Coccydynia from fall
Started by Pain Applicant1
No epidural unless canal stenosis or radicular complaint.
Impar all the way.
Impar all the way.
Caudal ESI and a little injected into the SC junction. If that doesn't work I RF.
Do you just RF the coccygeal nerve? You don't go after the ganglion impar, right?
Can you describe your technique and what code you use for billing?
Don't forget to r/o pudendal neuralgia when working up this issue. They can present similarly with history but physical exam is key on this.
Needle in the caudal space (tip at S3 ish), lateral side - pulsed RF. Both sides.
That's interesting, first time that I've heard of this one, actually sticking the RF probe in through the sacral hiatus? How do you bill this?
How would you differentiate these two? I've never seen pudendal neuralgia. Or maybe I have, and thought it was coccygodynia 😉
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Well obviously, one has a sclerodermal pattern c/w pudendal neuropathy while the other has a sclerodermal pattern c/w coccydynia.
clearly a diagnosis is needed.... i have seen all kinds of missed diagnoses including subluxed fractures, etc...
i wouldn't stick a needle until I had adequate imaging...
i have even had in older patients normal bone scans and then a CT scan that actually shows the fracture...
i wouldn't stick a needle until I had adequate imaging...
i have even had in older patients normal bone scans and then a CT scan that actually shows the fracture...
I posted the coccygeal nerve RF pictures before somewhere. I can never remember the link.
The nerves run just inside the walls of the sacral hiatus. I lay a cannula on either side parallel to the floor of the canal with the tip about 1 cm in from the entrance of the hiatus and burn.
BTW donut cushions are horrible. I always recommend a Tush Cush. These are expensive but there are cheap knockoffs on eBay. Basically a wedge shaped pillow with a notch cut out at the back for the coccyx. The donuts will compress or splay the ischia and play hell with the coccyx.
The nerves run just inside the walls of the sacral hiatus. I lay a cannula on either side parallel to the floor of the canal with the tip about 1 cm in from the entrance of the hiatus and burn.
BTW donut cushions are horrible. I always recommend a Tush Cush. These are expensive but there are cheap knockoffs on eBay. Basically a wedge shaped pillow with a notch cut out at the back for the coccyx. The donuts will compress or splay the ischia and play hell with the coccyx.
Yes, caudal esi with tip of needle between S4 and S3 (a shallow caudal) and then inject sacrococcygeal joint. Also agree with MM on the superiority of the tush cush over the donut.
Is there a real joint down there? We call it that, but does it really exist?
rudimentary disc? vestigial disc? trying to think of another big word.
lots of times these patients with coccydynia are new moms, so i tell them to sit on their boppie. for those of you who dont know what a boppie is: any chance you'd like to switch lives with me?
No thanks 😀
Not completely picturing this. Are you placing the needle APish on the medial side of the Cornu, or coming in steep caudad and parallel to a caphalocaudad nerve?
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Right before we had our first kid, my wife tells me: "we have to buy a boppie". My response: "what the F is a boppie?". They are also a great solution for your less savvy young moms with neck and upper back pain, they really help the ergonomics. I remember hauling that F_ing boppie everywhere we went for years (3 kids in 5 years later). I finally bought 3 or 4 and just left them where we visited frequently.
I saw something similar to this. basically running two parallels RF cannulaes on each side of the sacrum. Then have the tip of the cannula wher the SC lig is. Then doing a bipolar.....pray you dont burn bowel 😉
If a fracture is present, how long would you wait prior to injection? Is 6 weeks enough? I have another patient with an acute fall who's 90yo. I'd like to inject as so far I've had really good results with ganglion impar blocks. I started meds and am first sending her out for x ray to r/o fracture. If not present, I plan to inject. I'd rather not put her through a CT scan. Even if a fracture does come back on CT, will it really change the course of treatment?
Inject now for pain control while she is healing.
Bone scan or STIR MRI showing fx = time, activity mods, meds.
Bone scan or STIR MRI showing no fx = never get better no matter what.
time... just keep in mind she's 90 years old
That changes things.
I have done Gang Impar RF with a curved tip needle directly thorough the sacro-coccygeal ligament/ disc (m/b rudimentory disc), with good results! but I am willing to try that coccygeal nerve approach given in above posts. Thanks MM for the pix!!
But nothing (Gang Impar, Caudal ESI, TPI) have worked so far in fx/ subluxated patients! any new idea?😕
But nothing (Gang Impar, Caudal ESI, TPI) have worked so far in fx/ subluxated patients! any new idea?😕
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