From the Research
X-rays are indicated for patients with coccydynia, particularly when the pain is severe, persists for more than a few weeks, or follows a traumatic injury, as they can help identify fractures, dislocations, or abnormal alignment of the coccyx that might be causing pain, as recommended by the most recent study 1. The diagnosis of coccydynia involves a combination of physical examination, medical history, and imaging tests. According to the study by Sukun et al. 1, the first step in evaluating coccydynia is a dynamic X-ray examination of the coccyx in standing and sitting position, which can help identify morphologic parameters and hypermobility causing idiopathic coccydynia. Some key features to look for in X-ray examinations include:
- Type II coccyx morphology
- Subluxation of the intercoccygeal joint
- Presence of bony spicules
- Hypermobility, defined as more than 25% posterior subluxation while sitting or more than 25° flexion while sitting While X-rays are useful diagnostic tools, they may not always reveal soft tissue injuries or inflammation that could also cause tailbone pain. If X-rays are inconclusive but pain persists, additional imaging such as an MRI or CT scan may be recommended for a more detailed evaluation, as suggested by the study by Agildere et al. 2. It's essential to note that many cases of tailbone pain (coccydynia) resolve with conservative treatments like NSAIDs, cushions to relieve pressure when sitting, and physical therapy, even without imaging, as reported by the study by Cankurtaran et al. 3. However, persistent or severe pain warrants medical evaluation to rule out serious conditions like tumors or infections that might require more aggressive treatment.