Disorders of the coccyx and sacrococcygeal joint: Etiology, diagnosis, and management strategies.

Coccygeal and sacrococcygeal disorders represent an uncommon but clinically meaningful source of axial pain and disability. Although coccydynia accounts for only 1 %-3 % of back pain presentations, symptoms can be prolonged and debilitating, particularly among women and individuals with elevated or fluctuating body mass. Underrecognition and diagnostic uncertainty often delay appropriate management, as coccygeal pain is frequently mistaken for lumbosacral, pelvic, or gastrointestinal pathology. This review synthesizes current evidence on the epidemiology, anatomy, biomechanics, clinical presentation, diagnostic evaluation, and management of coccygeal disorders, with emphasis on decision-making relevant to generalist and musculoskeletal clinicians. Dynamic seated and standing radiographs are the preferred initial imaging modality, while CT and MRI help delineate structural, degenerative, or inflammatory pathology. Image-guided interventions, especially ganglion impar and sacrococcygeal joint injections, can provide diagnostic clarity and symptom relief. For carefully selected patients with persistent, localized pain and supportive imaging, coccygectomy offers durable outcomes with improving wound complication rates using modern techniques. A structured, stepwise approach to diagnosis and treatment enables timely recognition and effective management of this historically overlooked condition.