Sacrococcygeal Joint Injection

Coccydynia - strain of coccygeal ligaments, subluxation

Causes and findings:
• Trauma - fall onto buttock
• Prolonged sitting on hard surfaces
• Pain localized over sacrococcygeal joint
• Coccyx might be subluxed

Equipment:
Syringe - 1ml
Needle - 23G 1 inches (25mm) blue
Kenalog 40 - 20 mg
Lidocaine - 0.5 ml 2%
Total volume - 1 ml

Anatomy:
The ligaments at the sacrococcygeal joint line are usually very tender and can be palpated both on the dorsal and ventral surfaces. The gloved finger palpates the angle of the coccyx to check for subluxation of the bone.

Technique:
• Patient lies prone over small pillow
• Identify and mark tender site on dorsum of coccyx at joint line
• Insert needle down to touch bone
• Pepper solution around into tender ligaments

Aftercare:
Advise patient to avoid sitting on hard surfaces and to use a ring cushion. At follow-up 2 weeks later, manipulation of the coccyx might be necessary to correct any subluxation; the anti-inflammatory effect of the steroid enables this to be performed with less discomfort. The gloved finger is inserted into the rectum and a firm anteroposterior movement applied. Sometimes an audible click can be heard and some days later the relief of pain is apparent.

Comments:
Pain in this area can be symptomatic of psychological or psychosexual distress, in which case the appropriate treatment/advice is required. With somatic pain the protocol above appears to work either well or not at all. Surgery is not usually indicated or particularly successful.