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Background: Water slides and rides are increasingly popular attractions at amusement parks. There has been some documentation of various patterns of injury associated with these rides, most notably vaginal injuries caused by water jets. But we find no previous medical publications reporting the association between water slides/rides with coccydynia (coccyx pain) and tailbone injuries., Case Report: Our purpose in this case report was to assess for an association between water slides/rides with injuries to the coccyx causing coccyx pain. We conducted a retrospective chart review in a coccyx pain clinic on a medical school campus at a level I trauma center. The retrospective chart review took place over a 2-year period and encompassed 217 new patients. Four patients presenting to our coccyx pain clinic had either onset or exacerbation of symptoms with temporal relationship to water slide or ride activities. Three of 4 patients had abnormal dynamic instability on radiologic dynamic imaging, including standing versus seated radiographs and magnetic resonance imaging. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Recreational water slides/rides are a newly reported cause of coccygeal dynamic instability with resultant tailbone pain. Dynamic imaging studies (sitting vs. standing) of the coccyx should be considered in patients with coccyx pain after injuries on a water slide or ride. Many of these patients may initially seek care from emergency physicians., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Coccyx (tailbone) pain substantially decreases the quality of life for patients who suffer with this condition. Classic symptoms include midline pain located below the sacrum and above the anus. Symptoms are worse while sitting or during transitions from sitting to standing. Physical examination typically reveals focal tenderness during palpation of the coccyx. Diagnostic tests include radiographs. Advanced studies may include MRI, computerized tomography scans, or nuclear medicine bone scans. Treatments may include the use of cushions, medications by mouth, topical medications, local pain management injections, pelvic floor physical therapy, and (in rare cases) surgical removal of the coccyx (coccygectomy)., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Treating pain associated with acute coccyx fractures can be challenging. Intranasal calcitonin has been used to treat acute pain after vertebral fracture, and may even accelerate fracture healing. However, intranasal calcitonin has never previously been published as part of the treatment of acute coccyx fractures., Objective: To examine a series of cases in which intranasal calcitonin was used to treat coccydynia related to coccyx fractures., Study Design: Case series and literature review., Setting: Outpatient university-based coccyx pain center., Results: After use of intranasal calcitonin, pain levels decreased, adverse events were minimal, and the medication was generally well tolerated., Limitations: As this is not a randomized control trial, the patients treated with intranasal calcitonin were not compared to a control group. Additionally, the sample size of 8 patients is relatively small., Conclusions: We propose that clinicians consider use of intranasal calcitonin for the treatment of pain due to acute coccyx fractures.

A new technique for performing nerve blocks of the ganglion impar (ganglion Walther) is presented. These injections have been reported to relieve coccydynia (tailbone pain), as well as other malignant and nonmalignant pelvic pain syndromes. A variety of techniques have been previously described for blocking this sympathetic nerve ganglion, which is located in the retrorectal space just anterior to the upper coccygeal segments. Prior techniques have included approaches through the anococcygeal ligament, through the sacrococcygeal joint, and through intracoccygeal joint spaces. This article presents a new, paracoccygeal approach whereby the needle is inserted alongside the coccyx and the needle is guided through three discrete steps with a rotating or corkscrew trajectory. Compared with some of the previously published techniques, this paracoccygeal corkscrew approach has multiple potential benefits, including ease of fluoroscopic guidance using the lateral view, ability to easily use a stylet for the spinal needle, and use of a shorter, thinner needle. While no single technique works best for all patients and each technique has potential advantages and disadvantages, this new technique adds to the available options.

The article informs about treatment of Sacrococcygeal Joint in Patients with Coccydynia. Topics include sacrococcygeal angle was not significantly different between patients with idiopathic coccydynia as compared with non-symptomatic controls; and importance of looking below the sacrococcygeal joint when evaluating and treating patients with tailbone pain.

A letter to the editor is presented in response to the article “Coccygectomy Has a Favourable Effect on the Intensity, Manifestation, and Characteristics of Pain Caused by Coccygodynia: A Retrospective Evaluation of 34 Patients Followed for 3–18 years,” by Gáspár and colleagues within the issue.