From the Research
A tailbone X-ray is the first step in diagnosing coccydynia, particularly when a patient experiences persistent tailbone pain after trauma or injury, as it helps identify conditions like coccyx fractures, dislocations, or abnormal positioning 1. When evaluating coccydynia, the first step 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 1. The procedure is quick, painless, and involves minimal radiation exposure, with no special preparation needed beforehand. While X-rays are excellent for identifying fractures, they may not detect all soft tissue injuries around the coccyx, and if symptoms persist despite normal X-ray findings, additional imaging such as MRI or CT scan may be recommended for a more detailed evaluation 2. Some key features to look for in X-ray findings include Type II coccyx morphology, subluxation of the intercoccygeal joint, and presence of bony spicules, which can help guide treatment decisions 1. Treatment for tailbone injuries typically includes pain management with NSAIDs, cushions to reduce pressure when sitting, and in some cases, physical therapy, with most tailbone injuries healing within 4-8 weeks with conservative management 3. It's essential to note that radiologists should not overlook this region and should be familiar with the coccyx's morphologic appearance and the sacrococcygeal region's differential diagnosis to ensure accurate diagnosis and effective treatment 1. In cases where conservative management is not effective, further treatment options such as manipulations, ganglion impar block, injections, radiofrequency, and shock treatments, and finally coccygectomy, may be considered 1.