Appreciation Award Given to Dr Patrick Foye, MD

2017 Appreciation Award Given to Dr. Patrick Foye, M.D.
  • At this year’s graduation ceremonies for graduating residents physicians and fellows, the Department of Physical Medicine and Rehabilitation at Rutgers New Jersey Medical School presented the Department’s “Appreciation Award” to Dr. Foye, in honor of his almost-five-years serving as Interim Chair of the Department.
  • Dr Patrick Foye MD, PMR Appreciation Award 2017

Photos from 20 years ago

Photos from ~20 years ago
  • #FBF (Flash-back Friday)
  • with Dr. Denise Campagnolo (she was #NJMS/Kessler #PMandR Residency Director in that era).
  • I found these today.
  • But I’m not sure who that guy is with the thick, dark, hair.  :-) -Dr. Foye
  • Dr Patrick Foye MD, Denise Campagnolo_5 Dr Patrick Foye MD, Denise Campagnolo_1

Unboxing: Tailbone Pain as Published in PM&R Clinics of North America

Unboxing a New Publication on Tailbone Pain, Coccyx Pain, Pelvic Pain
  • Publishing is an important part of any career in Academic Medicine.
  • Publishing is how we share our research, our clinical pearls, our experience and expertise.
  • Publishing makes all of this available to other clinicians, physicians, researchers, and others who may be interested worldwide, for years to come.
  • The VIDEO below shows Patrick Foye, M.D., un-boxing a newly-received, freshly-minted copy of a new publication.
  • The journal is called, “Physical Medicine and Rehabilitation Clinics of North America”.
  • This entire hardcover edition was dedicated to “Pelvic Pain” and Dr. Foye wrote the chapter on “Coccydynia: Tailbone Pain” (Coccyx Pain).
  • To reveal the VIDEO, click on the images or click on the link below.
  • Unboxing Tailbone Pain PMR Clinics of NA, screenshot, closerUnboxing Tailbone Pain in PMR Clinics of NA
  • To reveal the VIDEO, CLICK this LINKhttps://youtu.be/mL0x2Ei4hx8
 Below is the TEXT transcribed from Dr. Foye’s Video:
  • I’m Dr.Patrick Foye, and I’m an M.D., or medical doctor, and I’m the Founder and Director of the Coccyx Pain Center or Tailbone Pain Center here in the United States, available online at www.TailboneDoctor.com.
  • And the reason that I’m holding this cardboard box that arrived in the mail today is sort of an unboxing of sorts Some of you may know that in addition to treating patients I am a full-time faculty member here at Rutgers New Jersey Medical School, where I’m a Professor within the Department of Physical Medicine and Rehabilitation and being a Professor, and an academic faculty member, part of what that means is that, in addition to being a physician and treating patients, that I’m also a medical educator, that I’m teaching medical students and residents physicians and fellows and colleagues and also doing research and publications.
  • And I probably have, I don’t know, easily over 100 publications (between research articles and book chapters and various publications over the years) which is not surprising given that I’ve been in academic medicine for more than twenty-one years.
  • But the part that’s neat for me is that it’s still exciting, and I still love what I do,  and I still love when I finally see something in print when I know that myself and my colleagues have been working on for a long time.
  • So, the unboxing, of sorts… This arrived here at the Tailbone Pain Center  here today and in opening it up it is basically the current addition of a journal called the Physical Medicine and Rehabilitation Clinics of North America.
  • And they did an entire hardcover issue on pelvic pain specifically.
  • And I was asked to write the section in here on coccyx pain or tailbone pain, since that’s my primary area.
  • So I can tell you that for myself and the other physicians across the country who have been involved in this particular publication this has been at least well over two years in the making.
  • Academic projects take a long time between the time you are invited to write an article or a paper or a manuscript or a book chapter and then doing the edits and going back and forth with the editors and sometimes with medical illustrators and then finally making it to publication and making it into print.
  • It’s always cool when it finally comes out and you actually have a tangible copy, and the idea that this tangible copy is also showing up in other places that physicians are getting their hands on this and hopefully learning, in this case, the proper way to evaluate and treat tailbone pain.
  • So within this, if I open it up here again: PM&R Clinics of North America, entire section on Pelvic Pain.
  • There are lots of different authors from around the country doing their own different sections.
  • There’s a section here on anatomy and physiology, office evaluation of  pelvic pain in general, myofascial pain  musculoskeletal pain and then the next chapter, which is mine, which is basically on coccyx pain.
  • So if I swing back to that, I’ll share just a little bit with you of what’s in here for physicians.
  • Now this is different than some of the things I’ve written and published more specifically for patients.
  • I still continue to do that as well and I’m a huge believer in empowering patients.
  • But this particular one is on is for is written for physicians.
  • So if you have a physician who perhaps is a Physical Medicine and Rehabilitation doctor, this might be something that’s on their shelf.
  • If you have tailbone pain you may want to ask them if they have received the pelvic pain edition of the PM&R clinics of North America journal, because there’ll be lots of information in there for them.
  • And, again, in this particular chapter on coccydynia or tailbone pain.
  • We talk in here about the terminology, how frequent this is, the anatomy, the different joints, ligaments, muscles, etc.
  • that that attach to the tailbone.
  • The different causes of tailbone pain.
  • So here we’re talking about coccyx fractures, dislocations, coccygeal dynamic instability (which means an unstable joint at the tailbone, which is one of the most common causes of tailbone pain, and something that you really need sitting versus standing x-rays in order to evaluate for and make that diagnosis).
  • Here I also talk about bone spurs at the lower tip of the tailbone (a common source of tailbone pain), abnormal positions of the coccyx, arthritis, sympathetic nervous system pain at the tailbone, pelvic floor dysfunction, cancer, bone infection,  and lots of other things that can cause pain.
  • It also educates doctors about the symptoms: pain with sitting being the most common and many patients will also have pain with sit-to-stand.
  • They may have other pains in other back low back and pelvis and buttock regions as well.
  • Here I mentioned about the physical exam findings to look for with tailbone pain, the diagnostic tests or imaging studies like x-rays and especially the sitting versus standing x-rays explaining to them what that is (because unfortunately many, many doctors around the country and around the world are not familiar with sitting versus standing x-rays for tailbone pain, which is really, really unfortunate because unstable joints are probably the most common cause of tailbone pain and they can only be diagnosed on imaging studies by doing the sitting versus standing images so those x-rays become really, really important).
  • But I also talked about MRI and CT scans and nuclear medicine bone scans and other things in this section, which is within that area about diagnostic tests.
  • I’ve also published… this is the first time I’ve published this particular algorithm, which is basically going from somebody that has pain and getting the x-rays (ideally the sitting versus standing x-rays) and then depending on what those show deciding whether the person needs to move forward with treatment versus whether they may need further imaging studies, such as MRI or CT scan or other things to look for malignancies and other conditions, depending on what your initial findings were on the initial X-rays.
  • And then depending on how they respond to treatment deciding whether to circle back and if you didn’t get the advanced imaging studies (like MRI or CT scans) to consider those in those patients if they’re not getting the kind of initial relief or response.
  • And then other things within treatment…
  • everything from cushions to medications to
  • Some of the interventional injections that can be done for tailbone pain are covered in here, from steroid injections to ganglion Impar sympathetic nerve blocks to nerve ablation.
  • All of that, physical therapy and in surgical cases…
  • coccygectomy, which is surgical removal of the tailbone.
  • Fortunately that’s not necessary the majority of the time and is sort of something that’s done only when people have exhausted other measures.
  • So, again, a lot of information packed in here for physicians.
  • And hopefully, the goal really is to educate physicians so that they can be as knowledgeable and experienced as possible in evaluating and treating patients with pelvic pain and in my section for tailbone pain (coccyx pain) in particular.
  • So hopefully that will be helpful for the physicians because then that will be helpful for their patients.
  • So again this one medical journal mainly for physicians.
  • I also have written an entire book much longer than what I have in here.
  • It’s an entire book about tailbone pain.
  • This one is written more for patients, or for people who are non-physicians, the people who are actually suffering with tailbone pain.
  • So this one is 272 pages, all about the coccyx, covering in much more detail a lot of these things and written in layperson language, so you don’t need a medical degree by any means to read this book.
  • You can find this on Amazon: you can get it as an ebook through Amazon, you can get the softcover copy through Amazon.
  • At the time that I’m making this video you can still get a free copy (just pay shipping and handling) you can get that through www.TailboneBook.com.
  • So lots of different ways to if you have tailbone pain and are looking for more information and looking to be empowered with knowledge, because then that helps you with knowing what makes sense in terms of evaluation or treatment.
  • So again lots of information for physicians and also for patients.
  • So hopefully spreading the word so that patients can get relief.
  • Because a lot of people unfortunately suffer unnecessarily for long periods of time with tailbone pain because not a lot of Doc’s are familiar with how to treat it.
  • If you’re looking for more information, certainly you can you can find me online at www.TailboneDoctor.com  And if you have questions or comments certainly post them down below beneath the video and I’ll look forward to hearing from you and may be meeting some of you someday.
  • All the best.
  • Bye-bye now.
Here is the published abstract:

PMR Clinics NA, Tailbone Pain Abstract

 

 

Patrick Foye MD Reviews 21 Years at Rutgers NJMS.

Summarizing 21 Years as a Medical Doctor, Physician, Medical Educator, Clinician, at Rutgers New Jersey Medical School
  • Patrick M. Foye, M.D. is a physician in New Jersey.
  • On the anniversary date of being 21 years on faculty at Rutgers New Jersey Medical School, Dr. Patrick Foye gave his off the cuff thoughts.
  • Looking forward hopefully to many more years of patient care and medical education!  :-)
  • To reveal the VIDEO, click the image below, or click on the Link below:
  • 21-years at NJMS, Patrick Foye MD, Dr Foye
  • Here is the Link to the Video: https://youtu.be/aEJM3peqEW4
Here is the TEXT transcribed from the video:
  • I am Dr. Patrick Foye, and I’m an M.D., or medical doctor.
  • And I’m making this video, particularly on the anniversary of my 21 years here on faculty at Rutgers New Jersey Medical School.
  • I actually first came to the medical school longer than that ago, about 28 years ago, as a medical student and graduated from here in 1992, so about 25 years ago.
  • Then I went and spent a couple of years working at a hospital in Chicago, doing my residency out there.
  • I came back and joined the faculty here at what was then called “UMDNJ New Jersey Medical School” in August of 1996.
  • And now here we are in August 2017, so 21 years later.
  • So on the anniversary date of my joining the faculty here, it just gives me pause to think back at what the last 21 years here have meant.
  • First of all, we are a medical school, so we are training medical students.
  • So along those lines, we graduate approximately 160 to 180 medical students per year.
  • So looking back at 21 years here, were are looking at ballpark of about 4,000 medical school graduates during my time here.
  • And I’m actively involved in the medical school curriculum, teaching them musculoskeletal medicine and pain management and those kinds of things.
  • So really I’ve had an opportunity to contribute to the knowledge base and hopefully the patient care skills for about 4,000 of our New Jersey medical school graduates who are out there making our school proud, doing terrific work in the clinical care for their patients, and healthcare administration, and research, and all kinds of other areas.
  • We also have a highly esteemed residency training program in Physical Medicine and Rehabilitation, the medical school here and the Kessler Institute for Rehabilitation and our other affiliate sites.
  • And that’s about another 8 to 10 graduates per year from the resident training program in PM&R, so another hundreds or a few hundred graduates from during my time here.
  • And it’s really gratifying at this point of my career, having been doing this for couple of decades, to be able to see many of those graduates out there doing great things, some of them are residency program directors themselves and course directors and running conferences where I myself go and I’m learning things from them.
  • And they’re publishing great articles, and of course doing terrific patient care in a wide variety of subspecialties and areas within Physical Medicine and Rehabilitation.
  • And then certainly for myself in addition to the educational aspects of teaching our students, and our residents, and our fellows, is treating patients myself, which is certainly the most gratifying part of my time here.
  • I do mostly all outpatient musculoskeletal medicine and pain management.
  • My subspecialty niche area is treating patients with “tailbone pain” or “coccyx pain”.
  • I run a Coccyx Pain Center or Tailbone Pain Center here.
  • And that has been incredibly gratifying.
  • To have patients who are suffering from pain and to be able to find an answer to what is causing their pain and then to be able help them find relief from the pain that their suffering with is immensely gratifying.
  • Here on campus we also have University Hospital.
  • It’s a “safety net” hospital.
  • It’s a state hospital here in New Jersey.
  • We treat lots of patients from near and far.
  • It’s a Level-1 Trauma Center, so many, many serious injuries are brought here by helicopter and ambulance and all of those kinds of things.
  • And it’s also a hospital that serves the needy.
  • So we are the number 1 provider of charity care services of any medical facility within the state of New Jersey.
  • And that’s really part of our mission here as well, taking care of patients who would not have access to medical care elsewhere.
  • So, in general as I look back now on 21 years here it has been a terrific 21 years.
  • I certainly have grown as a physician and as a person.
  • I’m at a different stage in my life than when I started here.
  • And I look back and think about the medical students and residents physician and fellows and my colleagues or attending physicians that I’ve gotten to work with, and the patients that I’ve been able to treat, and really it’s been a terrific 21 years.
  • So, those are my thoughts on 21 years at New Jersey Medical School, here in Newark, New Jersey.
  • Okay. Bye-bye.

3-D, 3-dimensional CT scan for Tailbone Pain, Coccyx Pain

Medical imaging studies for Tailbone Pain
  • Medical imaging studies can be very helpful in making an accurate diagnosis in patients with coccyx pain (also called coccydynia, or tailbone pain).
  • The most common medical imaging studies for tailbone pain include:
    • X-rays: especially “sitting-versus-standing” x-rays to look for “dynamic instability” ( unstable joints of the coccyx).
    • MRI: Magnetic Residents Imaging.
      • MRI is helpful at showing soft tissue structures such as pilonidal cysts, retrorectal cysts, abscess (an infected collection of fluid and pus).
      • MRI is also helpful when looking for bone infection (osteomyelitis).
      • MRI can help in evaluation for possible cancer (malignancy, such as chordoma, which is often fatal and has a tendency to occur at the sacrum and coccyx region).
    • CT scans: also called “computerized tomography” scans.
      • These can be helpful at showing details of the bone (e.g., the sacrum and coccyx).
      • 3-D ( “three-dimensional”) CT scan is a special type of CT scan, where the image can be rotated by the physician, as shown in the video below.
      • It is relatively uncommon to need 3-D CT scans in patients with tailbone pain, but in properly chosen patients it can be a VERY helpful imaging test.
Here is Dr. Foye’s VIDEO teaching about 3-D CT scans for Tailbone Pain, Coccyx Pain:

 

Here is the TEXT from the video:
  • OK, I am Dr. Patrick Foye and I’m an M.D., or medical doctor, and I’m Founder and Director of the Coccyx Pain Center or Tailbone Pain Center here in the United States.
  • You can find me online at www.TailboneDoctor.com.
  • This is just a short educational video on the topic of using CT scan (“cat scan” or computerized tomography scanning) in the evaluation of patients with tailbone pain and specifically the idea of using CT scan with three-dimensional reconstruction, which is what we’re looking at here for this particular individual.
  • So the majority of times we are doing our imaging studies for patients with tailbone pain (or coccyx pain, coccydynia) the majority of times we’re using things like x-rays (medically we call those radiographs).
  • So standard x-rays look at the tailbone, and especially x-rays done while the patient is sitting versus standing can be hugely helpful.
  • In other patients we may need to do advanced imaging studies such as MRI to look at additional detail.
  • But about 1% of the patients who I see for tailbone pain may benefit from what’s shown here which is a CT scan (a cat scan, computerized tomography scan) specifically with three-dimensional, or 3D, reconstruction.
  • So rather than just having a static image (like one image or one or one slice) what’s done here is actually all of those slices are put together in a digital way, on the computer of course, so that the clinician or a physician can basically rotate the image in multiple directions.
  • So I can go back and forth.
  • And what that allows me to do is to look from many different angles at a given area, if there’s an area of interest or concern on the patient’s imaging studies.
  • So just to sort of orient you here on this image…
  • So this is the sacrum of this individual up in here, from about here down to about here, that’s the sacrum.
  • The sacrum has these holes that you see in it.
  • That’s normal.
  • These are the sacral foramina which are the holes that the sacral nerves exits through.
  • But then we get down to here which is the coccyx or tailbone.
  • And one thing that’s particularly interesting here is that in this particular individual you can see that instead of coming to or sort of tapering down to a single point right at the midline…
  • we’re going to rotate this and you can see here that this person actually has two different prongs or points that come down rather than just one at the midline.
  • So this is somebody who has what’s called a “bifid” (B-I-F-I-D) coccyx or a “bifurcated” coccyx is another name or word for that.
  • Really just that describes this anatomical variation where instead of the tailbone coming down to one single point in the midline, instead it splits into a point that comes down on the right and a point that comes down on the left, as shown here.
  • This becomes important because if we were looking at this on x-ray…
  • well x-ray looking at the x-ray that would be taken face-on (which is called an AP view) a lot of times the AP view of the tailbone is blocked or obscured or made fuzzy because of the structures that are right in front of it blocking the view: so the rectum, the colon, other parts of the organs within the pelvis are there.
  • And they can basically (and stool within the within the colon) can make it difficult to see that lower part of the tailbone well on that view on an x-ray.
  • But then you go to the side view on the x-ray, which would look something like this (not quite, but similar) and you can see here that because of those two prongs down there, because one is overlapping on top of the other we’re not able to see the space in between them.
  • We would have no way to know that there were two separate prongs.
  • We would think from this view because they’re overlapping.
  • Just like if you were looking at my fingers you’d see two of them here versus now if you really just see one you know what looks like just one finger.
  • Whereas being able to rotate brings it out to where you can see the two.
  • So the same type of thing here.
  • You can see it looks like just one solid lower part of the tailbone.
  • But being able to rotate it now we can see that there’s actually two prongs or portions coming down.
  • So that becomes really interesting and important because in some patients we see an atomic variations.
  • If we’re not sure why we’re not seeing the tailbone appearance in the typical fashion in the lower part of the coccyx, then one of the things that physicians would be concerned about would be whether or not this may represent a malignancy (a cancer) of the tailbone region, such as chordoma, which unfortunately is highly fatal.
  • And having a CT scan with 3-D reconstruction like this allows me to rotate the image, bit by bit like this, to look for multiple different angles on the computer screen like this.
  • So that, again, I can see from multiple different points of view and decide whether this is just an anatomic variation similar to the way again just rotating my fingers here allows me to see that there’s two fingers rather than just one.
  • And the other thing that it allows is that knowing that it’s an anatomic variation then we can move forward with regular treatment of the condition here.
  • Or, on the other hand, if this was a malignancy well then we would move forward with getting appropriate further workup or treatment for that.
  • So, again, this is maybe one percent of patients who I see for tailbone pain here at the Tailbone Pain Center that I end up ordering this type of study who the CT scan with three-dimensional or 3d reconstruction.
  • It’s very cool technology.
  • But I only use it in very selected cases who have a specific question anatomically that we were unable to answer from the regular imaging studies (such as x-rays and MRI).
  • So that’s all for this.
  • This is an educational video, so this is not specific medical advice for any specific individual person or patient.
  • For that you would of course seek in-person consultation with your own treating physician.
  • If you’re looking for more information on the topic of tailbone pain or coccyx pain certainly you can visit me online at TailboneDoctor.com   or on Facebook/TailbonePainCenter.
  • So that’s all for now.
  • I hope this was helpful.
  • If you have questions or comments please feel free to post them down below.
  • Bye bye.
For more information on Tailbone Pain, Coccyx Pain: go to www.TailboneDoctor.com

 

 

Randy Foye, Patrick Foye, Newark, New Jersey

Despite my 21 years in medical practice in #Newark, props still go to #RandyFoye as Newark, NJ’s more famous Foye!

Randy Foye, Doctor Foye, Newark, NJ

 https://twitter.com/TailboneDoctor/status/892548950808571904

https://twitter.com/TailboneDoctor

 

Rutgers Article on Dr Patrick Foye and his Tailbone Pain Center

Below is an article published by Rutgers University regarding Patrick Foye, M.D., and his Tailbone Pain Center.

Header of Rutgers Today Website Rutgers Foye Tailbone Pain Article, part-1 Rutgers Foye Tailbone Pain Article, part-2 Rutgers Foye Tailbone Pain Article, part-3

The original article is posted here: http://news.rutgers.edu/news/rutgers-professor-focuses-medical-practice-part-body-gets-little-respect-%E2%80%93-coccyx/20160120#.WYEY71EpASK
 Here is the non-formatted text:

Rutgers Professor Focuses Medical Practice on a Part of the Body that Gets Little Respect – the Coccyx

New Jersey Medical School’s Patrick M. Foye runs the only Tailbone Pain Center in the United States

Patrick M. Foye,  also known as the Tailbone Doctor, focuses a large portion of his medical practice on a relatively unknown part of the body that gets no respect. In humans, the coccyx (or tailbone) is small, but it can cause a whole lot of pain and suffering.

A 1992 New Jersey Medical School (NJMS) graduate and professor and interim chair of the NJMS Department of Physical Medicine and Rehabilitation, Foye launched and runs the only Tailbone Pain Center in the United States. “You could go to Paris for care,” he says. “Many Americans want an excuse to visit Paris, but it’s an expensive trip and if your coccyx hurts, sitting for a long flight would be very painful.”The coccyx gets little attention, unless it’s causing extreme pain. Located right at the lowest end of the spine, the tailbone is misnamed since it’s not one, but three to five, vertebral bones. The name is part of the problem, comments Foye. “Also, its variability can cause confusion since physicians may see more bone segments than they expect and then incorrectly think this is due to fracture,” he states in his recently published book, Tailbone Pain Relief Now.

Surgery Not the Right Approach

Foye established the specialized center 15 years ago after treating several patients with coccyx complaints. When he researched the medical literature, he was shocked. “Either patients were told it was all in their minds and were dismissed; or if the pain was bad enough, tailbone amputation was recommended,” he says. Surgery is rarely the right way to go, according to Foye. Surgical recovery takes six months to a year; and the location of the tailbone next to the anus means a high infection rate following surgery.

Foye’s interest in coccyx pain intersected with the internet boom of the late ‘90s, when the number of web users worldwide jumped from 45 to 200 million in five years. As his proficiency treating the condition with injectable medications grew, New Jersey’s tailbone doctor invented several new treatment techniques and published his work in medical journals. Word spread rapidly among physicians, but it was a grateful patient – who had aggressively sought relief for two years before finding Foye – who insisted the tailbone doctor launch a website (www.TailboneDoctor.com) to let people know he was there. Several years ago, Foye posted informational videos to a YouTube channel, which has garnered more than 300,000 views. The website and the videos, as well as old-fashioned word of mouth, have driven patient visits to the Tailbone Pain Center into the thousands each year. Patients come from around the country and even from abroad.

“I’ve treated professional athletes, movie stars, musicians, construction workers, executives from Fortune 500 companies and mothers who can’t play with their kids on the floor – the spectrum of humanity,” he says. His patients range in age from 3 to 90 plus.

Unrelenting severe pain, right at the lower tip of the spine while sitting, is the primary complaint that brings patients to the center. Foye says that most X-rays of the lower spine are taken while the patient stands and rarely reveal coccyx problems. “In order to evaluate this condition, an X-ray needs to be taken while the patient is sitting,” he explains. Unavailable at most medical centers, the “sitting X-ray” may turn up a tailbone fracture or dislocation, an unstable tailbone joint, bone spurs, arthritis of the tailbone, or every once in a while, cancer or a bone infection. Mechanical pressure to the coccyx from a fall, giving birth, or prolonged sitting is commonly the cause.

While most of Foye’s patients had sought prior medical help, few found relief before coming to the center, where he provides specialized evaluations and treatments. He explains that a standard MRI of the lumbar area – a test often incorrectly ordered for tailbone pain – does not even include the coccyx; and that many coccyx pain patients are treated with physical therapy, which is often ineffective.

When the condition is properly diagnosed, treatments, including pillows that relieve pressure on the tailbone, local anti-inflammatory steroid injections, oral anti-inflammatory medicines and nerve blocks or nerve ablation, are usually successful. Surgical removal of the coccyx is sometimes necessary but is always a last resort, says Foye.

New Book  Free  Aims to Reach Sufferers

His book is one more avenue to reach a global population, according to Foye. While “seeing a patient in person” is always preferable, he says the end-goal is reaching as many tailbone pain sufferers as possible with accurate information. “I’m a physician and a medical educator,” Foye says. “I love teaching and helping others, so the book is perfect for that.” It’s available on Amazon but is currently free at www.TailbonePainBook.com.

Several hundred books were ordered within a couple weeks of publication; coccyx pain Facebook groups posted pages from the book  on several sites; and he’s received emails from readers in many countries, including India, the UK, Sweden, and Germany. That makes Foye very happy.

“The book has a worldwide reach far beyond my own practice,” he states. “I want to empower patients to advocate for themselves.”

In July, Foye will be the only U.S. speaker at the first-ever international conference on coccyx disorders, which will be held in Paris.


This article is scheduled to appear in the spring issue of New Jersey Medical School’s Pulse Magazine

MRI of Pilonidal Cyst causing Tailbone Pain, Coccyx Pain

What is a Pilonidal Cyst?
  • A pilonidal cyst is a collection of fluid and tissue, which can cause pain in the area of the sacrum and coccyx (tailbone).
  • I recently published an online article and video discussing the symptoms and physical exam findings of Pilonidal Cyst.
  • You can see that previous article and previous video here: Pilonidal Cyst Causing Tailbone Pain
The next step is to discuss the MRI findings of a Pilonidal Cyst.

 

  • MRI is an advanced imaging test that can show details such as a pilonidal cyst.
  • To reveal the video, click on the image or on the Link below:
  • MRI of Pilinidal Cyst, Coccyx Pain, Tailbone pain
  • Link to the Video: https://youtu.be/QAsZYiKyTyM
Here is the text from the video:
  • This is a video just showing a pilonidal cyst on an MRI.
  • So basically here, just to orient you, we’re looking at MRI slices.
  • We’re looking at the sacroiliac joint on the right and over here on the left.
  • And then here’s the sacrum.
  • You can just see the start of the where you can see the sacral canal here and a little bit of the sacral hiatus.
  • And if I start scrolling down we get down to lower sacrum right where the arrow is here.
  • The computer is a little sluggish.
  • But coming down here we can see the coccyx on cross-section here at oval-shaped white structure.
  • And then here is the pilonidal cyst.
  • So this bright white structure on this particular type of MRI image, where basically the white structure here is the pilonidal cyst.
  • And then this white line extending to the surface (because out here this is the skin out here, coccyx there).
  • So the pilonidal cyst has a “track” or “fistula tract” = the connection or tunnel coming down to the surface of the skin right there.
  • Here you can just see the line, that’s the track.
  • And the coccyx has now disappeared, so we’re actually now below the coccyx.
  • So the pilonidal cyst was right at the back of the coccyx slightly to this side here.
  • So this is the midline, so slightly to this side.
  • This is actually slightly to the left of midline.
  • I know that on the image it looks like it’s to the right, but that’s because the way the patient is laying, the way the image is taken.
  • Things over here on this side of the screen will be on the patient’s right side.
  • Whereas this side of the screen over here will be the patient’s left side so this is just slightly to the side.
For more information on Coccyx Pain, Tailbone Pain, go to: www.TailboneDoctor.com

 

Is a PILONIDAL CYST Causing Your Tailbone Pain, Coccyx Pain?

Sometimes, Coccyx Pain (Tailbone Pain) can be Caused by a Pilonidal Cyst…
  • A “cyst” is a collection of fluid. Think of it being like a tiny water balloon.
  • A pilonidal cyst is a particular type of cyst that contains not only fluid but also hair and other debris.
  • The most common location for a pilonidal cyst is within the skin behind the sacral or coccyx.
  • A pilonidal cyst can cause local pain and tenderness.
  • As the fluid from the cyst tries to escape from thus cyst, it creates a tunnel.  The tunnel is referred to as a track. When that track reaches the skin you can see a tiny hole in the skin. This is a fistula tract.
  • As fluid oozes out of the fistula tract, the patient may have a rash, redness, and itching of the skin in that area.
  • As the fluid oozes out, there is now less fluid within the cyst, so the pain and pressure from the cyst may decrease.
  • However, the fluid and pressure within the cyst may start to increase again, resulting in the pain coming back or increasing.
How Do You Tell the Difference between Pain Coming from a Pilonidal Cyst Versus Pain Coming from the Tailbone?
  • Usually, a physician with experience will be able to tell whether someone’s pain is coming from a pilonidal cyst or if the pain is coming from the coccyx (tailbone).
  • BOTH the tailbone and the cyst can cause local pain,, and pain that is worse with sitting.
  • However, the symptoms of a cyst are different than coccydynia if the cyst has started oozing to the surface, since the patient may feel the fluid wetness, along with itchiness, and may notice redness or rash on the skin in the area.
  • On physical exam, the physician should look directly at the skin over the involved area, specifically looking for the following signs of a pilonidal cyst:
    • a small hole (fistula) in the skin
    • redness of the skin
    • rash of the skin
    • wetness/dampness of the skin
  • On physical exam, the doctor can press carefully over the coccyx (tailbone) and over the nearby areas, to assess whether the tenderness is over the bones of the coccyx versus over the nearby soft tissues.
  • In some cases, medical imaging studies may be helpful and even necessary.
    • X-rays can show abnormalities of the coccyx, including fractures, dislocations, arthritis, bone spurs, etc..
    • X-rays generally will NOT show the pilonidal cyst.
    • MRI can show BOTH the coccyx AND the pilonidal cyst.
    • Unfortunately, medical imaging studies in the tailbone region frequently are NOT done correctly. They often fail to include the proper specific images that would be needed to assess the tailbone region. This is unfortunately true for x-rays, MRI, and CT scans. The ordering physician needs to be extremely clear in how they order the imaging studies, and the patient should encourage the radiology technician to make sure that the involved area is included and properly seen.
    • Click here for a separate article and video on MRI revealing a Pilonidal Cyst at the Tailbone.
The Video below explains how to tell if pain is due to a pilonidal cyst versus due to coccyx problems.
Here is the text from the video:
  • Hi, I’m Dr. Patrick Foye and I’m an M.D., or medical doctor, and I’m a medical school Professor and also the Founder and Director of the Coccyx Pain Center or Tailbone Pain Center here in the United States.
  • You can find me online at www.TailboneDoctor.com.
  • And this is really going to be just a short discussion about a pilonidal cyst and how you tell the difference between whether somebody has tailbone pain (or coccyx pain, coccydynia, pain that is coming from the tailbone itself) and distinguishing that from somebody who may have pain coming from a pilonidal cyst.
  • So first of all what are the things that they have in common? Well a few things.
  • Both of them are painful: a pilonidal cyst is painful and coccydynia is painful.
  • Number two: where they’re located.
  • Both of them tend to occur in the coccyx area, which is here at the lower end of the spine.
  • So slightly above the anus, kind of at the back of the pelvis.
  • The lower tip of the spine is the tailbone or coccyx.
  • Pilonidal cysts tend to occur at the back of the sacrum and coccyx.
  • So the area is generally very similar for both pilonidal cysts and for coccydynia.
  • The other thing that they have in common is that both of them not only are painful but they can happen after a sudden trauma, but they can also happen without trauma.
  • So that doesn’t help us to to tell the difference between the two.
  • So both of them have pain, pain with sitting, with or without trauma, the location.
  • All of that is very similar between the two.
  • So then how can you tell the difference? The main thing is that a pilonidal cyst is different because it’s not down at the bony level the way that the coccyx is.
  • So, again, for the tailbone or coccyx we’re talking about bone pain down at the coccyx itself and tenderness when you press typically onto the bone itself.
  • Whereas a pilonidal cyst, as I’ll show you in the illustration, here is not down at the bone.
  • It’s basically in the soft tissue structure.
  • So you can see this swelling here.
  • So often with a pilonidal cyst number one is that they’re not tender directly on the bone.
  • Number two is that they may feel this lump or bulge because they have this collection of fluid a cyst is just a bag of fluid think about like a tiny water balloon just beneath the skin there.
  • So that is the nature of a cyst (shown in yellow on the illustration here).
  • And basically as that fluid starts to collect you get a lot of irritation you may get redness of the skin over the area so it starts to look something like that.
  • And the other thing is that the cyst can start to try to find its way out.
  • So the fluid and the pressure will start to build up and then the fluid starts to tunnel its way out towards the edge of the skin.
  • And then at the skin you may see a little bit of a pimple over the area and it may burst open.
  • And when it bursts open it oozes or lets out all of that gunk, that junk, that’s in there (all of that debris).
  • What’s in there? Well there’s fluid as we mentioned.
  • Often there’s debris like bits of hair can be in there as well.
  • In fact, “pilonidal” means “nest of hair”. That’s the medical term.
  • But basically all of that stuff starts to ooze out and when it does it’s really irritating to the skin.
  • So again you’ll get more redness on the skin from a pilonidal cyst.
  • You’ll get itching of the skin.
  • You may get a rash of the skin just from being exposed to all of that stuff.
  • And it may start to smell badly as well, especially if this is infected, in which case it’s not just a pilonidal “cyst” it’s a pilonidal “abscess” (an actual infection in the area) Those are the things about a pilonidal cyst.
  • But with tailbone pain (coccyx pain) typically you don’t feel a substantial lump, you don’t get the redness on the skin usually, you don’t get the rash and the itching.
  • Those are not typical for musculoskeletal, mechanical, coccyx pain or tailbone pain.
  • Other things that are different: the treatments are very different.
  • For treatment of tailbone pain (coccydynia) I have a whole aisle whole book you can get on Amazon.com or at www.TailbonePainBook.com There’s 272 pages in here all about workup and treatment for a tailbone pain.
  • So that’s a lot, and I have a lot of videos and things online already about tailbone pain.
  • But within the book I think I have maybe just two sentences or so about pilonidal cysts in the area, just to keep a lookout for them.
  • So really the reason I’m doing this video is to add some additional info.
  • I do not treat pilonidal cysts directly, so if you have a pilonidal cyst don’t make the the long trip to come and see me the way that many people do for tailbone pain.
  • See your local primary care physician or perhaps a a local general surgeon.
  • Usually they will be able to treat a pilonidal cyst very very well.
  • The treatment really depends.
  • If it’s mild sometimes just a soaking in a warm bath that or putting warm compresses can help that to ease some of that pressure or get rid of out some of that junk.
  • If it’s really problematic one of the things you’ll want to do is certainly when you’re in consultation with your physician see about whether it makes sense to actually cut it open: “incision and drainage” there’s different techniques marsupialization, etc.
  • There’s ways to cut it open and drain that junk out of there.
  • So that hopefully not only do you relieve the pressure and get it out but that it does not come back.
  • Because sometimes, with a pilonidal cyst, the fluid can come back and build up again.
  • So the treatment then is really typically a relatively minor outpatient surgery to have that area opened up for a pilonidal cyst.
  • If it’s infected then it’s a pilonidal abscess so things get a little more involved and certainly antibiotic treatment becomes important.
  • So anyway that’s a couple of minutes just talking about what is a pilonidal cyst and how is it different from coccyx pain or tailbone pain.
  • So that if you have a pilonidal cyst you should be treated or evaluated for a pilonidal cyst.
  • And if you have a tailbone problem you should be treated or evaluated by someone with expertise in treating tailbone problems.
  • If you want more information certainly you can find me online at www.TailboneDoctor.com Or certainly, you can get a copy of the book: there’s an e-book that you can get on Amazon.
  • You can also get the hardcopy book on Amazon.
  • At the time that I’m making this video, I’m actually giving away the hard copy of the book for free you just pay for shipping and handling.
  • Only in the United States that’s printed paper book is available and for that you would get it through www.TailboneBook.com.
  • So lots of ways for you to get information.
  • I’m a big believer in empowering patients to learn as much as you can about your medical conditions so that in consultation with your treating physicians you can make the best decisions possible in your medical care.
  • So that’s all for now I hope that was helpful for you.
  • If you have questions or thoughts on this topic certainly post them down below and I look forward to reading them.

 

Tailbone Art on Magazine Cover here at Rutgers

Check out this lovely tailbone / coccyx illustration on the cover of our Literature / Arts magazine here at Rutgers New Jersey Medical School:

Coccyx on Magazine Cover

Full Link: http://njms.rutgers.edu/inside_njms/archives/2017q3/ArsLitBooklet.pdf

Great illustration by Stephanie Ruthberg, New Jersey Medical School. Well done!

 

Book Now Available! Click on the book to get it now:


Get the Book at www.TailbonePainBook.com