I recently watched a video about the middle cluneal nerve as a possible cause of coccyx pain, tailbone pain, coccydynia.
I think that this is possible, but probably very uncommon.
I sometimes treat cluneal nerve pain. It is relatively common to have pain from the SUPERIOR cluneal nerve after bone is harvested from the iliac crest for a bone graft to use in a spinal fusion surgery. But the SUPERIOR cluneal nerve does not involve the coccyx.
The standard medical understanding is that cluneal nerves are mainly known as a source of buttock pain, rather than midline pain at the coccyx.
However, it is true that the MIDDLE cluneal nerve is more midline than the distribution of the SUPERIOR cluneal nerve.
See image, where MCN is the middle cluneal nerve:
Middle Cluneal Nerve is mainly NOT in the area of Tailbone Pain, Coccyx Pain, Coccydynia. Source:
Image source: https://musculoskeletalkey.com/complications-of-iliac-crest-bone-graft-harvesting/ (From: Kim, K., Isu, T., Matsumoto, J. et al. Low back pain due to middle cluneal nerve entrapment neuropathy. Eur Spine J27, 309–313 (2018). https://doi.org/10.1007/s00586-017-5208-2 )
But… even though the MIDDLE cluneal nerve is more midline than the distribution of the SUPERIOR cluneal nerve, most of MIDDLE cluneal nerve distribution is at the BUTTOCK, rather than midline at the coccyx.
The video about the middle cluneal nerve (MCN) shows only one image of nerves, and in that image it does NOT show MCN innervation of the coccyx (actually, none of the images in the video label the MCN). See screenshot from that video:
Screenshot from Video about the Middle Cluneal Nerve and Coccyx Pain
In the video, the surgeon mentions that to test for whether pain is coming from the MCN they do a local anesthetic nerve block of the MCN … AND ALSO of the coccygeal nerves. To me, it seems likely that any relief of coccyx pain from such a COMBINED block of BOTH groups of nerves would be far more likely to be relief from the block of the COCCYGEAL nerves (which definitely do carry pain sensation from the coccyx) rather than being from the cluneal nerve block (which is proportionally less likely to carry sensation from the coccyx). (Admittedly, it was short video, so perhaps he meant that they do two separate blocks on separate dates for those separate nerves?)
Some fibers from the middle cluneal nerve may innervate the SKIN that is OVER the coccyx region. But I think that for most people with coccyx pain they have a problem with the coccyx itself, rather than the SKIN that is over the coccyx.
Still, it is POSSIBLE that the middle cluneal nerve MIGHT be involved in the uncommon instances where someone presents with tailbone region pain that is: A) unusual in that is is NOT tender when the doctor presses on the bones of the coccyx, B) is associated with altered sensation of the SKIN over the coccyx region, C) the symptoms are worse mainly to one SIDE of the coccyx, rather than at the midline, and D) the patient gets relief with a local anesthetic nerve block of the MCN but does NOT get relief with a similar local anesthetic nerve block of the coccygeal nerves.
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person by Dr. Foye’s Coccyx Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Tailbone Pain Center, New Jersey, United States.
In recognition of the 3rd Annual“Tailbone Pain Awareness Day” which will be November 15, 2020…
This eBook is Free on Amazon worldwide: Nov. 14-15, 2020, Pacific Time.
“Tailbone Pain Relief Now! Causes and Treatments for Your Sore or Injured Coccyx” by Patrick M. Foye, M.D., Director of the Coccyx Pain Center at Rutgers New Jersey Medical School.
Free Book on Tailbone Pain, Coccyx Pain, Coccydynia, Nov 14-15, 2020.
Free e-Book on Tailbone Pain, Coccyx Pain, Coccydynia.
Below is a List of Amazon Links Worldwide to get the Book “Tailbone Pain Relief Now!”
The book is filled with useful information about coccyx pain (tailbone pain), including causes, tests, and treatments.
You can use the Amazon website specific to your part of the world.
Tailbone Pain Awareness Day 2020, Facebook Live on Coccyx Pain, with Patrick Foye, MD
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person by Dr. Foye’s Coccyx Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Tailbone Pain Center, New Jersey, United States.
Here is an Infographic showing all the chapters in the coccyx book “Tailbone Pain Relief Now!”
#CoccyxPain #TailbonePain #Tailbone #Coccydynia
Infographic showing all the chapters in the coccyx book “Tailbone Pain Relief Now!” #CoccyxPain #TailbonePain #Tailbone #Coccydynia
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Coccyx Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Tailbone Pain Center, New Jersey, United States.
A few of my patients with tailbone pain are professional drummers.
One of them recently told me that he finds the Carmichael Throne Chairs (more specifically their stools for drummers) to be significantly helpful when he needs to sit for a prolonged duration when drumming during a set for a live gig.
I don’t sponsor or promote any particular products, but I provide this info. for educational benefit as these chairs and stools may be helpful for some other patients with coccyx pain, whether you are a drummer or not.
Carmichael Throne, Chairs and Drummer Stools, for Tailbone Pain
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Coccyx Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Tailbone Pain Center, New Jersey, United States.
Dr. Foye has published extensively in the medical literature, including writing medical textbook chapters, original research articles published in peer-reviewed journals, various review articles, and an entire 272-page book specifically about tailbone pain.
Below is a partial list of these publications.
Selected references (re: coccyx pain) from the medical literature:
Foye PM, et al. Successful injection for coccyx pain. Am J Phys Med Rehabil. 2006 Sep;85(9):783-4.
Foye PM. Finding the cause of coccydynia (coccyx pain). J Bone Joint Surg [Br]. Published 1-18-07 online: http://www.jbjs.org.uk/cgi/eletters/88-B/10/1388.
Foye PM. Ganglion impar injection techniques for coccydynia (coccyx pain) and pelvic pain. Anesthesiology. 2007 May;106(5):1062-3.
Foye PM. Coccydynia (Coccyx Pain) Caused by Chordoma. Int Orthop. 2007 Jun;31(3):427.
Foye PM. New approaches to Ganglion Impar Blocks, via Coccygeal Joints. Regional Anesthesia and Pain Medicine. 2007 May-Jun;32(3):269.
Foye PM, Buttaci CJ. Coccyx Pain. In: Plantz SH, eMedicine: Physical Medicine and Rehabilitation. San Francisco: eMedicine; 2007. www.emedicine.com/pmr/topic242.htm
Foye PM. Reasons to Delay or Avoid Coccygectomy for Coccyx Pain. Injury. 2007 Nov;38(11):1328-1329. Epub 2007 Sep 19.
Foye PM. Ganglion Impar Blocks for Chronic Pelvic and Coccyx Pain. Pain Physician. 2007 Nov;10(6):780-1.
Buttaci CJ, Foye PM, Stitik TP. Coccydynia Successfully Treated with Ganglion Impar Blocks: A Case Series. American Journal of Physical Medicine and Rehabilitation. 2005; 84(3):218.
Liang CW, Foye PM, Sorenson MK. Low Incidence of Vascular Uptake in Ganglion Impar Injections for Coccydynia (Coccyx Pain). American Journal of Physical Medicine and Rehabilitation. 2007 Apr;86(4):S104.
Rhee M, Foye PM, Tung D. Coccydynia (Coccyx Pain) due to Dynamic Instability of the Tailbone: A Case Report. Archives of Physical Medicine and Rehabilitation. 2007 Sep;88(9): E36.
Foye PM, et al. Coccydynia (Coccyx Pain) after Colonoscopy. American Journal of Physical Medicine and Rehabilitation. 2008 Mar;87(3): S36.
Foye PM. A New Diagnostic Test for Coccyx Pain (Tailbone Pain): Seated MRI. American Journal of Physical Medicine and Rehabilitation. 2008 Mar;87(3): S36.
Foye PM. Safe ganglion Impar blocks for visceral and coccyx pain. Techniques in Regional Anesthesia and Pain Management. 2008 Apr;12(2):122-123.
Foye PM. Ganglion Impar Blocks via Coccygeal versus Sacrococcygeal Joints. Regional Anesthesia and Pain Medicine. 2008 May-Jun;33(3):279-80.
Foye PM. Dextrose prolotherapy for recalcitrant coccygodynia fractures. Journal of Orthopaedic Surgery (Hong Kong). 2008 Aug;16(2):270.
Foye PM, et al. Cookie-Bite Coccyx- Retained Coccygeal Fragment after Coccygectomy. American Journal of Physical Medicine and Rehabilitation. 2009 Mar;88(3): S56.
Foye PM, et al. Coccyx Cushions for Tailbone Pain: Donut Cushions Versus Wedge Cushions. American Journal of Physical Medicine and Rehabilitation. 2009 Mar;88(3): S56.
Foye PM. Tailbone Pain (Coccydynia) Treated with Phenol Chemical Ablation of Somatic Nerves at the Posterior Coccyx. American Journal of Physical Medicine and Rehabilitation. 2009 Mar;88(3): S56-57.
Foye PM, Patel SL. Paracoccygeal Corkscrew Approach to Ganglion Impar Injections for Tailbone Pain. Pain Practice (the official journal of the World Institute of Pain). 2009 July-Aug;9(4):317-321
Foye PM, Kamrava E, Enriquez R. Tailbone Pain Associated with a Keel-Shaped Coccyx: a Case Series. PM R, 2009 Sept;1(9):S176-S177.
Foye PM, Kamrava E, Enriquez R. Tailbone Pain from Coccyx Injuries on Water Slides: a Case Series. PM R, 2009 Sept;1(9):S177.
Foye PM, Enriquez R, Kamrava E. Seated MRI for Patients with Tailbone Pain: a Case Series. PM R, 2009 Sept;1(9):S223-S224.
Foye PM, et al. Psychological versus Physical Pain Descriptors in Patients with Tailbone Pain. AJPMR, 2010 April;89(4):S32-3.
Foye PM. Coccyx Pain Diagnostic Workup: Necessity of MRI in Detecting Malignancy Presenting with Tailbone Pain. AJPMR, 2010 April;89(4):S33.
Foye PM, Stitik TP. Diagnostic Ultrasound in a Patient with Tailbone Pain: Detecting Coccygeal Dislocation/Listhesis but Failing to Detect an Avulsion Fracture of the Coccyx. AJPMR, 2010 April;89(4):S33.
Foye PM. Coccyx Pain and MRI: Precoccygeal epidermal inclusion cyst. Singapore Med J. 2010 May;51(5):450.
Foye PM. Stigma Against Patients with Coccyx Pain. Pain Med. 2010 Dec;11(12):1872.
Foye PM. Causality of concomitant coccyx pain and lumbar pain. J Bone Joint Surg [Br]. 2010 Dec. http://www.bjj.boneandjoint.org.uk/content/92-B/12/1622/reply#jbjsbr_el_5412
Foye PM. Ganglion Impar Pulsed Radiofrequency for Coccyx Pain. Journal of Pain and Symptom Management. April 2011. 41(4):e11-12.
Foye PM, et al. Sit-To-Stand Exacerbation of Coccyx Pain As a Predictor of Coccygeal Dynamic Instability Versus Bone Spurs. Am J Phys Med Rehabil, 2011 April; 90(4):
Lercher K, Foye PM. Heterotopic Ossification of the Coccyx as a Post-Operative Complication of Coccygectomy. Am J Phys Med Rehabil, 2011 April; 90(4): 87-88.
Foye PM, et al. Local anesthetic injection L. Banana boat Tailbone Trauma: 100% Complete Listhesis, a Dynamic Dislocation. Am J Phys Med Rehabil, 2011 April; 90(4):a25.
Foye PM, Kumar S. CT Morphology and Morphometry of the normal adult coccyx. Eur Spine J. March 2014; 23(3):701. PMID: 24292276.
Foye PM, Desai RD. MRI, CT scan, and dynamic radiographs for coccydynia. Joint Bone Spine. 2014 May;81(3):280. PMID: 24462128. (Also expected to be published in La Revue du Rhumatisme as well after translation into French.)
Foye PM, et al. Coccyx fractures treated with intranasal calcitonin. Pain Physician. 2014 Mar-Apr;17(2):E229-33.
Mehnert MJ, Shamim F, Foye PM. Coccygodynia. Chapter In: Simon J, Freedman M, Mehnert MJ. Interventional Spine Procedures – A Case Based Approach. (Jaypee Brothers Medical Publishers Ltd. Published 2014) ISBN-13: 978-9351521693 ISBN-10: 9351521699
Foye PM. Tailbone Pain Relief Now! United States: Top Quality Publishing, 2015. Print (soft cover book, 272 pages). ISBN-13: 978-0996453509.
Hsieh S, Hwang GE, Foye PM, Kumbar SV, Koon CT. Iatrogenic Coccydynia (Coccyx Pain) After Chiropractic Actuator Treatments: Case Report. WebmedCentral PAIN 2015;6(10):WMC004998.
Foye, PM, Shenouda M. In: Maigne J-Y, Doursounian L. (ed.) Coccyx Disorders. (Best Practice Publishing, 2018). Papers from The First International Symposium on Coccyx Disorders. Chapter: Ganglion Impar (Walther) Sympathetic Nerve Procedures for Coccydynia. Pages 106-116. Online at: https://www.bestpractice-publishing.com/index.php/product/coccyx-disorders/
Foye PM, Sajid N, D’Onofrio GJ. Ganglion impar injection approaches and outcomes for coccydynia. Indian J Radiol Imaging 2018;28:482-3. Available online: http://www.ijri.org/text.asp?2018/28/4/482/247777
Foye PM, Abdelshahed DM, Kamrava E, Enriquez R, D’Onofrio GJ. Tailbone Pain from Coccyx Injuries on Water Slides: A Case Series. J Emerg Med. 2018 Aug;55(2):e33-e35. Available online here: https://www.jem-journal.com/article/S0736-4679(18)30373-1/fulltext (Accessed: 6-13-18)
Foye PM, Sanapati JS, John A, Jow SL. Avascular Necrosis (AVN) of the Coccyx as a Cause of Coccydynia (Tailbone Pain). WebmedCentral PAIN 2018;9(8):WMC005505. Available online here: http://www.webmedcentral.com/article_view/5505
Foye PM, Singh R, Tangri V. Cerebrospinal fluid leak after fracture of the sacrum or coccyx. Spine J. 2019 Dec;19(12):2044. doi: 10.1016/j.spinee.2019.07.018. PMID: 31759438.
Foye PM, Nweke N, Singh R. Variability in Coccygeal Dynamic Mobility in Different Populations. Interv Neuroradiol. 2020;26(2):239. Published online 2019: https://doi.org/10.1177/1591019919870422
Foye PM, Varghese CA, Singh R. Looking Below the Sacrococcygeal Joint in Patients with Coccydynia (Coccyx Pain). Indian Journal of Orthopaedics, 54(1), 104. Published in print 2/2020. IJOO. https://link.springer.com/article/10.1007/s43465-019-00036-y
Foye PM, Woon J, Zheng K, Leong K. Low incidence of vascular uptake during ganglion impar sympathetic nerve blocks for coccydynia. Indian Journal of Radiology and Imaging. April-June 2020;30(2): 181-183. DOI: 10.4103/ijri.IJRI_302_19
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Coccyx Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Tailbone Pain Center, New Jersey, United States.
Cerebrospinal fluid (CSF) leak after Fracture of the Sacrum or Coccyx.
Dr. Foye’s Summary:
Leakage of Cerebrospinal fluid (CSF) is much more commonly expected after fracture of the sacrum, rather than after fracture of the coccyx (tailbone).
The reason is that the anatomy of the sacrum contains the spinal canal, which contains CSF.
Meanwhile, the anatomy of the coccyx bones do NOT include any spinal canal, and thus the coccyx does not have any CSF.
Leakage of CSF after a fracture limited to only the coccyx would mainly only happen if the trauma caused substantial pulling onto the filum terminale (fibrous tissue that extends from the lower tip of the spinal cord to its attachment on the upper coccyx).
Citation: Foye PM, Singh R, Tangri V. Cerebrospinal fluid leak after fracture of the sacrum or coccyx. Spine J. 2019;19(12):2044. doi:10.1016/j.spinee.2019.07.018
Cerebrospinal Fluid Leak after Coccyx Fracture, Published
Cerebrospinal Fluid Leak after Coccyx Fracture, Published in The Spine Journal
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Coccyx Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Tailbone Pain Center, New Jersey, United States.
As a medical school Professor and international medical educator, Dr. Foye provides free educational content through many different social media sites.
Here are some places where you can find Dr. Foye and his educational materials online:
Note and Disclaimer: Public education via social media is NOT a substitute for in-person medical attention from a physician with experience in treating your condition. Posts by Dr. Foye in public website should NOT be considered as a recommendation for any specific person to take or not take any particular action regarding their medical care. Instead, those with medical conditions should discuss their conditions with their in-person treating physicians. Also, Dr. Foye’s comments online do not necessarily reflect the views of any university, school, hospital or employer. Also, medical knowledge and opinions change over time, so the materials you may read may become outdated over time and, once again, you should discuss all options and concerns with an in-person physician with experience in treating the condition that you are suffering from.
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Coccyx Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Tailbone Pain Center, New Jersey, United States.
