Tail piece.

Lancet

337, page 1386, June 08. 1991.

Editorial

Abstract

Clinicians have evolved numerous therapies for coccydynia, many of doubtful value. Wray et al carried out a randomised trial. They compared the efficacy of injection alone against manipulation under anaesthesia and injection. 120 patients were recruited. The aetiology was a fall in 30 and childbirth in 14; 15 had had repetitive strain on their bottoms (eg, from a rowing machine or bicycling); and 6 dated their symptoms from a surgical procedure (3 in the lithotomy position). 60% responded to injection alone, and 85% to manipulation and injection.

On completion of the trial, 23 patients came to coccygectomy and all but 2 had a good result. Thus, the Leicester workers have swept away many of the ill-conceived notions surrounding this complaint, and have shown that 80% of patients with coccydynia can be treated conservatively.

The curious perception of many surgeons that coccygectomy is a mad or bad operation is belied both by this and by other reports. Patients with coccydynia deserve more than a look of incredulity from their doctor and the offer of a ring cushion.

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