Coracoid, Conoid, Coronoid - Everything You Need To Know - Dr. Nabil Ebraheim
Dr. Ebraheim’s educational animated video defines the differences between the coracoid process, conoid ligament and the coronoid process, in a very simple way that helps you understand more.
Coracoid:
Is a hook shaped bony process that is attached to the neck of the scapula.
It is considered the surgeon lighthouse.
It’s a land mark to avoid neurovascular injury during surgery.
It’s probably safe lateral to the coracoid you can do the approach to the shoulder and you can do the surgery.
Medial to the coracoid is the danger area where the neurovascular structures are, and you want to avoid these areas.
Always feel the coracoid.
The coracoid process is the site of attachment of several structures:
The conoid and trapezoid ligament
The coracoacromial ligament
The coracohumeral ligament
Also it gives attachment to the conjoint tendon, which is made of the coracobracialis and short head of the biceps muscle, in addition to the pectoralis minor muscle.
The subscapularis muscle passes under the coracoid and it insert into the lesser tuberosity of the humerus.
There are 2 types of the coracoid fractures:
1- Proximal to the coracoclavicular ligament usually associated with other injuries, treatment could be surgery.
2- Fracture distal to the coracoclavicular ligament, no surgery is needed.
Subcoracoid impingement:
It is an impingement of the subscapularis tendon between the coracoid and the lesser tuberosity of the proximal humerus.
There is a test for that they call it coracoid impingement test.
Clicking and pain is reproduced with passive shoulder flexion, adduction and internal rotation.
The coracoid process id also important in anchoring ligaments or tendons to the clavicle in order to restore the stability of the AC joint.
The Laterjet- Bristow procedure is performed when there is bone loss on the front of the glenoid cavity with multiple dislocations of the shoulder.
The coracoid is transferred with its attached muscles into the deficient area in the glenoid, which is usually the anterior inferior area.
Conoid:
It is a ligament, a structure, a part of the coracoclavicular ligament, it is a strong ligament, it keeps the clavicle and AC joint in place.
The AC join is stabilized by the joint capsule by the AC ligament which prevent anterior posterior translation, and also by the coracoclavicular ligament which prevent vertical displacement of the clavicle.
The coracoclavicular (CC) ligament is the most important ligament; injury to the CC ligament will cause vertical displacement of the clavicle and cause at least type III AC joint separation.
Sometimes, if this ligament is ruptured the condition may become painful and chronic.
The patient may need to have surgery in the form of a tendon graft in order to restore the stability of the AC joint.
This conoid ligament and the trapezoid part of the coracoclavicular ligament have a major role in stabilization of the clavicle in the coracoid.
Fractures of the distal third of the clavicle show the importance of this ligament.
So if the fracture of the distal clavicle is lateral to the ligament then the fracture is usually stable and no surgery is needed.
If the fracture is of the distal third of the clavicle is medial to the ligament or through the ligament, totally or partially, then the fracture becomes unstable, and the medial clavicle becomes displaced vertically due to the pulling of the sternocledomastoid muscle.
This type of the fracture of the distal third of the clavicle has a high incidence of nonunion and could be an indication of surgery.
Anatomy of conoid ligament: the conoid is medial; the trapezoid is lateral, as it is shown in the video.
Coronoid process: is a triangular process projects from the anterior proximal ulna, it is an anterior buttress of the olecranon which articulated with the trochlea of the distal humerus.
Nothing inserts into the tip of the coronoid process.
The coronoid process is twice as high as the olecranon tip.
The coronoid process contains the site of insertion for the medial collateral ligament, especially the anterior oblique ligament, also the site of insertion of the brachialis.
If the coronoid process is fractured, look for elbow instability.
The coronoid process is also involved in the terrible triad injury, which involves:
1- Elbow dislocation
2- Radial head fracture
3- Coronoid fracture, the lateral collateral ligament is injured.
this triad is terrible because there is a high complication with these injuries, and also recurrence of the elbow dislocation and also more re-operations.
in this case you are going the repair the lateral collateral ligament, fix the radial head, and fix or suture the coronoid process.
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