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PHTY301 > 8b TMJ > Flashcards

8b TMJ Flashcards

1
Q

TMJ anatomy

A

Insertion of condyle of mandible into mandibular fossa of
temporal bone.
A synovial, condylar, and modified ovoid hinged joint with
fibrocartilage joint surface.
An articular disc completely divides each joint into two cavities

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2
Q

What are the two movements of TMJ

A

rotation and gliding

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3
Q

When does rotation occur at TMJ

A

Rotation -from beginning of movement to mid-range movement
Upper head of lateral pterygoid muscles pulls the disc anteriorly
and prepares for condylar rotation - through two condylar heads
Disc provides congruent contours

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4
Q

When does gliding occur at TMJ

A

Gliding – the 2nd movement – a translatory movement
of condyle and disc along the slope articular surface
Both essential for full mouth opening and closing

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5
Q

Resting position TMJ

A

Resting position – TUTALC (tongue up, teeth apart, lips

closed)

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6
Q

Loose packed positiong TMJ

A

Loose packed position -Slightly open, teeth apart, tongue up

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7
Q

Restricted capsular pattern TMJ

A

Restricted capsular pattern -reduced opening and protraction

OR If unilateral mandible deviates to one side

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8
Q

Close packed positiong

A

Close packed position – Mouth closed, teeth tightly clenched

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9
Q

Movements upper cavity TMJ

A

• Upper cavity - gliding, translation, sliding

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10
Q

Movements lower cavity TMJ

A

Lower cavity – rotation and then hinge movement

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11
Q

Area of pain TMJ

A
  • Area of pain: Pain over the TMJ joint

* In or around the ear

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12
Q

Muscles that could be sore TMJ

A

• +/- Soreness of facial mms: masseter and

temporalis

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13
Q

TMJ Specific Patient History

A

• Any pain /restriction in opening or closing mouth?
• Any pain with eating ?
• Does the patient chew on the right or left side? ( malocclusion)
• Which jaw movements cause pain?
• Do symptoms change over 24 hours? (OA)
• Provoking activities – yawning, biting, chewing, swallowing,
speaking, shouting ?
• Dos the patient breathe through nose or mouth?
• Any clicking/crepitus of the jaw ?
• Has the mouth or jaw ever locked?
• Doe the patient have any habits - smoking a pipe, leaning on
chin, chewing gum, hair, pursing and chewing lips, biting nails,
other nervous habits? – all place additional stress on TMJ
• Does the patient grind or tightly clench their teeth? (=
bruxism)
• Any related psychosocial problems ?
• Are there any teeth missing? ( deviation )
• Any teeth sensitive – indicative of tooth decay
• Any difficulty swallowing ?

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14
Q

Special questions TMJ patient interview

A

• Any thumb sucking?
• Any ear problems – hearing loss, ringing in ears, blocking,
dizziness?
• Any habitual head posture?
• Any voice changes? – may indicate muscle spasm
• Any headaches?
• Has patient had any recent dental work?
• Does the patient wear a dental plate?

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15
Q

P/E TMJ

A
  • Observation: posture (poke chin)
  • Active ROM (add OP)
  • Resisted isometric movements
  • Palpation
  • Passive ROM of mandible
  • Passive joint mobilisations
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16
Q

Observations TMJ

A 
• Posture of head and neck (poke chin)
• Facial symmetry – horizontal and vertical
• Vertical should be in thirds –
– hair line to bipupital line
– bipupital line to nose
– nose to chin
Any paralysis ?
Normal teeth alignment?
• Any mal-occlusion - a major cause TMJ disc problems
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17
Q

Note occlusal position

A

• Class 1 occlusion = normal antero-posterior alignmemt of
maxillary teeth to mandibular teeth
• Class 2 – malocclusion – overbite of mandibular on maxillary
• Class 111 malocclusion – underbite of mandibular relative to
maxillary

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18
Q

AROM TMJ

A

Ch eck Cervical AROM – should have full ROM while keeping
mouth closed
• Flexion – mandible moves up / anterior; posterior neck
structures tight
• Extension - mandible down and back; anterior neck
structures tight
TMJ AROM (move to pain or move to limit)
• Opening /closing mouth (depression/elevation)
• Protrusion (protraction) / retrusion (retraction) mandible
• Lateral deviation of mandible left and right

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19
Q

How much TMJ opening do you need for normal acitivity

A

Need 25-35 mm for normal activity

20
Q

Normal opening

A

Normal opening –should be straight line – and 35-

60mm ( 2-3 finger widths in mouth )

21
Q

Normal lateral deviation TMJ

A

Lateral deviation – normal 10-15 mm

22
Q

Normal protrusion -

A

normal >7mm

23
Q

Normal retrusion (retraction)

A

Retrusion (retraction)- normal 3-4mm

24
Q

Muscles: Elevators (closes mouth)

A
  • Temporalis Elevators (closes mouth)
  • Masseter Elevators (closes mouth)
  • Medial pterygoid Elevators (closes mouth)
25
Q

Muscles: Depressors (opens mouth)

A
  • Lateral pterygoid Depressors (opens)

* Digastric Depressors (opens)

26
Q

Suprahyoids action

A

• Suprahyoids - influence jaw position, tongue

mobility, speech, swallowing

27
Q

Infrahyoids actition

A

• Infrahyoids - stabilise hyoid bone

28
Q

Nerve supply TMJ joint

A

• Supplied by both cranial and cervical nerves
• CR V (trigeminal n)
– Nb. Muscle weakness may signal an UMN problem

29
Q

Auriculotemporal nerve

A

• Auriculotemporal nerve
– Also supplies posterior capsule and blood vessels, rertodiscal pad,
typanice membrane, external auditory meatus, tragus
– Could give rise to symptoms such as tinnitus, dizziness, hearing
problems

30
Q

Resisted isometric movements TMJ

A

• Resisted isometric movements
– Resisted opening – depression
– Resisted closing – elevation or occlusion
– Resisted lateral deviation

31
Q

Reflexes TMJ

A

Reflexes ( jaw reflex test for cranial nerve V ) and cutaneous
distribution. Know the dermatomes.

32
Q

Palpation TMJ

A 
• Through external meatus
Feel for:
• Smooth movement
• Equal opening R and L
• Then place fingers over mandibular condyles – pain,
tenderness
• Palpate mandible along entire length
• Hyoid / thyroid
33
Q

Accessory/Joint Play Movements TMJ

A
  • Longitudinal cephalad
  • Longitudinal caudad (within the patient’s mouth)
  • Lateral glide mandible (within the patient’s mouth)
  • Medial glide of mandible (transverse)
  • Posterior glide of mandible
  • Anterior glide of the mandible
34
Q

Treatment Modalities TMJ

A
  • Soft tissue massage – masseter / temporalis
  • Joint mobilisations
  • Movement pattern retraining
  • Neuromuscular control
  • Posture retraining
  • Review patient habits – chewing gum, leaning on hand
  • Workplace set up
  • Relaxation techniques
  • Dental referral – splints,
35
Q

MWM TMJ

A 
• Anterior/inf translation of the
mandible along the joint line
and correct deviation as the
patient opens the jaw. Pt can
add OP.
• 3 times reassessed. Then 3
sets of 6.
36
Q

Four common conditions presenting

to physiotherapy TMJ

A
  • Hypomobility
  • Hypermobility
  • Disc derangement
  • Myofascial pain
37
Q

Causes Hypomobility TMJ

A 
Causes:
• Disc derangement
• Arthritis
• Inflammation
• Joint effusion
• Myofascial pain
• Muscle spasm
• 2° to parafunctional habits
38
Q

Treatment hypomobility TMJ

A 
Treatment:
• Joint mobilisation
• Active exercise
• Passive stretching
• Exercises for muscle
relaxation using mirror for
biofeedback
• Correct muscle imbalance
• Posture correction
39
Q

Causes hypermobility TMJ

A 
Causes:
• Lax capsule and ligs
• Systemic hypermobility
• Disc displacement
• OA
• Psychiatric disorders
• Parafunctional habits eg.
prolonged bottle feeding,
thumb sucking, dummy use in
children
• Habitual wide opening of
mouth
40
Q

Treatment hypermobility TMJ

A 
Treatment:
• Jaw control,
• tongue on roof of mouth
while opening, guide
movement of mandible,
control anterior translation
• Use of mirror for
biofeedback
• Posture correction
• Concentric/eccentric
exercise
• Isometric exercise
41
Q

Causes disc dereangement TMJ

A 
Causes:
• Mal-occlusion - condyle
displaces post during closing
• Trauma – partial tear of disc
from capsule
• Excessive pressure - from
clenching or trauma
• Incoordination of pterygoids -
so disc snaps over condyle on
opening
• Degeneration
• Stretching of ligaments – eg.
by frequent subluxation
42
Q

Treatment disc derangement TMJ

A 
Treatment:
• Locked jaw:
• distract mandible away from
opposing joint surface, thumb
inside mouth
• Avoidance of exacerbating
factors
• Heat
• Soft diet
• Surgery
43
Q

Causes myofacial pain TMJ

A 
No organic disease or joint
derangement
• Dull ache unilaterally
• H/A and neck pn
• Aggravated by chewing,
tension
• May be present on waking
(night bruxism (grinding))
• Symptoms diffuse
• Jaw stiffness
• Muscles tender
44
Q

Treatment myofascial pain TMJ

A

Treatment:
• Stretch, mobilisation
• Relaxation (TUTALC)
• Dental splint

45
Q

Causes dislocation of TMJ

A

 Yawning or taking a large bite,
 Excessive contraction of the lateral pterygoids
 Heads of the mandible to dislocate anteriorly
 (pass anterior to the articular tubercles).
 Mandible remains wide open and unable to close
 A sideways blow to the chin when the mouth is open dislocates the TMJ on the
side that received the blow.

46
Q

Arthritis of TMJ

A

 TMJ may become inflamed from the degenerative arthritis
 Abnormal function of the TMJ may result in structural problems
 Dental occlusion and joint clicking (crepitus).
 The clicking is thought to result from delayed anterior disc movement during
mandibular depression and elevation
 Adhesions
 Breakdown of cartilage

PHTY301 (9 decks)

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