Coccyx Fracture: (Tailbone Fracture)

Presentation

The patient presents after falling onto the buttocks or getting kicked in the sacrococcygeal synchondrosis during an athletic activity, complaining of pain at the tip of the spine that is worse with sitting and perhaps with defecation owing to the use of the levator ani and the anococcygeal muscles. There is little or no pain with standing, but walking may be uncomfortable. Because part of the gluteus maximus inserts on the coccyx, pain can also occur when rising from a seated position.

On physical examination, there is point tenderness and perhaps deformity of the coccyx that may be best palpated by examining through the rectum with a gloved finger ( Fig. 104.1 ).