Tailbone pain or Coccydynia can be caused by damage to the Middle Cluneal Nerves. In this video, Peripheral Nerve Surgeon Dr. Tim Tollestrup talks about how a simple surgical procedure to denervate the Middle Cluneal Nerves can provide permanent relief and help the patient avoid more invasive surgery.
The middle cluneal nerves are an interesting set of peripheral nerves because these are the nerves that come out of the backside of the sacrum. If these nerves are damaged, it can produce a sensation of low back pain, people can complain of pain in the sacral area, and the very lowest of these nerves can cause tailbone pain or coccygeal pain. There’s lots and lots of patients out there who are diagnosed with coccydynia or tailbone pain. This can be after some kind of traumatic injury, like a fall, or just prolonged chronic sitting I think sometimes irritates these nerves and causes them to be pain generators.
Most of the time, the doctors don’t really understand where this pain is coming from. They’re removing the coccyx thinking that the coccyx is the source of the pain when in reality it’s these little damaged nerves. These nerves are quite small nerves, and you really have to know where to look for them. That’s very often a procedure which does not give them good pain relief, and in a situation where the pain is actually coming from these damaged nerves, it could make it worse because now you’ve added another surgery and more trauma and scarring and stuff around these nerves.
The way to really diagnose this accurately when somebody has coccydynia would be to undergo diagnostic blocks of the lower sacral and coccygeal nerves and see if that resolves the pain. If it does, then you know you could undergo a procedure where these little nerves are removed on an outpatient type basis. Really the recovery is very quick and you don’t sacrifice the structural importance of the coccyx.
Very often patients will have pain in the SI joint area or the upper sacrum that is most of the time actually confused with SI joint pain, or it might be confused as a spine problem. Rather than having a very morbid fusion of the SI joint, it would be good to check and see what the true source of the pain is. Even in cases where there’s a lot of arthritis in the SI joint and that’s the source of the pain, you might be able to do an SI joint denervation by removing some of these little nerves and cutting the pain pathway instead of putting a screw across your SI joint.SHOW LESS