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Musculoskeletal Conditions 2 > Exam 1: TMJ > Flashcards

Exam 1: TMJ Flashcards

1
Q

shape of TMJ disc

A

bi-concave
superior (from ant-post): slightly concave, flat, convex
inferior (from a-p): flat inferiorly, concave, concave

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2
Q

What is the primary ligament of the TMJ?

A

lateral ligament

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3
Q

What are the primary muscles of mastication?

A

masseter, temporalis, medial and lateral pterygoids

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4
Q

What are the secondary muscles of mastication?

A

digastric, hyoids

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5
Q

Mandible elevators

A

masster, temporalis, medial pterygoid

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6
Q

Mandible depressors

A

lateral pterygoid, assisted by suprahyoids

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7
Q

so early BRAIN BREAK

A

go look at the TMJ kines review

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8
Q

How are neck muscles and TMJ muscles related?

A

Cervical and cranial flexors and extensors are influenced by muscles of mastication and the hyoids; dysfunction in any group can create imbalances. C-spine influences mandibular closing, rest position, occlusal patterns and masticatory muscle activity.

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9
Q

How does mouth breathing facilitate FHP?

A
  • low and forward tongue position
  • abnormal swallowing
  • hyperactive accessory muscles (SCM, scaleni, pectorals)
  • decreased diaphragm use
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10
Q

Cervical flexors and TMD

A

reduced endurance, but no decrease in strength

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11
Q

What are outcome measures for TMJ?

A

TMJ scale

Temporomandibuar joint disability questionnaire

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12
Q

What factors increased confidence that a patient has TMD?

A

History of locking jaw and decreased ROM

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13
Q

What is the limitation of radiography at the TMJ?

A

It’s difficult to get an unobstructed view of articular surfaces

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14
Q

What views are used for TMJ radiography?

A

transcranial
submentovertex
cephalometry: lateral radiographs

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15
Q

transcranial view

A
  • lateral oblique projection of TMJ

- osseous structures of TMJ-condyle, articular eminence mandibular fossa

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16
Q

submentovertex

A

alignment and shape of condyles

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17
Q

cephalometry: lateral radiographs

A
  • method of measuring dimensions of head
  • profile assessment, mandibular angle, height of hyoid
  • craniovertebral relationship
  • cervical alignment
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18
Q

What’s the best modality for seeing the disk?

A

MRI

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19
Q

describe the dual axis system

A

Axis 1 assigns dx of most commonly occurring masticatory muscle and/or TMJ disorders
Axis 2 is used to assess behavioral, psychological, and psychosocial factors relevant to TMD

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20
Q

Axis 1 groups

A

I-muscle disorders
II-TMJ disc displacements
III-arthralgia, arthritis, arthroses of TMJ

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21
Q

Axis 2 factors

A
  1. pain status variables
  2. functional mandibular limitations
  3. psychological distress
  4. graded scale of chronic pain
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22
Q

capsular fibrosis

A
  • can result from hypomobility, systemic process (RA), immobilization, head and neck cancer, procedure, trauma, acute inflammation
  • capsule tightens down; pain and/or decreased ROM
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23
Q

Hypomobility commonly accompanies…

A
  • resoluation of acute articular inflammatory process
  • chronic low-grade articular inflammatory process
  • immobilization that involved capsule
24
Q

What CN may refer pain with TMD?

A

CN V

25
Q

How much should a non-reducing disk open their mouth?

A

limit interincisal opening to 30mm to protect retrodiscal tissues from being overstretched

26
Q

What are PIRs?

A
  • postisometric relaxation techniques
  • active muscle contractions of various intensities
  • control position in a specific direction against a counter-force to facilitate motion
27
Q

What is the most common mechanical disorder of the TMJ?

A

hypermobility

28
Q

What movement characterizes hypermobility?

A

early/excessive anterior translation

-occurs in first 11mm instead of last 15-25mm

29
Q

How does hypermobility ultimately end for some people?

A
  • arthritic changes

- loss of motion (hypomobility)

30
Q

What kind of curves are associated with hypo and hyper mobility?

A

hypo-C curve

hyper-S curve

31
Q

capsulitis

A
  • can be due to injury, disease, or developmental abnormalities
  • inflammatory response to fibrous capsule, synovial membrane, or retrodiskal tissues
  • likely due to joint overloading
32
Q

How can capsulitis affect mastication?

A

It can disrupt normal pattern and cause asymmetric muscle activity and mandibular malalignment

33
Q

Signs and symptoms of capsulitis

A
  • pain at rest or on closing
  • increased pain with functional and parafunctional movements
  • pain on involved side, possible CNV referral
  • impairment from minor joint restrictions to total immobilization
34
Q

retrodiskitis

A

encroachment of condyle on articular disk; causes inflammation or exacerbation of inflammatory condition

35
Q

What can cause retrodiskitis?

A
  • repetitive microtrauma

- acute external trauma to chin

36
Q

How can retrodiskitis affect the lateral pterygoid?

A

can lead to overfatigue and disrupt disk movement with jaw movement

37
Q

signs and sx of retrodiskitis

A
  • constant pain, palpable postero-lateral TMJ tenderness
  • pain increases with clenching or moving to affected side
  • swelling may force condyle ant->acute malocclusion
38
Q

intervention of retrodiskitis caused by microtrauma

A
  • splint to reduce bruxism, decrease jt pressure
  • ant repositioning therapy (splints)
  • patient education: reduce pain, muscle guarding; stretching and muscular re-education
39
Q

OA/DJD presentation

A
  • similar to other jt dysfunction
  • pain and crepitus during ROM
  • movement restriction
  • crepitation likely to persist
40
Q

OA/DJD presentation

A
  • surgery, meds
  • AROM throughout the day
  • joint protection (avoid excessive opening)
  • rest position of tongue
41
Q

How does malocclusion relate to disc derangement?

A
  • overclosure of the mouth with backwards displacement of condyle
  • may cause partial tearing of disk from capsular attachment
42
Q

Theories on how disk derangment happens

A
  • excessive pressure on joint-clenching, trauma
  • uncoordinated bodies of lateral pterygoid
  • deterioration of disk and cartilaginous surfaces
  • stretching of ligaments by frequent subluxation
43
Q

What does clicking during various ranges of opening probably mean?

A
  • ruptures or tears of the disk
  • early: small degree of ant displacement
  • near max opening: farther ant displacement
44
Q

Opening click

A
  • anteriorly displaced disc with condyle posterior and superior
  • condyle must pass over posterior band of disk adn fall into normal position on disk
45
Q

closing click

A
  • condyle slips behind posterior edge of band of disc (disc left ant & med)
  • opening click as disk snaps back into position
  • results in disk displacement
46
Q

ADD with reduction-signs

A
  • click on opening accompanied by jarring of the joint (disk in place)
  • subtler click during closing (disk has displaced anterior)
47
Q

ROM with ADDw/R

A

generally normal; vertical opening may be greater than normal

48
Q

ADD without reduction

A
  • no noise, series of reproducible restrictions during mandibular movement
  • disc blocks translator glide: “closed lock”
  • max opening to 20-25 mm
  • mandible deflected to affected side at end of opening
  • occasional locking
49
Q

ROM with ADDw/oR

A
  • lateral excursion to contralateral side is limited

- over time, more normal range due to stretching of posterior attachments (physiologic changes to closed lock)

50
Q

What can cause trismus?

A

So many things!

  • disk
  • inflammation around teeth or muscles of mastication
  • radiation therapy to head/neck
  • TMJ dysfunction
  • abscess
51
Q

ADDw/R intervention

A
  • repositioning appliance-dentist
  • TMJ and cervical muscle relaxation exercises
  • the usual
  • self-monitoring
52
Q

TMJ clicking interventions

A
  • controlled joint movement under load
  • isometric stabilization exercises
  • ant positioning splint
  • low-load exercises
53
Q

ADDw/oR intervention

A
  • joint mobes
  • soft tissue mobes
  • normalize the disc and then tx like reducing ADD
  • surgery
  • splint, self-exercise
  • education
54
Q

Peds & TMJ

A
  • JRA
  • often associated with c-spine involvement
  • unilateral involvement-mandibular asymmetry
  • undergrowth (micrognatihia)
  • malocclusion of teeth
55
Q

sugeries

A
  • arthrocenteis
  • arthroscopic surgery
  • open joint surgery: joint reconstruction, prosthetic joint replacement
56
Q

BRAIN BREAK

A

read all that good EBP starting on page 17 of your cut up copy
and while you’re at it, look at the subjective history on page 19

57
Q

who’s likely to be a non-responder?

A

pretreatment mouth opening less than 30 mm in combination with MRI struck disc and unchanged disc shape with opening

Musculoskeletal Conditions 2 (4 decks)

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