Medical Student Philadelphia College of Osteopathic Medicine - Georgia Campus Cumming, Georgia
Case Diagnosis: A 39-year old male presents to the clinic with a 1.5 year history of focal, atraumatic pain over the midline of the coccyx and a past medical history significant for degenerative disc disease and Grade 1 spondylolisthesis.
Case Description or Program Description: Diagnostic ultrasound of the sacrum and coccyx was significant for enlarged sacrococcygeal joint capsule with calcifications. This is an indication for remote trauma. Some portions of the sacrococcygeal ligament did not have calcifications. No region of the joint or ligament displayed neovascularization.
Ultrasound-guided injection of the sacrococcygeal joint and ligaments was performed with a needle insertion and injected with a mixture of 1.5cc 50% dextrose and 1.5cc 1% lidocaine. Sacrococcygeal joint calcifications were broken up with a 25-gauge needle and the ligament was fenestrated with 10 passes of the needle.
Setting: PCOM Osteopathic Manipulation Medicine Office Visit
Assessment/Results: Prolotherapy to the sacrococcygeal ligaments and joint led to a patient-reported 25% to 30% improvement in symptoms 16 days post-procedure. In the second visit 4 weeks later, the patient reports a 50% improvement in pain symptoms and describes it as dull and diffuse around the coccyx. Another injection is performed during this visit. Although the patient noted milder improvements in symptoms 4 weeks post-injection, the patient can lie down and move around. Sitting down is still a problem. A third injection is performed during the next visit which on follow-up 4 weeks later was significant for a patient-reported 75% to 85% improvement in pain.
Discussion (relevance): Though the history did not mention any trauma, remote trauma may have led to the development of chronic mechanical pain. Diagnostic ultrasound proves useful in identifying the precise cause of pain.
Conclusions: This case underscores the importance of continued education with regards to image-guided injections in order to precisely target damaged ligaments.