Korean J Pain.  2023 Jul;36(3):272-280. 10.3344/kjp.23175.

Coccydynia: anatomic origin and considerations regarding the effectiveness of injections for pain management

• Lee SH
• Yang M
• Won HS
• Kim YD

• KMID: 2544240
• DOI: http://doi.org/10.3344/kjp.23175

Abstract

Coccydynia is a debilitating pain disorder. However, its pathophysiology is not well understood. When approaching coccydynia, the exact underlying cause of pain must be identified to develop an appropriate treatment plan. The specific approach to coccydynia can vary depending on an individual's condition and the underlying cause. Thorough evaluation by a pain physician is essential to determine the most appropriate course of treatment. The purpose of this review is to examine the various causes contributing to coccygeal pain and specifically focus on the exact anatomical neurostructures, such as the anococcygeal nerve, perforating cutaneous nerve, and ganglion impar. We also reviewed the relevant clinical outcomes and suggested recommendations for each anatomical structure.

Keyword

Anatomy; Chronic Pain; Coccyx; Ganglia, Sympathetic; Injections; Low Back Pain; Lumbosacral Region; Nerve Block; Pelvic Pain; Prevalence; Sacrococcygeal Region

Figure

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  Fig. 1 Cutaneous nerves distributing the skin of coccygeal region. AN: anococcygeal nerve, PCN: the perforating cutaneous nerve, STL: sacrotuberous ligament.

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  Fig. 2 Schematic drawing of the anococcygeal nerves and adjacent structures. AN: anococcygeal nerve, GI: ganglion impar, CP: coccygeal plexus.

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  Fig. 3 Intrapelvic view of ganglion impar (GI). SSN: sacral splanchnic nerve, ST: sympathetic trunk.

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  Fig. 4 Sacrococcygeal joint (SCJ) and adjacent ligaments. ASL: anterior sacrococcygeal ligament, dPSL: deep posterior sacrococcygeal ligament, sPSL: superficial posterior sacrococcygeal ligament, ICL: intercornual ligament, LSL: lateral sacrococcygeal ligament, CTP: coccygeal transverse process, ICJ: intercoccygeal joint.

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  Fig. 5 Schematic drawing showing commonly used methods for ganglion impar blockade. Directions of needles indicate lateral (A) and trans-coccygeal approaches (B), respectively.

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  Fig. 6 Ultrasound guided joint injection for patients with coccydynia. Arrows indicate each injection site on ultrasound image and coccyx.

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