Case of Coccyodynia

Boston Medical and Surgical Journal

82: 458-465 June 16, 1870

Z. B. Adams

Boston Society for Medical Improvement

February 4. 1870. Carrie E., 11 years old last Christmas. Pale, delicate-looking, well grown and rather tall. Two years ago last September she slipped in going down stairs, and fell, striking upon the tip of the coccyx against the edges of several successive stairs. Complained of severe pain and tenderness about the coccyx, which has continued, more or less, up to the present time, with occasional exacerbations, on receiving any jar or shock. At times after slight injury, such as a sudden push, slip or stumble, has been confined to the bed or chair for several weeks, being unable to stand erect or walk without great suffering. Has always pain on going up stairs or rising from a chair. No pain in defecation. A constant dull aching or soreness is complained of in the part. At the present time the region of the coccyx is so sensitive that she will not allow it to be touched. Is losing flesh and color; bowels irregular, and appetite poor and capricious. It is difficult to dress or undress her, as she cannot bear to be moved to an erect posture. Leeching and counter-irritation, sedatives and narcotics, have been tried without satisfactory results.

I advised Prof. J. V. Simpson's method of subcutaneous tenotomy. After some hesitation this was consented to.

It was necessary to administer ether, on account of the excessive sensitiveness of the parts. A small puncture was made directly over the tip of the coccyx. Through this a tenotomy knife was entered along the back of the bones, and the muscular attachments divided on each side. Although there had been no complaint of pain in defecation, the attachment of the levator ani to the tip of the coccyx was alsocut, and the knife passed completely round.

On recovering from the ether, it was at once perceived that the excessive sensitiveness of the part had disappeared. As soon as the soreness resulting from the operation began to diminish, it was found that she could stand and walk without the slightest pain. Gradually the feeling of soreness or dull aching also wore away.

It is stated by Simpson, and Dr. Adams believed generally admitted, that coccyodynia is a disorder peculiar to the female sex, or occurring only exceptionally in the male. The explanation of this may be found, perhaps, in the anatomical peculiarity of the female coccyx, in which the bony segments are separated by thin plates of fibro-cartilage, and the whole from the sacrum by an articular synovial sac. In the male these parts are found to be ossified quite early in life. If, then, we suppose the injury to be inflicted upon these little plates of fibro-cartilage, or upon the bursa, it is easy to conceive how the gluteus, when in full action, as in erecting the pelvis upon the fixed thigh, acts to push the segments of the coccyx together and the whole against the sacrum; and accordingly the remedy is found in division of those fibres of the glutei maximi which are attached to the sides of the ossa coccygis.

Dr. Hodges said this operation had been done several times by himself, Dr. J. M. Warren, and others in this city.

http://www.nejm.org/doi/full/10.1056/NEJM187006160822404

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