Template:VUB
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Search Strategy[edit source]
1. SEARCH STRATEGY ARTICLES
Keywords:
• Coccyx fracture ( 55 results and 3 free full texts): Most successful search
• Coccygectomy (85 results and 16 free full texts)
• Coccygeoplasty (1 free full text).
• Coccyx fracture AND physiotherapy (1 result)
Search engines : Pubmed / Web of knowledge
It is also very useful to check the references of each usable article.
2. SEARCH STRATEGY BOOKS
Keywords:
• Traumatology
• Fractures
• Orthopaedics
Search engines: VUBIS catalogus / UA catalogus
Definition/Description[edit source]
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Clinically Relevant Anatomy[edit source]
The coccyx, also known as the tailbone, is a small triangular bone that is usually formed by fusion of the four rudimentary coccygeal vertebrae, although in some people there may be one less or one more. The coccygeal vertebra 1 (Co1) may remain separate from the fused group, but with increasing age Co1 often fuses with the sacrum and the remaining coccygeal vertebrae usually fuse to form a single bone. (level of evidence D)
The forward movement of coccyx is performed actively by the M. levator ani, and the backward movement of coccyx is passively caused by relaxation of these muscles. The coccyx also provides the site of attachment for the M. gluteus maximus as well as the M. levator ani, which is responsible for voluntary control of bladder and bowel. (level of evidence B) The coccyx does not participate with the other vertebrae in support of body weight when standing, however when sitting it may flex anteriorly, indicating that it’s receiving some weight. ( level of evidence D)i
The coccyx is part of the sacrococcygeal joint, an cartilaginous joint with an IV disc. Fibrocartilage and ligaments join the apex of the sacrum to the base of the coccyx. The anterior and posterior sacrococcygeal ligaments are long strands that reinforce the joint. (level of evidence D)
The coccyx is also attached with the margin of the anus by the anococcygeal ligament. (level of evidence D)iii
Epidemiology /Etiology[edit source]
Fracture of the coccyx often arise after a fall on the buttock, most prevalent a fall of the stairs on the tailbone, or by an impact directly applied. (level of evidence D) An especially difficult childbirth occasionally injures the mother’s coccyx. ( level of evidence D)
Characteristics/Clinical Presentation[edit source]
1. GENERAL SYMPTOMS
General symptoms that appear are (level of evidence D)iv,vii,viii :
• Pain that increases in severity when sitting or getting up from a chair
• Provoked pain over the tailbone
• Bruising or swelling in the tailbone area
• Bowel movements and straining are often painful
• There are no neurological signs
An important number of people suffer from long lasting pains over the coccyx following trauma (with or without fracture of the coccyx), better known as cocydynia.(level of evidence D)
2. CLINICAL PRESENTATION IN PATIENTS WITH SPINAL CORD INJURY
Patients with SCI, suffering from painful symptoms in the low back, gluteal, hip and thigh region, have coccyx fracture with a frequency of 34,6%. Patients who had coccyx fracture have higher pain scores when compared with those who don’t have any fracture, however the difference is only statistical significant regarding Sensory Pain Index (SPI) and total McGill scores.( level of evidence C)
Differential Diagnosis[edit source]
Diagnostic Procedures[edit source]
1. MEDICAL DIAGNOSIS
A plain radiography or MRI is necessary to confirm the diagnose of a coccyx fracture. (level of evidence D)
2. CLINICAL DIAGNOSIS
The diagnose is made after rectal examination. (level of evidence D)iv By passing the finger up the rectum and then pressing the bone backwards and forward, the unnatural degree of motion will then be felt. Related to the age and sex of the patient must be remembered that in the female this bone naturally possesses more motion than in the male, and that in youth a degree of motion, that does not exist at a later period of life, is present, allowing the ossification being less complete. However the free motion of the bone is taken as a symptom. (level of evidence D)
Outcome Measures[edit source]
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Examination[edit source]
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Medical Management
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Physical Therapy Management
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Key Research[edit source]
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Resources
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Clinical Bottom Line[edit source]
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Recent Related Research (from Pubmed)[edit source]
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References[edit source]