the coccyx is subluxed anteriorly at the level of the sacrococcygeal joint or at the level of the first or second intercoccygeal joints (~10%) Commonly described features of coccydynia are: rigid coccyx with a spicule or spur at its tip bursa along the dorsal surface of the coccyx presence of fluid collection within the sacrococcygeal synchondrosis large draining vein on the ventral coccyx any inflammation or soft tissue abnormalities around the coccyx Soft tissue edema or draining abutting tip of coccyx is most commonly related to a rigid coccyx, while uncommon in a flexible coccyx.
Ref: Eur Spine J. 2012 Oct; 21(10): 2097–2104. Magnetic resonance imaging findings in the painful adult coccyx Jean-Yves Maigne,1 Isabelle Pigeau,2
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!