Marinko Lee N, Pecci Matthew
Department of Physical Therapy and Athletic Training, Boston University, Boston, MA.
J Orthop Sports Phys Ther. 2014 Aug;44(8):615-21. doi: 10.2519/jospt.2014.4850. Epub 2014 Jun 23.
Case report.
Coccydynia is a painful condition of the sacrococcygeal region, with symptoms associated with sitting and rising from a seated position. There is no gold standard for diagnosis of this condition; however, coccyx mobility assessment, pain provocation testing, and imaging have been proposed as reasonable diagnostic approaches. Once correctly diagnosed, treatment options for coccydynia include conservative management and surgical excision. The purpose of this report is to describe the different but successful clinical management strategies of 2 patients with coccydynia.
Two women, 26 and 31 years of age, presented to physical therapy with persistent coccygeal pain that increased with prolonged sitting and intensified when transitioning from sit to stand. One patient had a traumatic onset of symptoms, in contrast to the other patient, for whom prolonged sitting was the precipitating factor. Both individuals were considered to have hypomobility of the sacrococcygeal joint, as assessed through intrarectal mobility testing, which also reproduced their symptoms. In both patients, examination of the lumbar spine was negative for alleviation or reproduction of symptoms. The patient with a traumatic onset of symptoms was referred to physical therapy at the onset of her symptoms, whereas the patient with a nontraumatic onset of symptoms was initially treated with a cortisone injection and, when symptoms returned 1 year later, was referred to physical therapy. Both individuals underwent manual therapy to the sacrococcygeal joint over 3 treatment sessions.
The patient with traumatic onset of symptoms had almost complete resolution of symptoms, whereas the patient with a nontraumatic onset only had temporary relief. This patient required further diagnostic examination and surgical excision.
Although the mechanisms of injury were different, both patients presented with similar clinical symptoms, and both were considered to have coccydynia through coccyx mobility assessment and pain provocation testing. Successful clinical outcomes were achieved in both cases; however, the interventions were significantly different. Level of Evidence Therapy, level 4.
病例报告。
尾骨痛是一种发生于骶尾区域的疼痛病症，症状与坐立及从坐姿起身有关。该病的诊断尚无金标准；不过，尾骨活动度评估、疼痛激发试验及影像学检查已被提议作为合理的诊断方法。一旦正确诊断，尾骨痛的治疗选择包括保守治疗和手术切除。本报告的目的是描述2例尾骨痛患者不同但成功的临床管理策略。
两名女性，年龄分别为26岁和31岁，因持续性尾骨疼痛前来接受物理治疗，疼痛在长时间坐位时加重，从坐位转变为站立位时加剧。一名患者症状有外伤诱因，另一名患者则相反，长时间坐位是诱发因素。通过直肠内活动度测试评估，两人均被认为存在骶尾关节活动度降低，该测试还再现了她们的症状。两名患者的腰椎检查均未发现症状减轻或再现。症状有外伤诱因的患者在症状出现时即被转诊至物理治疗，而症状无外伤诱因的患者最初接受了皮质醇注射治疗，1年后症状复发时被转诊至物理治疗。两人均在3次治疗疗程中接受了针对骶尾关节的手法治疗。
症状有外伤诱因的患者症状几乎完全缓解，而症状无外伤诱因的患者仅获得了暂时缓解。该患者需要进一步的诊断检查和手术切除。
尽管损伤机制不同，但两名患者均表现出相似的临床症状，且通过尾骨活动度评估和疼痛激发试验均被诊断为尾骨痛。两例均取得了成功的临床结果；然而，干预措施明显不同。证据等级：治疗，4级。
