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TMD > 4. TMJ Disorders > Flashcards

4. TMJ Disorders Flashcards

1
Q

Definition of TMD

A

encompases a group of musculoskeletal and neuromuscular conditions that involve the TMJ, masticatory muscles and all associated tissues

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2
Q

DC/TMD stands for

A

Diagnostic criteria for TMD

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3
Q

DC/TMD includes what in addition to a clinical exam

A

history questionaire for pain

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4
Q

What is the difference between Axis I and II

A

Axis I= Diagnostic criteria

Axis II= psycho-social criteria

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5
Q

What are the TMD conditions with validated diagnoses

A
  • Myalgia
  • Myofascial pain with referral
  • Arthralgia
  • Headache attributed to TMD
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6
Q

What does is mean to say that the diagnoses have been validated

A

high specificity and sensitivity levels –> validation (determines how certain you are in identifying true false positives and negatives)

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7
Q

What are the two main groups of Axis I classification

A

paint related TMD

Intra-articular TMD

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8
Q

The TMD condition that most commonly affects the muscles is

A

myalgia

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9
Q

Define Myalgia

A
  • Pain of origin is muscle
  • Pain modified by jaw movement, function and parafunction
  • Replication of pain with provocation testing of masticatory muscles
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10
Q

Describe the history and clinical components that must be present for a diagnosis of myalgia

A

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)

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11
Q

MUO +MAO =?

A

Vertical range of motion

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12
Q

What percentage of myalgia cases don’t occur in the temporalis and masseter region

A

1-2%

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13
Q

Define myofascial pain with referral

A
  • Pain of muscle origin
  • With referral of pain beyond the boundary of the muscle being palpated
  • Spreading pain may also be present
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14
Q

Describe the historic and clinical features of the exam that test positive for myofascial pain with referral

A

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
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15
Q

How much kg of pressure are used when palpating at the lateral pole and around the TMJ

A

Around the TMJ= 1 kg

Lateral pole= 0.5 kg

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16
Q

Define Arthralgia

A
  • Pain of joint origin
  • Pain is affected by jaw movement, function and parafunction
  • Replication of pain though provocation testing of the TMJ
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17
Q

Describe the historic and clinical findings associated with Dx of arthralgia

A

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
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18
Q

What are the four activities you ask about when asking the patient if performing any of these activities makes thier pain better or worse

A
  • 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
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19
Q

When evaluating the patients mandibular range of motions when do you ask if the patient is experiencing familiar pain

A

MUO

MAO

20
Q

What are the only headaches we treat as headache and how do we treat them

A

Headache associated to TMD (treat by treating the TMD because the headaches are secondary to TMD)

21
Q

Define Headache attributed to TMD

A
  • 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
22
Q

Describe the historical and clinical dx findings for headache attributed to TMD

A

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)
23
Q

For specificity and sensitivity percentages anything about _ is great

A

80%

24
Q

Pain related TMD conditions have (high/low) diagnostic validity

A

high

25
Q

Other muscle condiitons that are not validated are

A
  • Muscle spasms
  • Contracture
  • Myostitis
  • Hypertrophy
26
Q

Define muscle space

A

-Involuntary, reversible, sudden tonic contraction of a muscle

27
Q

Examination of muscle spasms must confirm what two factors for Dx

A
  • Immediate onset of myalgia (muscle pain)

- Immediate limited ROM

28
Q

What is the gold standard for Dx of muscle spasms

A

elevated EMG (This is the reference standard for muscle spasms)

29
Q

Define contracture

A

Shortening of a muscle due to fibrosis of a tendon, ligament or muscle fibers

30
Q

Pain can occur in contracture if

A

muscle is over-extended

31
Q

People with contracture tend to have a history of

A

radiation, trauma or infection

32
Q

Progression of contracture leads to

A

loss of ROM (range of motion) MUO and MAO are limited

33
Q

Define myositis

A

Pain is of muscle origin with clinical characteristics of inflammation or infection

34
Q

Myositis generally arises how

A
  • Direct trauma (acute)

- Autoimmune disease (chronic)

35
Q

Myostitis ossificans includes what findings

A
  • muscle calcification
  • local myalgia
  • presence of edema, erythema, and increased temp
  • serologic tests for inflammation
36
Q

What is the most accepted treatment for traumatic myosistis ossificans (TMO)

A

excision followed by physiotherapy

37
Q

TMO has a (high/low) rate of recurrance and why

A

low because may be concealsed due to short term follow up

38
Q

Etiologies of hypertrophy include

A
  • Familial/genetic origin

- Secondary to overuse and/or chronic tensing of the muscles

39
Q

Hypertrophy typically (is/isn’t) associated with pain

A

isn’t .

40
Q

Describe the vicisous cycle theory

A
  • 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
41
Q

Why is the vicious cycle theory no longer accepted

A
  • No difference in EMG between rest cases and controls

- Pain reduces muscle contraction

42
Q

Describe the pain adaptation model

A

Pain related changes should be viewed as adaptive because they help prevent further damage and promote healing

43
Q

Describe the integrated pain adaptation model

A

-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

44
Q

People with chronic pain diseases typically have a (high/low) pain threshold… what affect will this have on TMD dx

A

low… more likely to experience pain upon palpation (these people thus have a higher likelihood of having a pain related TMD Dx)

45
Q

Review the cases

A

ok

TMD (13 decks)

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