Being a good dad, turns out to be a Pain In the A$$!!
Smokindaddy
Posts: 1,107 ✭
I have a 19 month old daughter that I love spending time and playing with. She loves to be chased and tickled, and loves when I hold her close to my chest and roll around on the ground with her. So about 4 months ago, we were playing and I was rolling with her on the couch and we rolled off and I landed on my lower back. I didn't think anything of it. The next morning I woke up a little sore in the tail bone area and still didn't think anything of it.
Fast forward 4 months with a whole lot of pain later, I finally went to the Dr. yesterday cause the pain got to the point to where I could hardly sit anymore. After two X-Rays I was told I need to get to the hospital as quick as I could for a CT scan. So now that Im super freaked out, I head over and when I get to the department for the CT scan, the woman that does the checking in tells me that CT scans are scheduled a week in advance and they never take someone in as quick as I came in. So she asks a co-worker and he tells her that my Dr. called over and that everything is set up and tells her to take me in. So, now even more freaked out, I followed her back, changed and had my CT scan. When it's done Im told to go back to my Dr's office for the results.
As Im driving back Im thinking about all the horrible things that could be wrong and how im only 33 about to be 34 and how I still have a whole lot of living to do. I get back to my Dr's office and am left sitting in a room for an hour before he finally walks in and gives me the news. He asks me if I remember falling at all 4 months ago, the only thing that I can even come up with is playing with my daughter and rolling off the couch and landing on the lower part of my back. He looks at me and says, you have a boken tail bone, and it did not heal right, and there is nothing that can be done to correct it. At that moment I breath a hugh sigh of releif and then it hits me. I ask him, am I going to be in pain for the rest of my life?, his response, most likely. I was then given a script for pain killlers and sent home.
So like the title of this tread states, Being a good dad, turns out to be a Pain In My A$$ for the rest of my life!!! lol Even though this is very painful, I wouldn't change a thing, I love making my little girl happy.
Fast forward 4 months with a whole lot of pain later, I finally went to the Dr. yesterday cause the pain got to the point to where I could hardly sit anymore. After two X-Rays I was told I need to get to the hospital as quick as I could for a CT scan. So now that Im super freaked out, I head over and when I get to the department for the CT scan, the woman that does the checking in tells me that CT scans are scheduled a week in advance and they never take someone in as quick as I came in. So she asks a co-worker and he tells her that my Dr. called over and that everything is set up and tells her to take me in. So, now even more freaked out, I followed her back, changed and had my CT scan. When it's done Im told to go back to my Dr's office for the results.
As Im driving back Im thinking about all the horrible things that could be wrong and how im only 33 about to be 34 and how I still have a whole lot of living to do. I get back to my Dr's office and am left sitting in a room for an hour before he finally walks in and gives me the news. He asks me if I remember falling at all 4 months ago, the only thing that I can even come up with is playing with my daughter and rolling off the couch and landing on the lower part of my back. He looks at me and says, you have a boken tail bone, and it did not heal right, and there is nothing that can be done to correct it. At that moment I breath a hugh sigh of releif and then it hits me. I ask him, am I going to be in pain for the rest of my life?, his response, most likely. I was then given a script for pain killlers and sent home.
So like the title of this tread states, Being a good dad, turns out to be a Pain In My A$$ for the rest of my life!!! lol Even though this is very painful, I wouldn't change a thing, I love making my little girl happy.
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Seriously it is really painful. Wife broke hers and we had the sitting donut for weeks. It healed fine butt the doctor said the same thing. It is like a big toe. Can't do a whole lot for it but hope it heals right.
On the other hand, my wife may be the best Dr. I know. She uses webMD to come up with answers for everything. She was telling me last night that a lot of people experiance tail bone pain of some kind and that some people have just had their tail bone removed. Something to think about I guess.
Care must be taken during the surgery to avoid injury to the ****, which is located just anterior to the coccyx. The ganglion impar also is located just anterior to the coccyx, so a potential risk of injury to the sympathetic nervous system exists during coccygectomy.
The multiple muscular and ligamentous attachments to the coccyx present additional anatomic concerns for patients undergoing coccygectomy. For example, the levator ani and other pelvic floor muscles attach directly to the coccyx; thus, some degree of sagging of the pelvic floor is possible after coccygectomy. Another important attachment to the coccyx is the sphincter ani externus, which is responsible for bowel continence (thus raising the possibility of surgical complications, such as fecal incontinence).
Coccygectomy has been associated with relatively high rates of postoperative infection. A case series of 20 patients treated with total coccygectomy reported that 90% of the patients eventually felt improvement, but overall postoperative complications included 7 wound problems (thus more than one third of the patients)4 patients with superficial infections and 3 patients with persistent drainage.[17]
In a retrospective study of 32 patients with coccydynia who were treated by an orthopedic spine surgeon, the investigators concluded that patients with coccydynia should be managed conservatively when possible, including with nonsteroidal anti-inflammatory drugs (NSAIDs) and repeat injections. In the study, 11 patients (34%) underwent surgical treatment via coccygectomy. Marked improvement was reported in 9 (82%) of the surgical patients, but 3 (27%) of the 11 developed wound infections and 1 (9%) developed wound dehiscence.[18] The authors felt that coccygectomy can offer reasonable results when conservative treatment fails but that patients should be warned of the high rate of infection.
In another small case series, which reported on coccygectomy in 16 patients with chronic coccydynia (8 patients with posttraumatic coccydynia and 8 patients with nontraumatic coccydynia), superior surgical results were reported in patients whose coccydynia had been preceded by trauma.[19]
Although a number of small studies have reported significant rates of symptomatic relief via coccygectomy, the authors of these reports have generally indicated that surgery was performed in only a small percentage of the patients presenting with coccydynia. For example, one study reported that of all patients with coccydynia referred for orthopedic surgical consultation, only 15% underwent surgical treatment.[20]
Further, most of the authors of the surgical studies have recommended a thorough course of nonsurgical treatment (eg, oral medications, series of injections) prior to considering surgery.
Previous Next Section: Ganglion Impar Sympathetic Nerve Blocks Ganglion Impar Sympathetic Nerve BlocksThe ganglion impar (ganglion of Walther) is the terminal ganglion of the paravertebral sympathetic nervous system; it is the only nonpaired sympathetic ganglion. The ganglion impar is usually located anterior to the sacrococcygeal junction, the first intracoccygeal junction, or the first coccygeal vertebra.[21, 22, 23, 24, 25, 26, 27]
One possible mechanism for persistent coccydynia is excessive activity or sensitivity of the ganglion impar, thus creating sympathetically maintained coccyx pain.[28]
Local injection of an anesthetic can effectively block the ganglion impar and thereby relieve coccyx pain. In a published report by Foye and colleagues, nerve blocks using local anesthetics with a fast onset (eg, lidocaine) were shown to provide substantial relief even by the time a patient sat up on the procedure table.[28]
After the local anesthetic block wears off, some of the coccyx pain may start to return, but generally it returns at a much lower severity than existed prior to the injection. Physical medicine and rehabilitation coccydynia physicians and researchers at New Jersey Medical School refer to this new plateau of severity as "resetting the thermostat."
Published reports document that some patients with coccydynia receive complete and permanent relief via a single ganglion impar block.[28]
In patients with less than 100% permanent relief, repeat ganglion impar blocks have been shown to provide additional benefit, further lowering the plateau level of pain. Thus, in patients without complete resolution, repeat injections are often medically necessary and clinically helpful. TechniquesOlder techniques for performing the ganglion impar block involved approaching the anterior sacrococcygeal region by using a curved needle inserted below the distal coccygeal tip. The older technique required a larger-diameter and longer-length needle (in particular, the longer length of that needle being inserted into the patient) compared with the current (transsacrococcygeal) approach, which uses a short, thin needle.
In the past, many coccygeal procedures were performed without image guidance (blind injection, such as without fluoroscopy), an omission with the potential to compromise the accuracy and safety of the injection.
The more recent transsacrococcygeal approach to the ganglion impar involves inserting a thin needle into the sacrococcygeal junction, from posterior to anterior.[29, 30] The transsacrococcygeal approach for ganglion impar sympathetic blockade uses a lateral fluoroscopic view to visualize the sacrococcygeal junction. A small, 25-gauge spinal needle is then inserted through the junction until the needle tip is just anterior to that articulation. Radiographic contrast can be used to confirm that the needle placement is not intravascular, not too far anterior (within the ****), and not too superficial (within the sacrococcygeal disc).[28]
The procedure is only minimally invasive. It requires a sterile technique (particularly given the proximity to the **** and ****) and fluoroscopic guidance to ensure safe and accurate needle placement. The ganglion impar block (which is anterior to the coccyx) can be preceded by a separate local anesthetic block of the coccygeal nerve (a somatic, nonsympathetic nerve posterior to the coccyx) to anesthetize the posterior region prior to the impar injection and to provide more complete relief of the coccydynia. Often, it makes sense to combine these injections on the same injection date, so that both anterior and posterior relief is obtained.
A case series reported good results from the administration of 20 ganglion impar blocks by physical medicine and rehabilitation physicians at New Jersey Medical School to patients who were suffering from persistent coccydynia despite treatment with oral medications, cushions, and other conservative therapies. The results showed that each of the 20 injections provided significant relief in these patients. The percentage of relief obtained per injection varied from 20-75%, with most patients reporting 50-75% relief obtained per injection and with the relief generally lasting weeks to months or longer. For cases in which patients had incomplete relief after a given injection, additional analgesic benefit was obtained from subsequent injections. Thus, repeat injections were often helpful. Foye and colleagues at New Jersey Medical School also published a new, slightly more direct approach to ganglion impar injections.[28] Specifically, they reported the option of passing the needle through the first intracoccygeal joint (the space between the first and second coccygeal segments) instead of through the sacrococcygeal joint.
An important benefit to this approach over the transsacrococcygeal one is that the first intracoccygeal joint is often easier to visualize, since it is not obstructed by the sacral or coccygeal cornua. This site is slightly closer to the location of the ganglion impar, according to cadaver dissection studies.[24] Nerve ablationAblation injections may provide more long-lasting relief in appropriately selected patients. Ablation is the intentional destruction of human tissue for treatment purposes. For example, ablation can be used to intentionally destroy nerve fibers at the coccyx, so that those nerves can no longer send pain signals to the brain. Thermocoagulation of the ganglion impar using radiofrequency ablation (RFA) has been reported.[31, 32] Ablation can also be accomplished chemically (eg, by carefully injecting neurotoxic agents such as phenol and/or ethyl alcohol directly onto the targeted nerve tissues). These coccygeal ablation injections have been in clinical use for multiple decades and thus are no longer considered experimental.[1, 1]
Ablation is typically reserved for patients whose pain has failed to be adequately relieved via oral analgesic medications, cushions, coccyx steroid injections, and coccygeal sympathetic nerve blocks (ganglion impar). The ideal specific site for ablation may depend on the individual patients specific site of coccygeal pathology. Prior to ablation, a diagnostic injection (test injection, with local anesthetic) is generally performed to ascertain whether a specific target site is likely to provide relief if ablated. Patients who obtain substantial transient (anesthetic) relief via the diagnostic injection would be good candidates for subsequent nerve ablation at the same site where the diagnostic injection was done. If ablation fails to provide as much relief as the anesthetic/test injection provided, the ablation may soon be repeated, to provide more complete destruction of those nerve fibers.
Even after successful relief via ablation, some patients may have eventual return of the some of their coccyx pain many months or years later, if the remaining coccygeal nerve fibers regrow collateral reinnervation to the sites denervated by the ablation. In those cases, repeat ablation may be performed.
Since ablation injections are intended to cause destructive (albeit therapeutic) changes, they should only be performed by physicians skilled and experienced in these procedures. In addition, they should be performed under image-guidance (eg, fluoroscopy, to add to the specificity of the targeted injection site) and using the smallest amount (eg, milliliters) of ablation necessary to provide the desired therapeutic relief.
Ablation injections may help some coccydynia patients avoid more invasive treatments, eg, helping them avoid surgical removal of the coccyx (coccygectomy).
Previous Next Section: Ganglion Impar Sympathetic Nerve Blocks
Other Injection SitesSacrococcygeal joint injectionsWhen the primary pain generator is thought to be at the sacrococcygeal joint, local injection can be administered to this site. Image guidance (eg, fluoroscopy) can be helpful to ensure accurate placement, particularly because the joint space is typically narrow and individual anatomic coccygeal variability may make surface palpation alone unreliable. Injection with local anesthetic (eg, lidocaine) alone (ie, without any corticosteroids) may serve as a diagnostic injection if fluoroscopy and contrast have first confirmed accurate placement within the joint. Injection with corticosteroids may be helpful in cases of focal inflammation at the sacrococcygeal joint (eg, after local trauma and perhaps with degenerative changes at this site).
If injected too superficially (posterior to the sacrococcygeal junction), corticosteroids may theoretically cause subcutaneous fat atrophy at this site.
Epidural steroid injectionsAlthough many pain management centers perform caudal epidural steroid injections for coccydynia, a relative paucity of published research supports epidural steroid use for coccyx pain.
Ischial bursa injectionsThe authors of this article have found that in cases in which ischial bursitis is suspected as a substantial component of the patient's buttock pain, local injection of the bursa can be performed either with local anesthetic alone (diagnostic injection) or with corticosteroids (therapeutic injection).
Previous Next Section: Ganglion Impar Sympathetic Nerve Blocks
Manipulation (Mobilization)Osteopathic, chiropractic, or other "manual medicine" techniques to mobilize the coccyx are sometimes performed by clinicians who feel that the sacrococcygeal segments of a given patient have decreased mobility.
Manipulation with fingers placed inside the **** may theoretically have a role in helping to relocate a dislocated coccygeal vertebra.[1] Adequate anesthesia may be necessary for the patient to tolerate the relocation.
Since effectively bracing/immobilizing a dislocated coccyx in the relocated position is not possible, it is unclear whether relocation via manipulation provides sustained improvement in position.
A randomized study in patients with chronic coccydynia found that 51 patients treated with intrarectal manipulation had good results almost twice as frequently as did the control group, as determined at 1 month (36% vs 20%, P = .075) and at 6 months (22% vs 12%, P = .18). The main predictors of a good outcome were a stable coccyx, shorter symptom duration, traumatic etiology, and a lower score in the affective (emotional) parts of the McGill and Dallas questionnaires. The authors concluded that intrarectal manipulation had "mild effectiveness" for chronic coccydynia.[33]
---Medscape