Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Inflammation of the bony area (tailbone
or coccyx) located between the buttocks is referred to as
coccydynia. Coccydynia is associated with pain and tenderness at the tip
of the tailbone between the buttocks. The pain is often worsened by sitting.
What causes coccydynia?
Coccydynia is often caused by an injury, but it may occur
seemingly spontaneously. There are many causes of tailbone pain which
can mimic coccydynia, including sciatica, infection, pilonidal cysts,
and fractured bone.
How is coccydynia diagnosed?
Coccydynia is commonly diagnosed based solely on the symptoms and the
examination findings of local tenderness. Other conditions can be excluded
by the examination (such as shingles, which typically would be associated
with local rash) and other testing (to exclude bone or tissue disorders,
such as with CAT scan or MRI
scan).
How is coccydynia treated?
Patients with coccydynia are advised to use a well-padded
seat when sitting and avoid long periods of sitting when
possible. If the condition becomes severe or persistently troublesome, then medical attention should be sought to
accurately evaluate the cause of the pain.
Rest, avoiding re-injury to the affected area, antiinflammation and pain medications can
relieve symptoms. Some patients with persistent coccydynia are
treated with local cortisone injection. This injection is simply
performed in the doctor's office and can potentially dramatically
relieve the pain and even resolve the symptoms for many. Rarely, when
patients have unrelenting pain, a surgical resection of the coccyx
can be performed to remove the irritated bony prominence.
There are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
An MRI (or magnetic resonance imaging) scan is a
radiology technique that uses magnetism, radio waves, and a computer
to produce images of body structures. The MRI scanner is a tube
surrounded by a giant circular magnet. The patient is placed on
a moveable bed that is inserted into the magnet. The magnet creates
a strong magnetic field that aligns the protons of hydrogen atoms,
which are then exposed to a beam of radio waves. This spins the
various protons of the body, and they produce a faint signal
that is detected by the receiver portion of the MRI scanner.
The receiver information is processed by a computer, and an image
is produced.
The image and resolution produced by MRI is quite detailed and can
detect tiny changes of structures within the body. For some procedures, contrast agents, such as gadolinium, are used to increase the accuracy of the images.