Which is better when evaluating tailbone pain (coccyx pain), an MRI or a CT scan?
CT scan can be very good at showing bone, but MRI can show not only bone but ALSO give good definition of soft tissue structures.
Some of the soft tissue structures that show up clearly on MRI include:
abscess (which is essentially an infection like a pocket/collection of pus)
pilonidal cyst
other fluid collections or areas of inflammation
soft tissue malignancies
other soft tissue masses [e.g., retrorectal hamartoma, which is a mass that happens behind the rectum and immediately in front of the sacrum and coccyx],
fluid/inflammation within the bones (e.g., due to osteomyelitis = bone infection, which can especially occur after bed sores [pressure ulcers] or surgical removal of the elbow and [coccygectomy].
MRI is more expensive than CT scan
so insurance companies usually require people/doctors to go through more hurdles to get an MRI rather than a CT scan.
Radiation risks:
Also, CT scans unfortunately deliver radiation to the patient, whereas MRI delivers no such radiation.
Either can be helpful:
For all these reasons, I generally prefer MRI instead of CT scans.
I do order CT scans sometimes, but usually it is in those where the MRI can not be done (due to metal in the patient that can prevent putting them in the MRI magnet), or if the MRI shows something that needs a different type of clarification, etc.
MRI and CT scans take images similar to taking a series of slices.
Imagine a block of cheese on a slicing machine in a delicatessen. You could slice the block of cheese from left to right, from top to bottom, or from front to back.
In medical imaging, there are different terms for these different types of slices:
Slices from left to right (such as a vertical slice that appears to split the body into a right side and the left side): These are “sagittal” views.
Slices from top to bottom (e.g. in the standing position this would be like taking a horizontal slice up at the level of the head, another at the level of the neck, another at the level of the chest/torso, another at the abdomen, another of the pelvis, of course in reality would be multiple such slices at any such given level): These are “axial” views.
Slices from front to back: These are “coronal” views.
In general, the sagittal views are usually the most helpful for looking at coccyx anatomical abnormalities.
THIN sections: Another factor is that MRI of the coccyx needs to be done using multiple thin sagittal slices at the midline, otherwise it is possible that there would be no slice (image) right at the level of the coccyx.
That is especially important for the lower coccyx, since that is the thinnest, most-narrow part of the coccyx.
On standard MRI images there are relatively “thick” slices. With those thick slices it can sometimes occur that one slice (image) is just to the right of the coccyx and the very next image is just to the left of the coccyx, thus missing (skipping over) the bone of interest (the coccyx).
Do you have a lawsuit related to your tailbone injury (coccyx injury)?
The first step in a legal case involving a tailbone injury or coccyx pain would be proving that a tailbone problem actually exists.
The legal system is generally based on evidence. Subjective factors like self-reported symptoms might get some consideration, but typically more consideration is given to “objective evidence” that essentially “proves” that there is a tailbone problem or injury.
Examples of subjective, self-reported symptoms include your own statements about
the pain that you feel,
the difficulties that you have with sitting on certain surfaces, etc.
Examples of objective evidence include:
abnormalities that the physician documents from performing a careful and thorough physical examination
abnormalities on x-rays
coned-down x-ray views of the coccyx
sitting-versus-standing x-rays of the coccyx are especially helpful. Without this type of x-rays, a large percentage of tailbone injuries will fail to be diagnosed. Without these sitting x-rays the abnormality will be missed, unrecognized, thus weakening your legal case.
abnormalities on MRI
abnormalities on CT scans
abnormalities on bone scans
Causality: proving that a specific incident caused your tailbone injury
Factors that support the notion that a specific incident caused your tailbone injury:
No tailbone injuries or tailbone pain prior to the incident in question
No unrelated medical explanation for your tailbone pain (e.g., the symptoms are not being caused by a pilonidal cyst or a tailbone malignancy).
Tailbone symptoms reported relatively soon after the incident (admittedly this is sometimes difficult because patients may initially report general low back pain or buttock pain, so it may not initially be clearly understood that the pain is coming from the tailbone)
No previous imaging studies showing that the tailbone abnormality already existed prior to the incident in question.
Book Chapter on Legal Cases for Tailbone Injuries
My book, Tailbone Pain Relief Now! has an entire chapter on Legal Cases for Tailbone Injuries.
That chapter covers some of the challenges in getting objective evidence confirming the coccyx injury, establishing “causality” (i.e., that a specific injury caused the coccyx problems), etc.
If you are in the United States, you can get a copy of my book for free (just pay the shipping/handling) at www.TailbonePainBook.com
Determining Financial Compensation for a Tailbone Injury
It can be challenging to come to a specific dollar amount for financial compensation for a tailbone injury.
You probably should discuss that with an attorney who has expertise in the area of law that this applies
if this is a workplace injury then find an attorney who represents injured workers,
if this was from an automobile injury then find an attorney who represents auto accident victims
Presumably they would need to take into account:
medical costs: doctor’s visits, prescription medications, over-the-counter medications, tailbone injections, surgery (coccygectomy), etc.
lost work time: how much time did you miss from work due to this injury? Include days missed for medical appointments, etc.
long-term disability (if any)
Total disability:
Total disability means your totally unable to return to any type of work.
Compensation for total disability may include consideration for how many years of work you will lose.
if we roughly assume that people retire at 65…
then if you went out of work at age 60 you only lost five years of paid employment
if you went out of work at age 30 then you have lost 35 years of paid employment.
“Partial” disability:
Partial disability means that you are not able to do all of the same work that you did before.
Maybe you are not able to do the same type of job you did before, but you can work doing something else.
Perhaps you can no longer do a sitting job like driving a bus or flying a plane, but you can do a different type of work that does not require such prolonged sitting.
Maybe you can do the same type of job you did before, but due to decreased sitting tolerance you can only sit for long enough to work part time, instead of full time.
Your financial loss from the tailbone injury might take into consideration whether your new job or part-time status results in a lower yearly income than the work that you were able to do prior to the tailbone injury.
Finding an attorney
Consider using Google or another search engine to find an attorney in your geographic area who specializes in the type of case that you have.
For example:
Auto injury attorney in Seattle
Injured worker attorney in Chicago
Read reviews about the attorney online.
Some attorneys will give a free consult so you can see if they are a good fit for you and your case.
Attorneys may work on commission, meaning that they keep a percentage of what is awarded. The hope then would be that having the attorney involved increases the award enough to have made it worthwhile to have involved the attorney.
There are many different types of injections that pain management physicians like myself can provide for patients.
Often, an important first step is deciding whether any given patient needs an injection at all, and if so which specific type of injection they may benefit from.
What is an epidural steroid injection?
An epidural injection is an injection that places medication into the epidural space.
The epidural space is located within the spinal canal.
Placing steroids into the epidural space may help decrease inflammation at that specific site.
For example, if someone has a disc herniation in their lower back causing irritation and inflammation of the disc and epidural space and spinal nerves at that level, they may benefit from injecting an anti-inflammatory steroid into the epidural space at that level.
Epidurals can be done at various levels of the spine, including the cervical spine, thoracic spine, and lumbosacral spine.
The physician performing the injection can place the needle tip into the epidural space using different approaches or pathways for the needle.
Three different approaches include:
Transforaminal epidural
Interlaminar epidural
Caudal epidural
However, note that NONE of the approaches above place anti-inflammatory medication at the coccyx.
Why don’t epidural injections help decrease tailbone pain?
I have read hundreds of medical articles on tailbone pain, but I do not know of even one single article that has shown epidural steroid injections to be helpful at decreasing tailbone pain.
I have also seen *many* patients who have come to see me reporting that they have undergone epidural steroid injections in hopes of getting relief of their tailbone pain, only to receive zero benefit.
This is not surprising. As noted above, the epidural space is located within the spinal canal and the spinal canal does not go as low down as the tailbone.
There is a spinal canal within the cervical spine, thoracic spine, lumbar spine, and sacrum, but there is NO spinal canal or epidural space within the coccyx.
So, if the doctor is injecting a treatment into the epidural space then he or she is not injecting the medication at the tailbone.
Why do doctors do epidural injections for tailbone pain if they do not help?
I believe that almost all doctors are trying to do their best to help their patients.
Most doctors know very little about coccydynia (coccyx pain, or tailbone pain).
Even doctors who specialize in treating painful musculoskeletal conditions often know very little about the causes of tailbone pain, the best of diagnostic tests for tailbone pain, or the best and most current treatments for tailbone pain.
So, the doctors provide the treatments that they know how to do.
They do epidural injections for tailbone pain because, simply, they know how to do epidural injections.
They hope that maybe the injections will help the patient with tailbone pain, the way that they often see these injections help patients with other kinds of spine pain.
Out of all of the different epidural injections, the one that is closest to the coccyx is the “caudal” epidural injection. So maybe the doctor will “try” a caudal epidural steroid injection for a patient with tailbone pain.
But when the epidural injections fail to provide relief, the doctor may not understand why were they may not know what else to do or recommend.
Which injections *are* most helpful for tailbone pain?
Sometimes a patient with tailbone pain (coccyx pain) or their employer will ask for my official medical opinion on sitting tolerance, ability to work, etc.
In those situations I typically provide information about the difficulties that patients with tailbone pain have with prolonged sitting.
Some useful approaches can include sit-stand workstations. For example, you can arrange to have a computer workstation that raises and lowers throughout the day, so that you can stand at the workstation when your tailbone is sore from sitting and you can sit down at the workstation when your legs and back are tired from standing.
Another modification is simply allowing the person to alternate between sitting/standing at will throughout the workday.
For some jobs these modifications are not really possible though.
For example, an airline pilot can’t stand up while flying the plane, nor can a taxi driver or bus driver stand up at random.
Even typical office jobs can be difficult to modify. For example, it may be socially awkward to stand up throughout an entire business meeting while all of the representatives from other companies are sitting down at the table.
Another difficulty with these modifications is that many people are physically unable to stand throughout most of the workday.
For example, if you have arthritis or other sources of pain in your feet, knees, hips, or lower back, it may be very difficult to stand throughout the bulk of the work day.
If a patient responds very well to treatment, they may be able to sit normally throughout the workday.
However, during flareups (exacerbations) of the tailbone pain, the person might not be able to sit at all or might have pain so severe that it mentally distracts them from being able to reasonably concentrate on work tasks.
Every person is unique in their sources of tailbone pain, severity of tailbone pain, response to treatments, frequency and severity of exacerbations, work duty requirements, etc.
So, an individualized approach makes the most sense.
Since publishing my book Tailbone Pain Relief Now! I have been very grateful for the positive feedback that I have received from around the world.
Readers have sent me emails and Facebook posts from Europe, Scandinavia, Asia, Australia, and the United States and Canada.
The most intriguing e-mail I received was from Puerto Rico…
Overall, I have been extremely impressed with Amazon and my book warehouse for their prompt and efficient shipping of my book to people with tailbone pain (coccyx pain) all of the world.
But I received one e-mail from Puerto Rico asking why two weeks after ordering the book he still had not received it.
Why did this book go missing???
So we tracked the book shipment through the United States Postal Service.
We saw that he had ordered the book on September 24, 2015.
The book warehouse in Indiana shipped it out that very same day, and it was then tracked by the United States Postal Service.
By 10 PM on September 27, the book arrived in Jacksonville, Florida.
From there, the United States Postal Service tracking system seems to reach a dead end, without any further information about the whereabouts or delivery of the book. Even now, months later, it still lists the book shipment as being “in transit”, but not yet delivered.
Tailbone Book, Delivery Tracking , before the shipwreck
I shared this shipping information with the man in Puerto Rico who had been wondering why he never received his book.
From there, he figured out the tragic next turn in the story…
Two days after my book arrived in Jacksonville, Florida, it would have been aboard the cargo ship El Faro, on what turned out to be its final and fatal voyage.
Per Wikipedia: “On September 30, 2015, at 2:00 a.m., El Faro left Jacksonville, Florida for San Juan, Puerto Rico, carrying a cargo of 391 shipping containers, about 294 trailers and cars, and a crew of 33 people”.
By the following morning, Tropical Storm Joaquin had become more severe and was now a category three hurricane. The cargo ship was near the eye of the storm, amid large waves 20 to 40 feet tall (6 to 12 meters) and winds exceeding 90 miles per hour (150 km/h). The captain reported that the ship had taken on water and soon thereafter all communications with the ship or lost.
Extensive search and rescue operations found debris from the ship, but tragically they did not find the ship or any survivors.
The United States Navy searched the ocean floor and found the ship almost one month after it had gone under. It was found on October 31, at a depth of approximately 3 miles below the surface (15,000 feet, or 4600 meters).
Underwater image confirms shipwreck El Faro on ocean floor
The ship, its cargo, and any crew still within the vessel remain entombed 3 miles under water. My heart goes out to crew members’ families, who have lost their loved ones.
It is unfortunately common that patients tell me that the prior physician treating their tailbone pain never actually examined their tailbone.
It is crazy to that a doctor would be providing medical care for a specific musculoskeletal location and yet not have the time or skills to perform a basic physical exam of the painful site.
Any physician who is treating the tailbone should, at a minimum, be able to perform a physical exam where they palpate (press upon) the tailbone, at least externally, to confirm whether that site is tender and whether that tenderness matches the symptoms that you are seeing them for.
Most physicians should also be able to perform a visual exam (inspection) of the anal/perianal area, and potentially an internal/rectal/digital exam.
If it is a musculoskeletal/pain physician that prefers not to perform the anal portion of the exam, then typically it would be a matter of seeing a primary care physician or a gastroenterologist. There are times when things like an internal thrombosed hemorrhoid or an anal fissure can be the cause of anal pain (which is very close to the lower tip of the coccyx).
Essentially all surgery results in some scar tissue at the surgical site.
Not all scar tissue needs to be treated. If the scar tissue is not causing any symptoms or problems, sometimes it’s best to just ignore it.
However, scar tissue can sometimes be painful or cause irritation of nerves, muscles, and tendons in the area.
Also, scar tissue may restrict movement of muscles, tendons, ligaments, or joints. In the pelvis, this may cause problems throughout the pelvic floor.
Massaging the area of scar can help to loosen up any fibrotic tissues that are getting stuck and clump together.
However, this can be painful. So it’s important to work closely with your treating physician to obtain good relief of pain since this may help you to tolerate working on the scar tissue.
External approaches include massaging the scar tissue from OUTSIDE the skin.
Internal approaches include massaging the scar tissue from inside. This typically would involve wearing a medical glove and placing one or two fingers inside the rectum.
It can be extremely valuable to find a physical therapist with specific training and expertise in treating problems of the pelvic floor.
