The 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 trochlear notch, which connects to it at the humerus. In the second case - the anterior process on the branch of the mandible, the place of attachment of the temporal muscle.
The structure of the lower jaw
The jaw apparatus is formed by 2 jaws - the upper fixed and the lower movable. The latter is articulated with the skull. The mandible has a horseshoe-shaped body and branches extending upward at an obtuse angle, which become thinner towards the end.
The front branch and forms the coronoid process of the lower jaw. The temporalis muscle is attached to it. The correctness of jaw movements to a large extent depends on this process. If it is broken, the mouth simply will not open. The second process, the posterior one, is condylar, which forms an articulation with the skull - the temporomandibular joint (TMJ). Both processes have 2 surfaces - outer andinner and 2 edges - front and back.
The leading edge passes into the coronoid process, and the rear - into the articular. Between them there is a deep notch. The temporal ridge runs along the middle part of the coronoid process, and the tendon of the temporal muscle is attached to it.
TMJ is a combined joint, so its movements can occur in 3 planes: the joint can rise and fall (opening and closing the mouth), vertical and horizontal displacements. The joint is supported by ligaments.
Pathologies of the lower jaw
All diseases related to the joints can also be found in the mandibular joint. The most common are arthrosis, arthritis, osteoporosis, congenital anomalies and injuries.
Of course, arthrosis is more common, in which degenerative-dystrophic changes in bone tissue occur in the limbs and spine, which receive heavy loads, but the joints of the skull are not immune from them.
Types of arthrosis of the jaw
One of the criteria for the systematization of pathology is its etiology. Arthrosis can be primary (occurs after 50 years and is associated with aging of the body) and secondary (occurs against the background of existing diseases), it is more frequent.
Among the provoking factors are:
- tooth loss;
- malocclusion;
- maxillofacial injuries;
- failed dentures;
- dental surgery;
- chronic TMJ arthritis;
- increased tooth wear;
- grinding teeth (bruxism).
According to the x-ray picture, arthrosis issclerosing and deforming. Signs of sclerosing:
- bone thickening;
- narrowing of the joint space.
Signs of a deforming shape:
- thickening of articular surfaces;
- osteophytes;
- at a late stage - a sharp deformity of the articular head.
The coronoid process is not part of the joint, but osteophytes in arthrosis necessarily cause its damage.
Injuries of mandibular processes
The most common type of trauma is fractures. The lower jaw is a fragile structure, so its injuries are not uncommon. A coronoid fracture occurs when there is a strong blow to the chin from top to bottom. The treatment is difficult, the rehabilitation period is long.
If the coronoid process of the jaw is broken, then when you try to open the mouth, the jaw moves 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 observed in children from 7 to 14 years old, which is associated with their increased physical activity.
So, prevention measures:
- To prevent a child from falling from a height, adults must constantly supervise him.
- When playing sports, personal protective equipment is required - knee pads, elbow pads, helmets, belts.
- When driving in a car, child seats are required, and seat belts for adultssecurity.
- Both adults and children should try not to get into fights and brawls with punches in the face or falls.
- If we are talking about extreme sports, use protective equipment.
- Teeth should not be tested by cracking hard nuts, etc.
- Loads on the jaw must be adequate. You can't chew gum 24 hours a day.
- Don't open your mouth too wide in everyday life.
Fractured elbow
Considered a complex injury and is recorded in 20% of fractures. The anatomy of the elbow joint is quite complex, so an elbow fracture is considered dangerous due to many irreversible complications and a very long healing time.
Anatomy of the elbow joint
The elbow joint when viewed from the front consists of 3 bones: the ulna, radius and shoulder.
Behind the joint sequentially:
- humerus;
- olecranon;
- radius and ulna;
- coronoid process of the ulna.
Any joint can be injured, and treatment and symptoms will vary.
Causes of process fractures
Fracture of the condyle occurs with a direct injury - if, when falling from a height, the falling arm is extended. In this case, the fracture is often displaced.
A fracture of the coronoid process of the ulna is always an indirect injury - a fall on the back of the forearm with maximum flexion.
Fracturesthe shaft of the humerus arise from a direct blow (fracture from a club). It usually happens during road accidents and fights.
In addition to these reasons, fractures of the coronoid process of the ulna can occur even with the most minimal grazing of the bone. This is typical for osteoporosis, arthrosis, osteoarthritis.
Fractured process
Fractures of the coronoid process of the ulna in an isolated form are rare. In case of a bruise or fracture due to a fall from a height, the humerus, as it were, knocks down the process with force and fragments it. In addition, he suffers from posterior dislocations of the forearm, but most often his defeat occurs with an intra-articular fracture. In general, its fracture is rare because it is deeply hidden by a significant layer of soft tissues. The base or the very top breaks. Comminuted fractures of the coronoid (medial) process almost never occur.
Symptomatic manifestations
When examining the victim, there is a pronounced edema and ulnar hematoma due to soft tissue damage. 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 may have mild symptoms or manifest as follows:
- pain with transition to fingers;
- immobility of the elbow joint - complete or partial;
- edema and bruising.
There may be open fractures with external damage to the skin, muscles, blood vessels, nerves.
If a fracture occurs with displacement of fragments, the victim himself cannot straighten his arm at the elbow. Severe pain interferes. You can passively extend your elbow. With a fracture of the coronoid process without displacement, movements in the elbow joint are possible, but severely limited.
Diagnostic measures
Usually, for diagnosis, it is necessary to take an x-ray in two projections: frontal and lateral. The situation is different with the coronoid process: pictures in 2 projections will not give a result.
For diagnosing, it is necessary to position the hand so that the process leaves the area of superposition of the shadow of the ray head. To do this, the arm is placed in such a way that the process and epicondyle of the shoulder are in contact with the cassette. The forearm should remain in half pronation and in a 160 degree flexion position.
Pronation means turning the arm inward. The direction of the x-ray should be aimed at the coronoid process. Then it becomes visible, emerges from 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 union, due to which the joint becomes immobile or limitedly mobile.
Conservative treatment
When treating a fracture of the coronoid process, reposition is not required, since there are no pronounced displacements. Process treatment is carried outon an outpatient basis for 6–8 days, while the arm is fixed with a posterior plaster splint, the forearm is bent at an angle of 60–65 degrees. Then a complex of functional treatment is prescribed. Ability to work is restored already on the 6th day.
Immobilization
Plaster splint 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, the course of joint restoration begins. For the coronoid process, this means:
- exercise.
- Physiotherapy treatments.
exercise therapy
Exercise therapy is an important part of treatment to help restore joint mobility. If it is excluded and not carried out, joint contracture may occur, when the joint remains immobile after the end of treatment. Exercises are performed already on the 2nd day of the cast under the supervision of a rehabilitation doctor.
Exercise is always individual and depends on the age of the patient and the severity of the fracture. The movements designed are for plaster-free areas.
The simplest exercise for a fracture of the coronoid process - placing a hand behind the head - helps relieve swelling and normalizes blood flow. On the 10th day after the plaster, the muscles are trained under the bandage. Next come flexion and extension at the elbow.
A set of therapeutic exercises is performed 4 times a day, with 10 sets.
You can’t immediately engage actively, increase the pace andloads only gradually. The exercise therapy complex is selected individually, taking into account the severity of the fracture.
Exercise therapy is good to combine with physiotherapy: magnetotherapy, electrophoresis, UHF, mud therapy. If exercise therapy and physiotherapy are prescribed at the beginning of recovery, then massage is performed in the middle of rehabilitation and at the end.
In case of a fracture of the coronoid process, massage is absolutely impossible because of the risk of developing myositis ossificans. Even after recovery, it is better not to overload the joint, 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 splints: thick cardboard, plywood, board. A splint is placed on the elbow to immobilize the hand, wrist, and shoulder joints. As a rule, the arm must be flexed for fixation, but if this is painful, the limb is left in its original position and fixed. If left untreated, joint contracture develops.
Fixing the hand
For fixing a hand with a fracture of the coronoid process in the emergency room, no plaster is applied, only plaster splints, orthoses, splints, fixators and bandages can be used.
Tissue retainers may well replace plaster casts, while they also provide tissue massage. An elbow brace is an external orthopedic device that protects the joint from injury.
Elbow brace is very popular with athletes, it unloads the joint and relievespain. It can also be used for prevention, because it unloads the joint during training. A bandage is very valuable for arthrosis in the elderly, it slows down the development of degenerative processes and speeds up recovery.
Prevention
When an arm is broken, the whole process of immobilization is important from the very beginning. He does not choose on his own. All doctor's prescriptions should be strictly followed.
Other pathologies of the elbow joint
These are arthritis, arthrosis and deforming arthrosis, osteoporosis, dysplasia.
Arthrosis develops in the joint, but as the process progresses, bone outgrowths grow, which cover neighboring bone tissues, for example, the same coronoid process. Osteoarthritis usually occurs after 45 years of age. 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 elbow arthrosis:
- elbow injury at a young age;
- metabolic disorder;
- rheumatism;
- chronic ENT infections;
- heredity.
Symptoms of elbow arthrosis
Main symptoms include:
- pain when moving and walking;
- pain at rest in later stages;
- crunching when moving from rubbing the bones against each other, it is accompanied by pain;
- joint stiffness due to narrowing of the joint space, growth of spines and muscle spasm.
Often whenIn elbow arthrosis, the so-called Thompson symptom is observed - the patient cannot hold the hand bent into a fist in the back position. He quickly spreads his fingers. The elbow joint changes - osteophytes grow, the elbow swells.
Deforming arthrosis of the elbow joint accounts for 50% of all elbow arthrosis. Complaints are similar, the pains are constantly growing.
Osteology in dogs
In dogs, the 2 coronoid processes are the same as in humans - in the lower jaw and elbow joint.
Elbow dysplasia (ODS) in dogs is an inherited disease in which there is an abnormal joint structure with improper articulation of the elbow. Such an incorrect joint is subject to wear, signs of arthrosis develop faster in it. If left untreated, it progresses rapidly.
There is no diagnosis of dysplasia itself. This is the collective name of all anatomical pathologies formed during the period of 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 olecranon;
- chipping off the coronoid process of the ulna;
- stratifying osteochondritis;
- mismatch of the bones of the joint (discongruence).
Different joint pathologies are similar in symptoms. That is why it is so important to seek professional help. Diagnosis can only be made by X-ray results.
