Caudalgia (coccygodynia) is pain in the tailbone, lower sacrum and adjacent muscles, or other soft tissues, and can be caused by a variety of disorders. It is characterized by pain in the sacrococcygeal region during prolonged sitting or standing up from a sitting position. Caudal pain is often seen in women, especially in middle-aged women, and the ratio of men to women is about 1:5.3. The margin of the coccyx is narrow, and there are sacral nodal ligaments attached on both sides. The tip is attached by the external anal sphincter. The posterior branch of the caudal nerve receives the sacral nerve traffic branch and is distributed in the skin of the posterior part of the coccyx, and the anterior branch of the caudal nerve is encircled forward by the underdeveloped transverse process of the coccyx. Because of its special anatomical location, the main clinical manifestation is difficulty in sitting, and its prognosis is mostly good. Wang Linqing, Department of Orthopedics, Lanzhou Hospital of Traditional Chinese Medicine and Traumatology
Etiology and pathology
The detailed mechanism of the pathogenesis of this disease is still unknown, according to the analysis of clinical data. Related to the following factors.
1, trauma is the most common, including tailbone fracture, dislocation or general trauma can be caused. This is due to tailbone injury, tissue hemorrhage, edema formation of fibrous tissue and scarring, pressure on the nerve endings around the tailbone, as well as local circulation disorders, affecting the metabolism of the tissue and produce pain, so that the local tissue spasm, pulling the tailbone, so that the pain increases. Local pain can sometimes last for several months.
2, deformity congenital tailbone deformity is mostly hook-shaped, such state is bound to cause high tension state of the surrounding muscles and ligaments to cause these tissues due to premature degeneration and cause pain. This kind of factor causes the disease, is less common than before.
3.A variety of other factors can cause this disease, including central lumbar disc herniation, sacral tumor or cyst, arch rupture with slippage and many other factors.
Western medicine diagnosis
(I) Diagnosis
Clinical manifestations: The main symptom of this disease is caudal pain, which is mostly limited. Sometimes there may be pain in the lower sacral area, upper hip area and along the sciatic nerve release area. Especially, the pain is more significant when sitting on a hard bench, coughing and defecating. Patients mostly do not like to sit on hard stools to prevent local pressure. In addition, depending on the cause of the disease, the pain may vary greatly. The pain occurs when the distal end of the fracture is displaced forward or laterally by the pull of the caudalis muscle and the anal raphe. The pain is milder in the standing or lying position, and increases when sitting or straining in stool; there is localized pressure pain. There may be caudal pressure and abnormal activity on anal palpation, and sometimes the fractured end and displacement may be palpable. Most of the symptoms are milder in cases due to other causes, especially in congenital and long-standing cases.
Other auxiliary examinations: X-ray plain film examination must be combined with clinical examination, because the tailbone itself may have forward flexion deformity. CT and MRI examinations are generally not required.
When diagnosing tailbone pain, it is important to think of other causes of tailbone pain, such as tailbone infection, tuberculosis or tumor. Therefore, a detailed history and careful examination, including rectal examination and X-ray examination, can be used to make the differentiation.
(B) Differential diagnosis
(1) Damage to the sacrococcygeal region: such as an unstable fifth lumbar slipped torus, which will cause caudal pain by compressing the dura and nerve roots. Larger central type disc herniation will also cause caudal pain. Taking lumbosacral brake can reduce the pain and control its further development.
2. Parasacral lipoma: Caudal pain is simply caused by edema or herniation caused by small fibrofatty nodules passing through deep fascia. In such patients, the fatty nodules can be palpated in the posterior part of the sacrum. Local closure or excision of the fatty nodule can be performed.
3.Infection foci at the pelvis: If the infection drains to the pelvic muscles through lymphatic drainage, it may lead to myositis or radioactive spasm of the muscles and produce caudal pain.
[Basic treatment
I. Tuina massage
1. The patient is placed in a lateral position, with the hip and knee joints flexed as much as possible. The operator wears gloves on the right hand, reaches into the anus with the index finger of the right hand, and puts it directly to the lower part of the coccyx and sacrum. Then massage both sides of the sacrococcygeal bone and the muscles attached to both sides of the coccyx in the left and right directions. The massage technique should be light at the beginning, and then gradually increase the massage power.
2, chronic strain injury caused by the prone position or side lying position can be taken to rest 2 to 3 weeks tailbone pain supine can also sit when the pad air circle. Hot water bath 2 to 3 times a day, can reduce the anal muscle spasm most in l to 3 months to heal; but there is a longer delay, need 3 to 6 months without tailbone weight-bearing treatment. The pressure is painless before weight-bearing sitting, too early to make the tailbone weight-bearing, the symptoms are easy to recur, and the disease process should start again.
Second, local closed treatment
This method is suitable for those with severe pain and clear pain points. For such cases, choose 1% lidocaine 2~3ml and strengthen dextran 25~50mg, inject it into the obvious place of pressure pain in sacrococcygeal region. When injecting, be careful not to enter the needle too deep to prevent stabbing rectum, once a week, 2-3 times as a course of treatment.
Other treatments
Hot water bath is effective in improving local circulation and relieving pain, and can be applied 1~2 times a day.
IV. Surgical treatment
Surgical treatment should not be used easily for patients with this disease, especially for menopausal women with neurasthenia. For surgery, caudatectomy can be done in general.
Indications for surgery: those with long-term non-surgical treatment with poor results and pain seriously affecting work, study and life; those with coccygeal tuberculosis; those with ankylosis of the sacrococcygeal joint; those with long coccyx and sitting pressure on the coccyx; those with coccyx protruding to form damage arthritis of the sacrococcygeal joint.
Contraindications to surgery: those who have applied conservative therapy for less than 6 months; those who have lower back pain before excluding lumbosacral disc herniation. In order to obtain good results, bupivacaine closure test should be routinely given before surgery, if the pain relief effect is good, the surgery effect is also good, otherwise it is not easy to perform surgery. Female patients are not easy to perform surgery in the week before menstruation.
V. Chinese medicine classification and prescription
The main treatment for early injury is to relax the tendons and activate the joints, reduce swelling and relieve pain. The formula is Peach-Hong Siwu Tang with reduction.
Peach kernel 10g safflower 10g red peony 15g angelica 12g
Chuanxiong 10g Danshen 20g Boswellia 9g Licorice 10g
At the same time, a decoction of the Wounding Section Washing Formula can be used to fumigate the sacrococcygeal area or to take a sitz bath. Twice a day, half an hour each time.
Surgical washing formula.
In the late stage of injury drug treatment is appropriate to relax the tendons and activate blood circulation, slow spasm and relieve pain, can be used to relax the tendons and activate blood circulation soup plus reduction.
At the same time, a decoction of haitongpi soup fumigation, or sitz bath, 1 to 2 times a day, half an hour each time. External use of musk and tiger bone paste and other compresses.
[Functional exercise and prevention]
Active physical exercise, especially posture training, exercise the gluteus muscle, enhance the strength of the gluteus muscle can make the pelvis tilt backward, the tailbone produces forward movement, reducing the chance of injury to the tailbone. In addition, avoid prolonged sitting to reduce the pressure on the tissues around the tail can also prevent the occurrence of chronic sacrococcygeal pain.