4. TMJ Disorders Flashcards
Definition of TMD
encompases a group of musculoskeletal and neuromuscular conditions that involve the TMJ, masticatory muscles and all associated tissues
DC/TMD stands for
Diagnostic criteria for TMD
DC/TMD includes what in addition to a clinical exam
history questionaire for pain
What is the difference between Axis I and II
Axis I= Diagnostic criteria
Axis II= psycho-social criteria
What are the TMD conditions with validated diagnoses
- Myalgia
- Myofascial pain with referral
- Arthralgia
- Headache attributed to TMD
What does is mean to say that the diagnoses have been validated
high specificity and sensitivity levels –> validation (determines how certain you are in identifying true false positives and negatives)
What are the two main groups of Axis I classification
paint related TMD
Intra-articular TMD
The TMD condition that most commonly affects the muscles is
myalgia
Define Myalgia
- Pain of origin is muscle
- Pain modified by jaw movement, function and parafunction
- Replication of pain with provocation testing of masticatory muscles
Describe the history and clinical components that must be present for a diagnosis of myalgia
Hx
- Presence of pain in the jaw, temple, ear or in ear region
- Pain is modified by jaw movement, function and parafunciton
Clinical
-Familiar pain in the temporalis and masseter with at least one of these tests (palpation of temporalis/masseter or familiar pain during max. unassisted opening, lateral or protrusive movements)
MUO +MAO =?
Vertical range of motion
What percentage of myalgia cases don’t occur in the temporalis and masseter region
1-2%
Define myofascial pain with referral
- Pain of muscle origin
- With referral of pain beyond the boundary of the muscle being palpated
- Spreading pain may also be present
Describe the historic and clinical features of the exam that test positive for myofascial pain with referral
Hx
- Pain in the jaw, temple, ear or in ear region
- Pain modified by jaw movement, function and parafunction
Clinical
- Confirmation of pain in the temporalis or masseter region
- Report familiar pain with palpation of temporalis or masseter
- Report pain at a site beyond the boundary of palpation
How much kg of pressure are used when palpating at the lateral pole and around the TMJ
Around the TMJ= 1 kg
Lateral pole= 0.5 kg
Define Arthralgia
- Pain of joint origin
- Pain is affected by jaw movement, function and parafunction
- Replication of pain though provocation testing of the TMJ
Describe the historic and clinical findings associated with Dx of arthralgia
History
- Presence of pain in the jaw, temple, ear and in ear regions
- Pain is modified by jaw movement, function and parafunction
Clinical
- Confirmation of pain in area of TMJ
- Pain upon palpation of the lateral pole or around the lateral pole OR
- Pain with max unassisted opening, protrusion, lateral movement
What are the four activities you ask about when asking the patient if performing any of these activities makes thier pain better or worse
- Chewing hard/tough food
- Opening your mouth or moving your jaw forward or to the side
- Jaw habits such as clenching, grinding, chewing gum
- Other jaw activities such as talking, kissing, yawning
When evaluating the patients mandibular range of motions when do you ask if the patient is experiencing familiar pain
MUO
MAO
What are the only headaches we treat as headache and how do we treat them
Headache associated to TMD (treat by treating the TMD because the headaches are secondary to TMD)
Define Headache attributed to TMD
- Headache in temple region secondary to pain-related TMD
- Affected by jaw movement, function and parafunction
- Replication of headache through provocation testing of masticatory system
Describe the historical and clinical dx findings for headache attributed to TMD
Hx
- Headache of any type in the temple region
- Headache modified by jaw movement, function and parafunciton
Clinical
- Confirm headache in temple region (temporalis)
- Report familiar headache in temple area with are least on of the following (pain on palpation of temporalis or pain upon max. unassited opening, protrusion or lateral movements)
For specificity and sensitivity percentages anything about _ is great
80%
Pain related TMD conditions have (high/low) diagnostic validity
high
Other muscle condiitons that are not validated are
- Muscle spasms
- Contracture
- Myostitis
- Hypertrophy
Define muscle space
-Involuntary, reversible, sudden tonic contraction of a muscle
Examination of muscle spasms must confirm what two factors for Dx
- Immediate onset of myalgia (muscle pain)
- Immediate limited ROM
What is the gold standard for Dx of muscle spasms
elevated EMG (This is the reference standard for muscle spasms)
Define contracture
Shortening of a muscle due to fibrosis of a tendon, ligament or muscle fibers
Pain can occur in contracture if
muscle is over-extended
People with contracture tend to have a history of
radiation, trauma or infection
Progression of contracture leads to
loss of ROM (range of motion) MUO and MAO are limited
Define myositis
Pain is of muscle origin with clinical characteristics of inflammation or infection
Myositis generally arises how
- Direct trauma (acute)
- Autoimmune disease (chronic)
Myostitis ossificans includes what findings
- muscle calcification
- local myalgia
- presence of edema, erythema, and increased temp
- serologic tests for inflammation
What is the most accepted treatment for traumatic myosistis ossificans (TMO)
excision followed by physiotherapy
TMO has a (high/low) rate of recurrance and why
low because may be concealsed due to short term follow up
Etiologies of hypertrophy include
- Familial/genetic origin
- Secondary to overuse and/or chronic tensing of the muscles
Hypertrophy typically (is/isn’t) associated with pain
isn’t .
Describe the vicisous cycle theory
- Proposed me chanism of myogenous pain (not currently accepted)
- Muscle pain became chronic because stimulation of nociceptors led to tonic excitation of motoneurons (hyperactivity)
- This lead to spasm, fatigue, and overwork and this then led to further stimulation of nociceptors resulting in a pain-spasm-pain cycle
Why is the vicious cycle theory no longer accepted
- No difference in EMG between rest cases and controls
- Pain reduces muscle contraction
Describe the pain adaptation model
Pain related changes should be viewed as adaptive because they help prevent further damage and promote healing
Describe the integrated pain adaptation model
-Effect of pain on motor activity relies on the complex interaction of bio-psychosocial characteristics as well as anatomical and functional complexitiy of the individual sensory-motor system
People with chronic pain diseases typically have a (high/low) pain threshold… what affect will this have on TMD dx
low… more likely to experience pain upon palpation (these people thus have a higher likelihood of having a pain related TMD Dx)
Review the cases
ok
