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Interventions II > Final - TMD > Flashcards

Final - TMD Flashcards

1
Q

Most common cause of orofacial pain and headache

A

TMD

includes disorders involving the masticatory muscles and/or TMJ

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2
Q

Conditions that can mimic TMJ pain requiring referral

A
  • tooth
  • ear
  • sinus
  • gland
  • Cancer
  • fracture
  • trigeminal neuralgia
  • giant cell arteritis (>50yo)
  • eagle’s syndrome
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3
Q

Trigeminal Neuralgia

A
  • shock like pain (milliseconds to 2 mins)
  • Trigger points or spontaneous pain
  • strong intensity
  • absence of pain between crises
  • pain often associated with involuntary contraction of the facial muscles at the same facial side of the pain
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4
Q

What can trigger Trigeminal Neuralgia pain?

A
  • ordinary activities such as speaking, swallowing, chewing and brushing teeth as well as by non-noxious facial stimuli such as touch or a puff of air
  • a simple change in the position of the head may trigger the pain, as well as lying down on the facial side pain
  • TMD can be secondary to TN or coexisting to it
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5
Q

Trigeminal Neuralgia can precede what?

A

diagnosis of MS
especially <40 yo
should add full cranial nerve screen, full balance eval, etc

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6
Q

Diagnosis of Probably Trigeminal Neuralgia

A
  • Paroxysmal attacks of pain lasting from a fraction of a second to 2 minutes, affecting one or more division of the trigeminal nerve
  • pain has at least one of these characteristics: intense, sharp, superficial or stabbing OR precipitating from trigger zones or by trigger factors
  • attacks are stereotyped in the individual patient
  • no clinically evident neurologic deficit
  • not attributed to another disorder
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7
Q

Red/Yellow flags for Probably Trigeminal Neuralgia

A
  • non-contiguous trigemina system distribution
  • bilateral symptoms
  • visual changes
  • age < 40 yo
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8
Q

Treatment for Trigeminal Neuralgia

A
  • pharmacological treatment management is the gold standard
  • surgical options exist particularly in cases of nerve compression
  • PT can be appropriate in conjunction with medial management if there are cervical and masticatory triggers to address
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9
Q

What is Giant Cell (aka Temporal) Arteritis

A
  • involves the major branches of the aorta, usually extrocranial branches of the carotid artery
  • typical age > 50 years with incidence increasing with age
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10
Q

Signs and symptoms of GCA are classified into subsets:

A
  • cranial arteritis
  • extracranial arteritis
  • systemic symptoms
  • polymyalgia rheumatic

**type of secondary headache disorder

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11
Q

Giant Cell Arteritis sxs

A
  • complaints of persistent pain/HA; temporal; often bilateral; jaw claudication
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12
Q

giant cell arteritis treatment

A
  • PT is not appropriate
  • referral for medical management
  • red flag for immediate referral could be new, severe HA > 50, especially in temporal region
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13
Q

What is Eagle’s Syndrome

A
  • elongation of the styloid process or calcification of the stylohyoid ligament
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14
Q

Eagle’s Syndrome Sxs

A
  • dull and throbbing ache in the neck/jaw worsens with head rotation, can become shooting/stabbing with movement
  • swallowing problems, may include a feeling that something is stuck in the throat
  • pain at the base of the tongue, painful tongue movements
  • tinnitus
  • change in voice
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15
Q

Eagle’s Syndrome Treatment

A

Referral Required

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16
Q

Other conditions that can cause TMD like symptoms

A

Trauma
WAD
Cervicalgia

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17
Q

Myogenous TMD diagnostic criteria

A
  • local myalgia
  • myofascial pain
  • myofascial pain with referral
18
Q

Arthrogeneous TMD Diagnostic Criteria

A
  • arthralgia
  • subluxation
  • disc displacements
  • degenerative joint disease
19
Q

Individuals with painful TMD have more what?

A

pain conditions and a greater number of medical comorbidies, particularly neurral/sensory and respiratory conditions than controls

20
Q

There is a strong relationship between what and what?

A
  • neck disability and jaw disability and patients with TMD report worse self-reported neck disability compared to individuals without TMD
21
Q

Subjects with TMD show reduced what?

A

cervical flexor and extensor muscle endurance

22
Q

TMD treatment guidelines

A
  • conservative, reversible, and evidence based therapeutic modalities
  • behavior modification
  • physical therapy
23
Q

General TMD Invention Strategies

A

(if a patient has pain related to ANY form of TMD)

  1. Address symptom reduction (pt ed and parafunctional habits)
  2. Address joint mobility issues
  3. Consider cervical spine and postural issues
  4. Address neuromuscular control
24
Q

Symptom Management

A
  • Biobehavioral strategies including education to decrease fear, anxiety, anger, and depression
  • Rest relief positions and postural education
  • decrease nocturnal and diurnal parafunctional habits and oral behaviors
  • reduce joint loading and modifying ADLs
  • STM
  • Modalities
25
Q

STM for TMD

A

External
Intraoral
MTrP release
Dry needling

26
Q

Joint Mobility

A
  • Increase: AROM, AAROM, Joint mobs
  • Decrease: stabilization, biofeedback
  • Maintain functional neutral ROM
27
Q

Cervical Spine Intervention

A
  • postural education
  • mobilization/manipulation
  • stretching
  • strengthening/stabilization (deep cervical flexors)
28
Q

Neuromuscular Re-education

A
  • strengthening?
  • mirror movements (controlled, uncontrolled)
  • biofeedback
  • tactile cuing
  • joint loading
29
Q

TMD: Myalgia

A
  • Myofascial pain with/without referral

- trismus (aka lockjaw; tonic contraction of the muscles of mastication often following radiation)

30
Q

Myofascial Pain with and Without Referral

A
  • education
  • STM
  • Manual Therapy
  • Ther Exs
  • Neuromuscular Re-Ed
  • Postural Training
  • Physical agents for pain relief or muscle relaxation
  • MTrP dry needling
    Why are they over using the muscles?
31
Q

Common Causes of TMD: Arthralgia

A
  • Osteoarthritis (DJD)
  • Disc Displacement Disorder: DDWR, DDWoR WLO, DDWoRWoLo
  • Synovitis/ Capsulitis/ Retrodiscitis
32
Q

Goal of treatment for DDWR

A
  • goal is to increase condyle/disc translation along the eminence without popping
  • pt ed
  • symptom control
  • controlled motion
  • joint loading with opening
  • open/close with estim
33
Q

Goal of Treatment for DDWoR WLO

A

get full opening

34
Q

Capsulitis/Retrodiscitis treatment

A
  • Protected rest
  • Protected mobility
  • patient education
  • modalities to reduce inflammation and pain
35
Q

Headache Attributed to TMD

A
  • painful TMD demonstrated by clinically based diagnostic criteria
  • evidence of causation shown by the following:
    history of headache in temples that is changed with jaw movement, function and/or parafunction AND report of familiar headache in the temple area with palpation of temporals OR ROM of jaw
  • headache should not be better accounted for by another headache diagnosis
36
Q

Surgical intervention for TMD

A
  • arthrocentesis
  • arthroscopy
  • open joint surgery
  • joint replacement
37
Q

Acute post op phase of TMJ arthroplasty

A
  • 0-72 hrs
  • symptom relief
  • controlled motion of opening
  • postural education
  • patient education
38
Q

Repair Phase s/p TMJ arthroplasty

A
  • 3 days - 6 weeks
  • increasing controlled motion to WNL opening and begin LD
  • continued symptom relief
  • gradual progression o isometric strengthening
  • increasing return to thick foods
39
Q

Oral appliance therapy

A
  • occlusal guard often used for bruxism and sx’s associated with myogeneous pain, usually which sleeping
  • full coverage, hard acrylic stabilization appliance
  • covers all maxillary or mandibular teeth
40
Q

Are open bites reversible?

A

no

41
Q

Anterior repositioning appliance

A
  • not routinely recommended for bruxism/pain
  • is sometimes used for disc displacement disorders with varying evidential support, and is increasingly being used in obstructive sleep apnea management
42
Q

Indications for dental referral for an oral appliance

A
  • waking up at night or in the morning with head, face, or jaw pain due to masticatory muscle pain or arthralgia as a result of bruxism
  • waking up in the morning with locking of the jaw as a result of bruxism
  • severe attrition of the teeth as a result of bruxism

Interventions II (8 decks)

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