Ultrasound-guided peripheral nerve blocks for anterior cutaneous nerve entrapment syndrome after robot-assisted gastrectomy: A case report

BACKGROUND Anterior cutaneous nerve entrapment syndrome(ACNES)is a condition mani-festing with pain caused by strangulation of the anterior cutaneous branch of the lower intercostal nerves.This case report aims to provide new insight into the selection of peripheral nerve blocks for the ACNES treatment.CASE SUMMARY A 66-year-old woman manifested ACNES after a robot-assisted distal gastrec-tomy.An ultrasound-guided rectal sheath block was effective for pain triggered by the port scar.However,the sudden severe pain,which radiated laterally from the previous site,remained.A transversus abdominis plane block was performed for the remaining pain and effectively relieved it.CONCLUSION In this case,the trocar port was inserted between the rectus and transverse abdominis muscles.The intercostal nerves might have been entrapped on both sides of the rectus and transversus abdominis muscles.Hence,rectus sheath and transverse abdominis plane blocks were required to achieve complete pain relief.To the best of our knowledge,this is the first report on use of a combination of rectus sheath and transverse abdominis plane blocks for pain relief in ACNES.

Ultrasound-guided rectus sheath block for anterior cutaneous nerve entrapment syndrome after laparoscopic surgery:A case report

BACKGROUND Anterior cutaneous nerve entrapment syndrome is defined as abdominal pain due to entrapped intercostal nerves.This is the first report of a patient successfully treated for anterior cutaneous nerve entrapment syndrome after laparoscopic surgery with an ultrasound-guided rectus sheath block.The rectus sheath block physically lysed adhesions and relieved pain from anterior cutaneous nerve entrapment syndrome.CASE SUMMARY The patient is a 44-year-old man who presented with severe left upper abdominal pain at an operative scar one month after laparoscopic ulcer repair.Diagnosis and treatment were performed using an ultrasound-guided rectus sheath block with 0.1%lidocaine 20 mL.The pain was relieved after the block.The diagnosis was anterior cutaneous nerve entrapment syndrome.Rectus sheath block may be effective for patients with anterior cutaneous nerve entrapment syndrome.CONCLUSION Ultrasound-guided rectus sheath block is a promising treatment modality for patients with postoperative anterior cutaneous nerve entrapment syndrome due to adhesions.

Entrapment of middle cluneal nerves as an unknown cause of low back pain

Entrapment of middle cluneal nerves induces low back pain and leg symptoms. The middle cluneal nerves can become spontaneously entrapped where this nerve pass under the long posterior sacroiliac ligament. A case of severe low back pain, which was completely treated by release of the middle cluneal nerve, was presented. Entrapment of middle cluneal nerves is possibly underdiagnosed cause of low-back and/or leg symptoms. Spinal surgeons should be aware of this clinical entity and avoid unnecessary spinal surgeries and sacroiliac fusion. This paper is to draw attention by pain clinicians in this unrecognized etiology.

Establishment of an animal model of extra-vertebral foramen cervical nerve entrapment by local electrical stimulation and selection of suitable stimulation parameters

A rat model of extra-vertebral foramen cervical nerve entrapment was established according to the following parameters： stimulation intensity 20 V; frequency 50 Hz; pulse width 200 μs; duration 333 ms/s for a total of 8 hours. After the electrical stimulation, rats exhibited mild muscle fiber atrophy, mild inflammatory exudates, connective tissue local fibrosis and chondrocyte metaplasia. Mean muscle fiber cross-sectional area was reduced. The nerve myelin sheath continuity was partially demyelinated. The microstructure of nerve cells was disrupted and these symptoms worsened with prolongation of the stimulation. The shoulder, neck and upper extremity muscles on the tested side demonstrated positive sharp waves and fibrillations. The severity increased with continuation of the stimulation. High amplitude and polyphasic motor unit potentials gradually appeared. Similar findings were seen in the contralateral side, but at a less severe level.

Anatomy and clinical application of suprascapular nerve to accessory nerve transfer

BACKGROUND Loss of motor function in the trapezius muscle is one complication of radical neck dissection after cutting the accessory nerve(AN) during surgery.Nerve repair is an effective method to restore trapezius muscle function,and includes neurolysis,direct suture,and nerve grafting.The suprascapular nerve(SCN) and AN are next to each other in position.The function of the AN and SCN in shoulder elevation and abduction movement is synergistic.SCN might be considered by surgeons for AN reanimation.AIM To obtain anatomical and clinical data for partial suprascapular nerve-to-AN transfer.METHODS Ten sides of cadavers perfused with formalin were obtained from the Department of Human Anatomy,Histology and Embryology,Peking University Health Science Center.The SCN(n = 10) and AN(n = 10) were carefully dissected in the posterior triangle of the neck,and the trapezius muscle was dissected to fully display the accessory nerve.The length of the SCN from the origin of the brachial plexus(a point) to the scapular notch(b point) and the distance of the SCN from the origin point(a point) to the point(c point) where the AN entered the border of the trapezius muscle were measured.The length and branches of the AN in the trapezius muscle were measured.A female patient aged 55 years underwent surgery for partial SCN to AN transfer at Department of Oral and Maxillofacial Surgery,Peking University School and Hospital of Stomatology.The patient suffered from recurrent upper gingival cancer.Radical neck dissection was performed on the right side,and the right AN was removed at the intersection between the nerve and the posterior border of the SCM muscle.One-third of the diameter of the SCN was cut off,and combined epineurial and perineurial sutures were applied between the distal end of the cut-off fascicles of the SCN and the proximal end of the AN without tension.Both subjective and objective evaluations were performed before,three months after,and nine months after surgery.For the subjective evaluation,the questionnaire included the Neck Dissection Impairment Index(NDII) and the Constant Shoulder Scale.Electromyography was used for the objective examination.Data were analyzed using t tests with SPSS 19.0 software to determine the relationship between the length of the SCN and the linear distance.A P value of < 0.05 was considered as statistically significant.RESULTS The whole length of the AN in the trapezius muscle was 16.89 cm.The average numbers of branches distributed in the descending,horizontal and ascending portions were 3.8,2.6 and 2.2,respectively.The diameter of the AN was 1.94 mm at the anterior border of the trapezius.The length of the suprascapular nerve from the origin of the brachial plexus to the scapular notch was longer than the distance of the suprascapular nerve from the origin point to the point where the accessory nerve entered the upper edge of the trapezius muscle.The amplitude of trapezius muscle electromyography indicated that both the horizontal and ascending portions of the trapezius muscle on the right side had better function than the left side nine months after surgery.The results showed that the right-sided supraspinatus and infraspinatus muscles did not lose more function than the left side.CONCLUSION Based on anatomical data and clinical application,partial suprascapular nerve-to-AN transfer could be achieved and may improve innervation of the affected trapezius muscle after radical neck dissection.

A Case of Septic Arthritis of the Shoulder Joint That Developed after Suprascapular Nerve Block

Septic arthritis of the shoulder is uncommon in the immunocompetent patient with no previous risk factors for joint infection. We treated an immunocompetent patient who developed septic arthritis of the shoulder after suprascapular nerve block for pain due to rotator cuff tear. An 80-year-old man with no underlying disease visited a nearby orthopedics clinic with complaint of left shoulder joint pain. Left suprascapular nerve block was performed, but the pain gradually aggravated. On the day after the block, he had a fever of 39&deg;C and came to our department. On examination, enlargement and tenderness were present at the injection site. Cellulitis at the site was suspected. He was admitted and administration of a cephem anti-biotic was started. Pain subsequently decreased. Magnetic resonance imaging (MRI) performed 4 days after hospitalization showed massive effusion close to the injection site. The effusion spread into the joint cavity through the tear site of the supraspinatus. Septic arthritis of the shoulder was strongly suspected, open irrigation and debridement were performed 11 days after hospitalization. After surgery, pain immediately improved. In our case the extra-articular infection caused by suprascapular nerve block considered to spread into the shoulder joint cavity through the site of rotator cuff tear, although there have been no reports of such cases. This case suggests the possibility that patients with rotator cuff tear may easily develop septic arthritis because extra-articular infection may spread into the joint cavity through the site of tear.

Anatomical Evaluation of a Technique for Suprascapular Nerve Blockade

Introduction: Analgesia following shoulder surgery commonly uses interscalene nerve blockade. When contraindicated (i.e. respiratory compromise), suprascapular nerve blockade can provide a viable alternative. Although a number of techniques have been used, Barber in 2005 described a simple method using anatomical landmarks. While theoretically straightforward, substantive evidence supporting the advantages attributed to the technique has yet to be identified. The present study anatomically examines the technique proposed by Barber to critically assess its potential to benefit clinical practice. Materials and Methods: Using the technique proposed by Barber in 2005, the Nevaiser portal was used to introduce a K-wire into the supraspinous fossa in the region of the suprascapular nerve. A spinal needle was inserted in the same manner and left in position in the presumed region of the transverse scapular ligament. Tissue was dissected out around the wire and needle to visualize their proximity to the suprascapular nerve and transverse scapular ligament respectively. Results: The K-wire was consistently located close to the suprascapular nerve with all cases being within 5 mm. Spinal needle placement relative to the transverse scapular ligament was variable with 50% anterior, 25% posterior, and 25% displaced (likely due to dissection). Conclusions: The results illustrate that it is possible to reliably place a needle close to the suprascapular nerve using the technique described by Barber in 2005. This study provides anatomical confirmation of Barbers description of a simple technique and the basis for clinical study.

Treatment of posterior interosseous nerve entrapment syndrome with ultrasound-guided hydrodissection:A case report

BACKGROUND Posterior interosseous nerve(PIN)entrapment syndrome is one of the causes of weakness and pain of the arm muscles,which is prone to missed diagnosis and misdiagnosis in clinic practice.This paper reports a case of PIN entrapment syndrome,with PIN injury indicated by electrophysiology.Musculoskeletal ultrasound was applied to identify that the entrapment point was located at the inlet of the Frohse arch and the outlet of the supinator muscle.Treatment with ultrasound-guided nerve hydrodissection was performed on the entrapment point,which significantly improved the symptoms.Ultrasound-guided nerve hydrodissection is an effective therapeutic method for PIN entrapment syndrome.CASE SUMMARY A male patient,35 years old,worked as an automobile mechanic.He felt slightly weak extension activity of his right fingers 2 years ago but sought no treatment.Later,the symptoms gradually became aggravated and led to finger drop,particularly severe in the right middle finger,accompanied by supination weakness of the right forearm.Neural electrophysiological examination showed that the patient had partial PIN injury of the right radius.Musculoskeletal ultrasound examination indicated PIN entrapment at the inlet of the Frohse arch and the outlet of the supinator muscle.Therefore,PIN entrapment syndrome was diagnosed.After treatment with ultrasound-guided nerve hydrodissection around the entrapment point,the dorsiflexion weakness of the right hand was significantly improved compared with before treatment.CONCLUSION Ultrasound-guided hydrodissection is efficacious for PIN entrapment syndrome,with high clinical value and great application prospects.

Myeloid sarcoma with ulnar nerve entrapment:A case report

BACKGROUND Myeloid sarcoma(MS) is relatively rare,occurring mainly in the skin and lymph nodes,and MS invasion of the ulnar nerve is particularly unusual.The main aim of this article is to present a case of MS invading the brachial plexus,causing ulnar nerve entrapment syndrome,and to further clinical understanding of the possibility of MS invasion of peripheral nerves.CASE SUMMARY We present the case of a 46-year-old man with a 13-year history of well-treated acute nonlymphocytic leukaemia who was admitted to the hospital after presenting with numbness and pain in his left little finger.The initial diagnosis was considered a simple case of nerve entrapment disease,with magnetic resonance imaging showing slightly abnormal left brachial plexus nerve alignment with local thickening,entrapment,and high signal on compression lipid images.Due to the severity of the ulnar nerve compression,we surgically investigated and cleared the entrapment and nerve tissue hyperplasia;however,subsequent pathological biopsy results revealed evidence of MS.The patient had significant relief from his neurological symptoms,with no postoperative complications,and was referred to the haemato-oncology department for further consultation about the primary disease.This is the first report of safe treatment of ulnar nerve entrapment from MS.It is intended to inform hand surgeons that nerve entrapment may be associated with extramedullary MS,as a rare presenting feature of the disease.CONCLUSION MS invasion of the brachial plexus and surrounding tissues of the upper arm,resulting in ulnar nerve entrapment and degeneration with significant neurological pain and numbness in the little finger,is uncommon.Surgical treatment significantly relieved the patient’s nerve entrapment symptoms and prevented further neurological impairment.This case is reported to highlight the rare presenting features of MS.

The Radial Nerve Entrapment in Pediatric Extension-Type Supracondylar Humeral Fractures. About Two Cases Reports

Radial nerve injuries in displaced extension-type supracondylar humeral fractures in children are well known. Entrapment in fracture of radial nerve is uncommon and rarely evocated in literature. We report two similar cases in the mechanism of injury, the clinical findings and the treatment and propose therapeutic guidelines.

Predictive Reliability of the Phoenix Sign for the Outcome of Common Fibular (Peroneal) Nerve Decompression Surgery

A positive Phoenix sign occurs when a patient, with a suspected focal nerve entrapment of the Common Fibular (Peroneal) Nerve (CFN) at the level of the fibular neck, demonstrates an improvement in dorsifexion after an ultrasound guided infiltration of a sub-anesthetic dose of lidocaine. Less than 5 cc’s of 1% or 2% lidocaine is utilized and the effect is seen within minutes after the infiltration, but usually lasts only 10 minutes. This effect may be due to the vasodilatory action of lidocaine on the microcirculation in the area of infiltration. This nerve block has significant diagnostic utility as it is highly specific in the confirmation of true focal entrapment of the CFN, has high predictive value for a patient who may undergo surgical nerve decompression if they have demonstrated a positive Phoenix Sign, and may help in the surgical decision-making process in patients who have had a drop foot for many years but still may regain some motor function after decompression. In this retrospective review, 26 patients were tested, and 25 of this cohort demonstrated a Positive Phoenix Sign (an increase in dorsiflexion strength of the Extensor Hallucis Longus muscle (EHL)). One patient had no response to the peripheral nerve block. Of the 25 patients who demonstrated a positive “Phoenix Sign” and underwent nerve decompression of the CFN, and 25 (100%) showed an increase in dorsiflexion strength of the EHL after nerve decompression surgery of the CFN. The one patient in this cohort who did not demonstrate any improvement in dorsiflexion of the EHL after the nerve block did not have any improvement after surgery.

肘管综合征术后翻修疗效评估

目的探讨肘管综合征翻修的原因,总结肘管综合征翻修术中的细节并评估疗效,降低该病的翻修率。方法对2019年4月至2022年8月我院收治的14例肘管综合征翻修患者资料进行分析,观察初次手术后尺神经的张力、形态、卡压部位是否解除及术后疗效,对比翻修术后症状改善情况,总结翻修原因并评估翻修术疗效。结果初次手术疗效不佳,术后3个月内无改善或症状持续加重者需行翻修术。翻修的主要原因是手术切口设计不规范(14/14),次要原因为未全程松解尺神经卡压点(12/14),少见原因为术区止血不确切(1/14)及对感觉神经保护不足(1/14)。根据顾氏肘管综合征功能评定标准,翻修术优良率为9/14。结论肘管综合征术后翻修的主要原因是手术细节的处理不当,术中规范化操作可降低翻修率,初次手术失败后翻修术仍是有效的。

双孔内窥镜与改良小切口治疗腕管综合征的临床随机对照研究

目的对比分析双孔内窥镜与改良小切口治疗腕管综合征分别在围手术期及术后康复期功能恢复情况及相关临床指标,归纳总结其治疗效果。方法2019年5月-2021年5月,采用单中心随机盲法临床试验,行双孔内窥镜下腕横韧带松解术和改良有限小切口微创松解术治疗腕管综合征59例,并记录患者术后不同时期的症状及生活改善程度,进行定性、定量的对比分析,并通过手术费用、住院时间、恢复时间等随访资料评价双孔内窥镜与改良小切口微创技术在治疗腕管综合征各方面的优劣。结果两种治疗方法对腕管综合征远期疗效一致,但手术费用、住院时间、术后短期症状缓解方面,改良小切口有优势;在手术瘢痕、切口疼痛方面内窥镜下腕横韧带松解术更有优势。结论双孔内窥镜与改良小切口治疗腕管综合征,两种疗效远期效果一致,但在术后康复及手术费用及时间等各方面,各有利弊,针对不同患者,应根据医疗机构实际条件和具体情况,选择合适手术方式。

浅谈铍针疗法及其临床应用

铍针为《灵枢·九针十二原》中“九针”的一种。当代医家黄荣发、董福慧、刘春山等,继承传统的铍针疗法,改进针具,创立了现代铍针疗法。其中,黄荣发恪守传统的针刺理论,以铍针针刺穴位,并辅以拔罐、按抚,创立铍针综合疗法。董福慧的“皮神经卡压”、刘春山的“解结”理论问世,将传统的铍针疗法与现代医学融会贯通。现代铍针在减张解压止痛、抑制致痛因子释放、影响肌电传导等方面发挥重要作用,在临床应用中疗效显著。该文梳理铍针疗法源流,总结了近现代铍针针具变革以及作用机理,为今后进一步扩大铍针治疗的适应症,进行规范的临床研究提供依据。

正中神经主干联合返支松解治疗中重度腕管综合征的临床效果

目的探讨正中神经主干松解联合返支探查松解术治疗腕管综合征的临床效果。方法选取2022年7月—2023年10月福建中医药大学附属人民医院诊断为中重度腕管综合征患者35例42侧,采用改良传统切口行正中神经主干松解同时对正中神经返支进行探查松解,对返支压迫及易形成卡压的因素彻底松解,术后定期随访。主要观察手术前后运动电位潜伏期和感觉神经传导速度变化及正中神经功能评分改变。结果所有患者均获随访。术后8周肌电图运动电位潜伏期和感觉神经传导速度分别为(3.96±1.03)ms、(44.84±3.00)m/s,优于术前的(8.47±1.61)ms、(32.98±2.09)m/s,差异有统计学意义(P<0.05);术后8周正中神经评分的优良率优于术前,差异有统计学意义(P<0.05)。结论中重度腕管综合征患者中,正中神经返支大多存在压迫或较多易卡因素,行腕管综合征切开减压手术时,不应拘泥于手术切口大小,应予以彻底松解以提高临床疗效。

杜藤颗粒联合小针刀治疗肩胛上神经卡压综合征疗效观察

目的:观察杜藤颗粒联合小针刀治疗肩胛上神经卡压综合征的疗效。方法:60例随机分为观察组和对照组各30例。两组均用小针刀治疗,观察组加用杜藤颗粒治疗。结果:观察组愈显率高于对照组(P<0.05),治疗后观察组VAS分值、Constant-Murley肩关节评分、SF-12评分均优于对照组(P<0.05)。结论:杜藤颗粒联合小针刀治疗肩胛上神经卡压综合征效果较好。

右美托咪定联合肌间沟臂丛和肩胛上神经阻滞麻醉在肩关节镜手术中的应用效果观察

目的观察右美托咪定联合肌间沟臂丛和肩胛上神经阻滞麻醉在肩关节镜手术中的应用效果。方法纳入2023年1月~2024年1月收治的120例肩关节镜手术患者,按随机数表法分为联合组(n=60)、参照组(n=60)。联合组给予右美托咪定联合肌间沟臂丛和肩胛上神经阻滞麻醉,参照组给予肌间沟臂丛和肩胛上神经阻滞麻醉。比较患者不同时间点的镇痛效果[采用疼痛视觉模拟评分(VAS)]、平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_(2))、最大肺活量(VC_(max))、用力肺活量(FVC)及第1秒用力呼气容积(FEV_(1)/FVC)差异;记录患者不良反应。结果在手术结束时、术后30 min及6 h时,组间VAS评分差异无统计学意义(P>0.05),术后12 h、24 h、48 h时,联合组VAS评分显著低于参照组(P<0.05);诱导后10 min、30 min及手术结束时,两组患者MAP、HR、SpO_(2)水平均较术前降低,且联合组高于参照组(P<0.05);术后24 h时,两组患者VC_(max)、FVC、FEV_(1)/FVC水平均低于术前,且联合组高于参照组(P<0.05);联合组不良反应发生率显著低于参照组(P<0.05)。结论在肩关节镜手术的患者中,在肌间沟臂丛和肩胛上神经阻滞的基础上联合右美托咪定能够延长术后镇痛时间,减少侵入性操作引起的疼痛,降低不良反应发生率,且具有肺功能保护作用。

袁梦石以扶正祛邪为主治疗上肢神经卡压综合征经验

根据上肢神经卡压综合征以麻木为主要临床表现、以劳倦耗气为主要病因的特点,袁梦石教授提出了以“扶正祛邪”为主要治则的辨病为主、辨证为辅治疗体系,认为治疗上应重视益气养血、鼓舞正气、调理肝脾肾,并根据病邪性质用祛风、除湿、散寒、化瘀等方法祛邪,辅以引经药。总结袁梦石教授治疗上肢神经卡压综合征的临床经验。

肩胛上神经阻滞联合任务导向训练治疗脑卒中后偏瘫肩痛的疗效观察

目的:探讨超声引导下肩胛上神经阻滞(SSNB)联合任务导向训练(TOT)对脑卒中后偏瘫肩痛(HSP)的疗效。方法:选取2020年4月—2023年6月江门市中心医院康复医学科收治的脑卒中后偏瘫患者47例为研究对象,根据治疗方案不同分为对照组(26例)和研究组(21例)。两组均进行TOT,研究组患者在TOT前先进行SSNB,两组再进行TOT,连续治疗12周。比较两组患者治疗前、治疗4周、治疗12周的视觉模拟评分法(VAS)、简化Fugl-Meyer运动功能评分法-上肢部分(FMA-UE)、改良Barthel指数(MBI)评分。结果:VAS评分在时间与治疗方法之间存在交互效应(P交互<0.05);时间、治疗方法在VAS评分主效应显著(P<0.05)。两组治疗后4周、12周VAS评分均低于治疗前,差异有统计学意义(P<0.05),研究组治疗后4周、12周VAS评分低于对照组,差异有统计学意义(P<0.05)。FMA-UE评分在时间与治疗方法之间存在交互效应(P交互<0.05);时间、治疗方法在FMA-UE评分主效应显著(P<0.05)。两组治疗后4周、12周FMA-UE评分均高于治疗前,差异有统计学意义(P<0.05),两组治疗后4周、12周FMA-UE评分比较,差异无统计学意义(P>0.05)。MBI评分在时间与治疗方法之间不存在交互效应(P交互>0.05);时间、治疗方法在MBI评分主效应不显著(P>0.05)。两组治疗后4周、12周MBI评分均高于治疗前,差异有统计学意义(P<0.05);两组治疗后4周、12周MBI评分比较,差异无统计学意义(P>0.05)。结论:SSNB联合TOT有助于缓解HSP症状,利于患者进行上肢运动功能训练。

Various Aetiologies of Non-Traumatic Coccydynia Cause Pain in the Posterior Sacrococcygeal Leg of the Pelvic Tripod: A Burden on the Healthcare Sector

Introduction: Coccydynia, television disease, and coccygodynia are the different names given to this disabling disease, which can become chronic. It was described by Simson in 1859. Coccydynia means pain at the end of the vertebral column. Non-traumatic coccydynia is a diagnosis, which is never straightforward like traumatic coccydynia because the onset is unclear, and both the patient and the unaware clinician face many challenges in treating it on time and with accuracy. Coccyx was likened to a cuckoo bird’s beak as a curved bone of fused 3 to 5 vertebrae with remnant disc material in some rare cases, unfused segments, linear scoliosis or subluxations and deformities. Stress X-rays of the coccyx in the antero-posterior and lateral views in standing and sitting reveal the “Dynamic Instability” due to congenital coccygeal morphological, pathological and mechanical variations. Material and Methods: This is a complex study having retrograde data collected from online publications from various databases, like PubMed, Embase, and Cochrane Library and also antegrade data collected from 100 patients with their consent from patients in Adam and Eve Specialised Medical Centre-based at Abu Dhabi, UAE and data was processed in the research centre of Krushi Orthopaedic Welfare Society based in India between 2014-2024 following all guidelines of Helsinki and approved by the ethics board of Krushi Orthopaedic Welfare Society. Clinical Presentation: The coccyx is painful, with aches, spasms, and an inability to sit. This affects daily activities without any particular date of onset. The onset remains insidious for the non-traumatic variety of coccydynia. Aetiology and Patho Anatomy: Non-traumatic coccydynia can be caused by a myriad of reasons, like congenital morphological variations, acquired dynamic instabilities, and hidden trauma remaining quiescent to re-surface as a strain-induced pain. Radiological Presentations: Unless clarity is focused on these coccygeal views, the errors of the unevacuated rectum, non-dynamic standing views, improper X-ray exposure and refuge by insurance companies to approve the much needed but multiple views in radiological investigation (Stress X-ray), MRI scan, lack of awareness by the clinician, all lead to missed diagnosis with its repercussions as congenital variations in morphology, acquired changes in structure/mobility, pathologies like tumours like congenital teratoma & adult onset chordoma, Tarlov cysts, pilonidal sinus or infections—even tuberculosis, dural syndrome, stiff coccyx due to ankylosing spondylitis and many others like relation to neurosis have all been documented. Treatment options are outside the scope of this research topic, as only the differential diagnosis is being stressed here, so that the clinician and the patient do not overlook the varying aetiology, which is the first step to timely and appropriate treatment. Conclusion: Level 3 evidence is available pointing towards many aetiologies causing non-traumatic coccydynia, and in this study of 100 patients by Krushi O W S, a non-profit organisation, the results were as follows: 1) Coccydynia is more common in Type II coccyx and bony spicules. 2) Coccydynia is more prevalent when the sacrococcygeal joints are not fused. 3) Coccydynia is more prevalent when there is subluxation at the intercoccygeal joints. 4) Coccydynia is more when the sacral angle is lower. 5) Coccydynia is associated with higher sacrococcygeal curved length. 6) Coccydynia is associated with a lower sacrococcygeal curvature index. 7) Gender variations: The coccygeal curvature index was lower in females with coccydynia;the intercoccygeal angle was lower in males. 8) Both obese and thin individuals can get affected due to different weight-bearing mechanics in play.