The coronoid process (Coronoid Process) is located in the elbow joint and lower jaw. In the first case, this is the anterior process of the epiphysis of the ulna, which is part of the block notch, which connects to it at the humerus. In the second case, the anterior process on the mandible branch, the site of attachment of the temporal muscle.
Jaw structure
The jaw apparatus is formed by 2 jaws - the upper fixed and lower mobile. The latter is articulated with a skull. The mandible has a horseshoe-shaped body and branches extending upward at an obtuse angle, which are thinning towards the end.
The front branch and forms the coronoid process of the lower jaw. The temporal muscle is attached to it. The correctness of the movements of the jaw to a large extent depends on this process. If it is violated, the mouth simply will not open. The second process, the posterior is the condyle, which forms the joint with the skull - the temporomandibular joint (TMJ). Both processes have 2 surfaces - the outer and inner and 2 edges - front and back.
The front edge passes into the coronoid process, and the posterior - in the articular. Between them there is a deep notch. The temporal crest runs along the middle part of the coronoid process, and the tendon of the temporal muscle is attached to it.
TMJ is a joint combined, so its movements can occur in 3 planes: the joint can rise and fall (opening and closing the mouth), displacement vertically and horizontally. The joint is supported by ligaments.
Pathology of the lower jaw
All diseases related to the joints can also be found in the mandibular joint. The most common arthrosis, arthritis, osteoporosis, congenital malformations and injuries.
Of course, arthrosis is more often observed, in which degenerative-dystrophic changes in the bone tissue in the limbs and spine occur, which receive large loads, but the joints of the skull are not immune to them.
Types of jaw arthrosis
One of the criteria for systematizing a pathology is its etiology. Arthrosis can be primary (occurs after 50 years and is associated with the aging of the body) and secondary (occurs against the background of existing diseases), it is more frequent.
Among the provoking factors can be identified:
- tooth loss;
- broken bite;
- maxillofacial injuries;
- unsuccessful prosthetics;
- dental operations;
- chronic TMJ arthritis;
- increased tooth abrasion;
- gnashing of teeth (bruxism).
According to the X-ray picture, arthrosis is sclerosing and deforming. Signs of sclerosing:
- bone compaction;
- narrowing of the joint space.
Signs of a deforming form:
- thickening of the articular surfaces;
- osteophytes;
- at a late stage - a sharp deformation of the articular head.
The coronoid process is not part of the joint, but osteophytes with arthrosis necessarily cause its damage.
Injuries of the processes of the lower jaw
The most common type of injury is fractures. The lower jaw is a fragile structure, so its injuries are not uncommon. Fracture of the coronoid process occurs when a strong blow to the chin occurs from top to bottom. The treatment is complex, the rehabilitation period is long.
If the coronoid process of the jaw is broken, then when you try to open the mouth, the jaw travels towards the injury. This is accompanied by severe pain. An accurate diagnosis will be made with a lateral x-ray at the maximum opening of the patient's mouth.
Prevention of jaw fractures
The most frequent fractures of the jaw (fractures of the coronoid process of the lower jaw, including) were noted in children from 7 to 14 years old, which is associated with their increased physical activity.
So, preventive measures:
- To avoid falling the child from a height, adults must constantly monitor it.
- When playing sports, personal protective equipment is required - knee pads, elbow pieces, helmets, belts.
- When riding in a car, child seats are compulsory for children, and adult seat belts.
- Both adults and children need to try not to get into situations of fights and brawls with blows to the face or falls.
- If we are talking about extreme sports - use protective equipment.
- Do not test your teeth for hardness by cracking hard nuts, etc.
- The load on the jaw should be adequate. Do not chew gum 24 hours a day.
- In everyday life, do not open your mouth too wide.
Fracture of the elbow
It is considered a complex injury and is recorded in 20% of cases of fractures. The anatomy of the elbow joint is quite complicated, so a fracture of the elbow is considered dangerous due to many irreversible complications and very long healing.
Elbow joint anatomy
The elbow joint when viewed from the front consists of 3 bones: the ulnar, radial and shoulder.
Back of the joint sequentially:
- brachial bone;
- ulnar process;
- radius and ulna;
- coronoid process of the ulna.
Any part of the joint can be injured, and the treatment and symptoms will vary.
Causes of bone fractures
Fracture of the condyle occurs with direct injury - if a falling arm has extended when falling from a height. In this case, the fracture often happens with a shift.
With a fracture of the coronoid process of the ulna, we are always talking about indirect injury - a fall on the back of the forearm with its maximum bending.
Fractures of the diaphysis of the humerus arise from a direct impact (fracture from a baton). It usually happens with accidents and fights.
In addition to these reasons, fractures of the coronoid process of the ulna can occur even with the most minimal bone grafting. This is characteristic of osteoporosis, arthrosis, osteoarthrosis.
Process fracture
Fractures of the coronoid process of the ulna in an isolated form are a rare occurrence. With a bruise or fracture due to a fall from a height, the humerus, as it were, knocks down the process with force and fragment it. In addition, he suffers from posterior forearm dislocations, but most often his lesion occurs during an intraarticular fracture. In general, his fracture is rare because it is deeply hidden by a significant layer of soft tissue. The base or the top breaks. Cellular fractures of the coronoid (medial) process are practically not found.
Symptomatic manifestations
When examining the victim, marked swelling and ulnar hematoma due to damage to the soft tissues are noted. The joint itself is deformed, at the site of the protrusion of the condyle, the skin sinks (this is clearly visible in the first minutes of the injury, then swelling spreads and everything disappears).
Fracture of the coronoid process of the ulna can have mild symptoms or manifest as follows:
- pain with the transition to the fingers;
- immobility of the elbow joint - full or partial;
- swelling and bruising.
There may be open fractures with external injuries of the skin, muscles, blood vessels, nerves.
If a fracture occurred with the displacement of fragments, the victim cannot straighten his arm at the elbow. Severe pain interferes. Passively unbend your elbow. With a fracture of the coronoid process without movement displacement in the elbow joint, it is possible, but very limited.
Diagnostic measures
Usually, for diagnosis, it is necessary to make an x-ray in two projections: direct and lateral. With the coronoid process, the situation is different: images in 2 projections will not give a result.
For diagnosis, it is necessary to position the brush so that the process leaves the zone of application of the shadow of the beam head. To do this, the hand is stacked so that the process and epicondyle of the shoulder are in contact with the cassette. The forearm should remain in semi-space and in the flexion position at an angle of 160.
Pronation means turning the arm inward. The direction of the x-ray should be aimed at the coronoid process. Then it becomes visible, leaves the shadow of the radius and the diagnosis of the fragment becomes 100% successful.
Treatment
Treatment of the ulna with a fracture of the coronoid process can be of two types: conservative or surgical. With improper therapy or its complete absence, the most common complication is improper fusion, due to which the joint becomes motionless or limitedly mobile.
Conservative treatment
In the treatment of a coronoid process fracture, reposition is not required, since there are no pronounced displacements. The process of the process is carried out on an outpatient basis for 6–8 days, while the arm is fixed with the posterior gypsum splint, the forearm is bent at an angle of 60–65 degrees. Then a complex of functional treatment is prescribed. Disability is restored on the 6th day.
Immobilization
Plaster cast is applied for 3-4 weeks. It starts from the fingers, ends with the shoulder. After 3 weeks, the splint is removed, and the joint is to be developed. The entire course of treatment with a rehabilitation period takes from 1.5 to 2 months.
Physiotherapy and exercise therapy
After treatment, a joint restoration course begins. For the coronoid process, this means:
- Exercise therapy.
- Physiotherapeutic procedures.
Exercise therapy
Exercise therapy is an important part of treatment that helps restore joint mobility. If it is excluded and not carried out, joint contracture may occur when, after the end of treatment, the joint remains motionless. Exercises are performed already on the 2nd day of gypsum under the supervision of a rehabilitologist.
Exercises are always individual and depend on the age of the patient and the severity of the fracture. Designed movements are designed for plaster free areas.
The simplest exercise for a fracture of the coronoid process - putting your hand behind your head - helps relieve swelling and normalizes blood flow. On the 10th day after the cast, the muscles are trained under a bandage. Next are the flexion and extension at the elbow.
A set of therapeutic exercises is performed 4 times a day, with 10 approaches.
You can’t be actively involved right away, building up the pace and loads is only gradual. The exercise therapy complex is selected individually, taking into account the severity of the fracture.
Exercise therapy is well combined with physiotherapy: magnetotherapy, electrophoresis, UHF, mud therapy. If exercise therapy and physiotherapy are prescribed at the beginning of recovery, then in the middle of rehabilitation and at the end of the massage.
In case of a fracture of the coronoid process, massage is absolutely impossible because of the risk of developing ossifying myositis. Even after recovery, the joint is better not to overload, because in this case the process is very fragile.
First aid
The first thing to do is call an ambulance. Then the victim needs to be given an analgesic. The hand should be immobilized, for this, any improvised means can be used as tires: thick cardboard, plywood, board. A splint is applied to the elbow to immobilize the wrist, wrist and shoulder joints. As a rule, for fixation, the arm should be bent, but if it is painful, the limb is left in its original position and fixed. If untreated, joint contracture develops.
Hand hold
To fix the hand with a fracture of the coronoid process in the emergency room, gypsum is not applied, only plaster braces, orthoses, tutors, fixators and bandages can be used.
Cloth fixers may well replace gypsum dressings, while they provide tissue massage. An orthosis on the elbow joint is an external orthopedic device that protects the joint from injuries.
Athletes like to use the elbow bandage very much, it unloads the joint and relieves pain. It can also be used for prevention, because it relieves the joint during training. A bandage for arthrosis in the elderly is very valuable, it slows down the development of degenerative processes and accelerates recovery.
Prevention
In case of arm fracture, the whole process of immobilization from the very beginning is important. He does not pick himself up. All doctor's prescriptions should be followed strictly.
Other pathologies of the elbow joint
These are arthritis, arthrosis and deforming arthrosis, osteoporosis, dysplasia.
Osteoarthritis develops in the joint, but with the progression of the process there is an increase in bone growths that cover neighboring bone tissue, for example, the same coronoid process. Arthrosis usually occurs after 45 years. The risk group includes women during menopause, athletes (tennis players) and people whose profession is associated with heavy loads on the elbow (for example, writers, musicians, professional drivers).
Causes of arthrosis of the elbow joint:
- elbow injury that occurred at a young age;
- metabolic disease;
- rheumatism;
- chronic infections of ENT organs;
- heredity.
Symptoms of arthrosis of the elbow joint
The main symptoms include:
- pain during movement and walking;
- pain at rest in later stages;
- a crunch during movements from friction of bones against each other, it is accompanied by pain;
- inactivity of the joint due to narrowing of the joint gap, spike growth and muscle spasm.
Often with ulnar arthrosis, the so-called Thompson symptom is observed - the patient cannot keep the hand bent into a fist in the back position. He spreads his fingers quickly. The elbow joint is modified - osteophytes grow, the elbow swells.
Deforming arthrosis of the elbow joint accounts for 50% of all elbow arthrosis. Complaints are similar, pain is constantly increasing.
Dog osteology
In dogs, 2 coronoid processes are the same as in humans - in the lower jaw and elbow joint.
Elbow dysplasia (DLS) in dogs is an inherited disease in which there is an abnormal joint structure with improper articulation of the elbow. Such an improper joint is prone to wear, it develops signs of arthrosis more quickly. If untreated, it progresses rapidly.
The diagnosis of dysplasia itself is not. This is the collective name of all anatomical pathologies that formed during embryogenesis and in the first months of life. Dysplasia means the abnormal development of any tissues, organs and bones. With dysplastic processes in the elbow joint there can be 4 types of disorders:
- fragmentation (separation) of the ulnar process;
- chipping of the coronoid process of the ulna;
- stratifying osteochondritis;
- mismatch of joint bones (discongruency).
Different joint pathologies are similar in symptoms. Therefore, it is so important to seek the help of specialists. Diagnosis can only be made by radiograph.