Head, Neck and TMJ Flashcards
BONES OF THE SKULL
Skull is composed of how many bones? ______
How many Cranial Bones? ______
How many Facial Bones? ______
Skull is composed of how many bones? 22
How many Cranial Bones? 8
How many Facial Bones? 14
CRANIAL BONES
- Encloses & protects the brain
- Attachment of ____________& ____________
- ______bones (______paired)
P2 - ______
E - ______
S - ______
T2 - ______
O - ______
F - ______
Keystone (in contact with all other bones)
= ______
- Encloses & protects the brain
- Attachment of meninges & ms
- 8 bones (2 paired)
P2 - Parietal
E - Ethmoid
S - Sphenoid
T2 - Temporal
O - Occipital
F - Frontal
Keystone (in contact with all other bones)
= Sphenoid
FACIAL BONES
- Protects & provide support for the entrances to the digestive & respiratory tract
- Attachment for mm of facial expression
- ______bones (______unpaired):
Vomer * Mandible
Conchae (Inferior Nasal) * Palatine
Nasal bones * Zygomatic
Maxillae * Lacrimal
*______– area of forehead above & bet the
eyebrows
- ______ reflex/______sign
FACIAL BONES
- Protects & provide support for the entrances
to the digestive & respiratory tract
- Attachment for mm of facial expression
- 14 bones (2 unpaired):
Vomer Mandible
Conchae (Inferior Nasal) Palatine
Nasal bones Zygomatic
Maxillae Lacrimal
*Glabella – area of forehead above & bet the
eyebrows
- Glabellar reflex/Myerson’s sign
ORBITAL MARGINS
Orbit
❑ Cavity or socket of the skull in which the eye & its appendages are
situated
❑ Boundaries:
❑ Sup: ______
❑ Lat: ______
❑ Inf: ______
❑ Med: ______, ______,
& ______
Optic Canal
❑ CN ______
❑ ______artery – blood
supply of the eyeball &
retina
❑ ______ –
temporary loss of vision
in one eye (monocular
blindness
Orbit
❑ Cavity or socket of the
skull in which the eye &
its appendages are
situated
❑ Boundaries:
❑ Sup: Frontal bone
❑ Lat: Zygomatic bone
❑ Inf: Maxilla
❑ Med: Maxilla, Frontal, & Lacrimal bone
Optic Canal
❑ CN2
❑ Ophthalmic artery – blood supply of the eyeball & retina
❑ Amaurosis Fugax – temporary loss of vision in one eye (monocular
blindness
LATERALVIEW
Important Landmarks:
1. ____________ – forms the roof of the cranium
2. ____________ – landmark for C1 TP palpation
3. ____________ – for tongue & neck ms
4. Petrous portion of temporal bone
- MC injured bone in TBI
- FITA = found inf of frontal bone & ant of temporal
bone
5. ____________– thinnest part of the lateral wall of skull
- Injury exposes MMA → ____________ → lead to death
Important Landmarks:
1. Parietal bone – forms the roof of the cranium
2. Mastoid process – landmark for C1 TP palpation
3. Styloid process – for tongue & neck ms
4. Petrous portion of temporal bone
- MC injured bone in TBI
- FITA = found inf of frontal bone & ant of temporal
bone
5. Pterion – thinnest part of the lateral wall of skull
- Injury exposes MMA → Meningitis → lead to death
POSTERIOR VIEW
Important Landmark:
1. External Occipital Protuberance
Aka: ____________/ ____________/ Seat of
____________
Rough prominence
Landmark for cervical motions & head
circumference
POSTERIOR VIEW
Important Landmark:
1. External Occipital Protuberance
Aka: Inion/ Bump of knowledge/ Seat of
intelligence
Rough prominence
Landmark for cervical motions & head
circumference
Head Circumference
- @ birth: ______ cm
- 4 mos: ______cm
- 1 year: ______cm
- Maturity: ______cm
Head too small: ______
→ ______
- Mental retardation d/t
mother’s alcoholism
Head too big: ______
→ consider Hydrocephalus
Head Circumference
- @ birth: 33-35 cm
- 4 mos: 41 cm
- 1 year: 47 cm
- Maturity: 57 cm
Head too small: Microcephaly
→ Fetal Alcohol Syndrome
- Mental retardation d/t
mother’s alcoholism
Head too big: Macrocephaly
→ consider Hydrocephalus
CSF Flow:
CSF Flow:
* Choroid Plexus
* Lateral ventricle
* Monroe (Foramen of)
* Third Ventricle
* Sylvian Aqueduct
* Fourth Ventricle
* Luschka (Lateral) (2)
* Magendie (Medial)
* Subarachnoid Space
* Arachnoid Villi
FONTANELLES (“Soft Spot”)
- To check the hydration status of the baby
- Sunken: Dehydrated
- Bulging: ______
Anterior Fontanelle
- Located bet ______& ______bone
- Diamond shape
- Closes at ______mos
Posterior Fontanelle
- Located bet ______& ______bone
- ______shape
- Closes at ______mos
- Earlier:
FONTANELLES (“Soft Spot”)
- To check the hydration status of the baby
- Sunken: Dehydrated
- Bulging: ↑ ICP
Anterior Fontanelle
- Located bet frontal & parietal bone
- Diamond shape
- Closes at 18 mos
Posterior Fontanelle
- Located bet parietal & occipital bone
- Triangular shape
- Closes at 12 mos
- Earlier:
MENINGES
1. ______(innermost)
- Nutrition of brain
- Covers the brain & SC
2.______(middle layer)
- (+) blood vessels
- Subarachnoid space – CSF filled
3. ______(outermost)
- Tough & flexible membrane
- Holds the brain in place
- Pia (innermost)
- Nutrition of brain
- Covers the brain & SC
2.Arachnoid (middle layer)
- (+) blood vessels
- Subarachnoid space – CSF filled - Dura (outermost)
- Tough & flexible membrane
- Holds the brain in place
CAVERNOUS SINUS TRIANGLE
Landmarks:
1. ______
2. ______
Affectation can cause:
- Affectation of CN ______
- ______passes through
- Communicates c dangerous
area of the face through ______ & ______
→ ______
Landmarks:
1. Corners of the lips
2. Tip of the nose
Affectation can cause:
- Affectation of CN 6
- ICA passes through
- Communicates c dangerous
area of the face through Ant
facial vein & emissary vein
→ meningitis
BLOOD SUPPLY TO THEBRAIN
- Anastomosis of the ______ and the ______
- ______
- Anastomosis of the Internal Carotid Arteries and the Vertebral Arteries
- CIRCLE of WILLIS
CN 1 – ______(______)
- ______(1st affected in TBI) - ______
CN 2 – ______(______)
- Visual Acuity & Visual Field
- Pupillary light reflex
CN 3 – ______ (______)
- Eyelid & Eyeball movement
CN 4 – ______(______)
- Innervates Superior Oblique
CN 5 – ______(______)
- Jaw jerk reflex; Ms of mastication
- Sensory: Face
CN 1 – Olfactory (Se)
- Smell (1st affected in TBI) - anosmia
CN 2 – Optic (Se)
- Visual Acuity & Visual Field
- Pupillary light reflex
CN 3 – Oculomotor (Mo)
- Eyelid & Eyeball movement
CN 4 – Trochlear (Mo)
- Innervates Superior Oblique
CN 5 – Trigeminal (Mi)
- Jaw jerk reflex; Ms of mastication
- Sensory: Face
CN 6 – ______(______)
- Innervates Lateral Rectus
CN 7 – ______(______)
- M: Facial ms
- S: Innervates ant 2/3 of the tongue
- Bell’s Palsy
CN 8 – ______(______)
- Hearing & Equilibrium
CN 9 – ______(______)
- S: ______
- M: ______– ______
CN 6 – Abducens (Mo)
- Innervates Lateral Rectus
CN 7 – Facial (Mi)
- M: Facial ms
- S: Innervates ant 2/3 of the tongue
- Bell’s Palsy
CN 8 – Vestibulocochlear (Se)
- Hearing & Equilibrium
CN 9 – Glossopharyngeal (Mi)
- S: Post 1/3 of the tongue
- M: Salivation – 9arotid gland
CN 10 – ______(______)
- S: Thoracic & Abdominal viscera
- M: Pharynx/Larynx
- ↓ HR; ↑ GI mobility
CN 11 – ______(______)
- Trapz & SCM
CN 12 – ______(______)
- Tongue movts & shape
CN 10 – Vagus (Mi)
- S: Thoracic & Abdominal viscera
- M: Pharynx/Larynx
- ↓ HR; ↑ GI mobility
CN 11 – Accessory (Mo)
- Trapz & SCM
CN 12 – Hypoglossal (Mo)
- Tongue movts & shape
CRANIAL FOSSA
Anterior Cranial Fossa: lodges the frontal lobe
1. ______ – passage of emissary vein
2. ______ – CN1
Middle Cranial Fossa: ______
1. Sella Turcica – ______
2. Foramen ROSL
- Foramen Rotundum – CN5 V2
- Foramen Ovale – CN5 V3
- Foramen Spinosum – MMA
- Foramen Lacerum – ICA
3. Carotid Canal – ICA
Anterior Cranial Fossa: lodges the frontal lobe
1. Foramen of Cecum – passage of emissary vein
2. Perforations in Cribriform plate – CN1
Middle Cranial Fossa: lodges the temporal lobe
1. Sella Turcica – pituitary gland
2. Foramen ROSL
- Foramen Rotundum – CN5 V2
- Foramen Ovale – CN5 V3
- Foramen Spinosum – MMA
- Foramen Lacerum – ICA
3. Carotid Canal – ICA
Posterior Cranial Fossa: lodges the ______ &
______
1. Internal Auditory Meatus – CN __ & __
2. Jugular foramen – ______
3. Foramen Magnum – ______, ______ &
______
4. Hypoglossal canal – CN ______
Posterior Cranial Fossa: lodges the occipital lobe &
brainstem
1. Internal Auditory Meatus – CN7 & 8
2. Jugular foramen – CN 9, 10 & 11; IJV
3. Foramen Magnum – MO, spinal part of CN 11 &
R/L vertebral arteries
4. Hypoglossal canal – CN 12
HYOID BONE
- Skeleton of the tongue
- No attachment/articulation c any
other bones
- Attached to the skull by the
______ ligament
- Attached to the thyroid cartilage
by the ______
- Landmark:
- C3: ______
- C4-C5: ______
- C6: ______
HYOID BONE
- Skeleton of the tongue
- No attachment/articulation c any
other bones
- Attached to the skull by the
stylohyoid ligament
- Attached to the thyroid cartilage
by the thyrohyoid membrane
- Landmark:
- C3: Hyoid
- C4-C5: Thyroid cartilage
- C6: Cricoid cartilage
VERTEBRAL ARTERY
Provides: ______% of BS to brain (______% ICA)
TP: ______ transverse foramen
Compressed at: ______
Causes: 1. ______
- Frequent head movt – Ext
(MC mechanism for non-penetrating injury
to the VA)
→ relief during cervical ______(______)
Rot to the (R): kinking on the opp side
Delayed s/sx: vertigo, nausea, tinnitus,
drop attacks, visual prob, stroke or death
VERTEBRAL ARTERY
Provides: 20% of BS to brain (80% ICA)
TP: C1-C6 transverse foramen
Compressed at: Foramen magnum
Causes: 1. Osteophyte formation
- Frequent head movt – Ext
(MC mechanism for non-penetrating injury
to the VA)
→ relief during cervical ext (chin tucks)
Rot to the (R): kinking on the opp side
Delayed s/sx: vertigo, nausea, tinnitus,
drop attacks, visual prob, stroke or death
TESTS FOR VASCULAR SIGNS
- BARRE’S TEST
- Px standing
- Sh F Flex 90 + FA supination + elbow ext + EC x 10-20 secs hold
- (+): ______/______
- Indic: ↓ blood flow to the brainstem - HAUTANT’S TEST
- ______ neck rot & ext - UNDERBURG’S TEST
- ______ neck rot & ext - CERVICAL QUADRANT TEST
TESTS FOR VASCULAR SIGNS
- BARRE’S TEST
- Px standing
- Sh F Flex 90 + FA supination + elbow ext + EC x 10-20 secs hold
- (+): Arm falls/pronates
- Indic: ↓ blood flow to the brainstem - HAUTANT’S TEST
- Sitting Barre c & s neck rot & ext - UNDERBURG’S TEST
- Marching Barre c neck rot & ext - CERVICAL QUADRANT TEST
Vertebral Artery/Cervical Quadrant Test
❑ Supine
❑ Neck ext + LF + Rot x 30sh
❑ Opp side is tested
❑ Look for vertebral sx
❑ Must be performed before
cervical traction
Vertebral Artery/Cervical Quadrant Test
❑ Supine
❑ Neck ext + LF + Rot x 30sh
❑ Opp side is tested
❑ Look for vertebral sx
❑ Must be performed before
cervical traction
CERVICAL NERVE
ROOTS
Myotomes
C1-C2 = ______
C3 = ______
C4 = ______
C5 = ______
C6 = ______
C7 = ______
C8 = ______
T1 = ______
CERVICAL NERVE
ROOTS
Myotomes
C1-C2 = Neck Flex
C3 = Neck Lat Flex
C4 = Sh Elevation
C5 = Sh Abd
C6 = Elbow Flex; Wrist Ext
C7 = Elbow Ext; Wrist Flex
C8 = Thumb Ext & Ulnar Dev c Finger Flex
T1 = Finger Abd/Add
CERVICAL NERVEROOTS
Dermatomes
C2 = ______
C3 = ______
C4 = ______
C5 = ______
C6 = ______
C7 = ______
C8 = ______
T1 = ______
T2 = ______
T4 = ______
T6 = ______
T10 = ______
CERVICAL NERVEROOTS
Dermatomes
C2 = Occiput
C3 = Nape
C4 = Acromion Process
C5 = Lat Epicondyle
C6 = Thumb
C7 = Middle finger
C8 = Little finger
T1 = Med Epicondyle
T2 = Axilla
T4 = Nipple
T6 = Xiphoid Process
T10 = Umbilicus
SCALP
Covers from the superior nuchal line of the occipital bone to the
supraorbital margin of the frontal bone
Extends laterally over the temporal fascia to the zygomatic arches
S - ______
C - ______ – rich in blood supply
A -______– flat tendon
L - ______
- contains ______ (valveless) = dangerous
P - ______(outside the surface of skull)
Covers from the superior nuchal line of the occipital bone to the
supraorbital margin of the frontal bone
Extends laterally over the temporal fascia to the zygomatic arches
S - Skin
C - Connective tissue – rich in blood supply
A -Aponeurosis – flat tendon
L - Loose areolar connective tissue
- contains emissary veins (valveless) = dangerous
P - Pericranium (outside the surface of skull)
MUSCLE IN THE SCALP
1.Occipitofrontalis
- Ms of ______= wrinkling of
forehead
- ______ = last ms to recover in
Bell’s Palsy
- Ms recovery from ______to ______
- ______> ______ >
______ > ______
1.Occipitofrontalis
- Ms of surprise = wrinkling of
forehead
- Frontalis = last ms to recover in
Bell’s Palsy
- Ms recovery from 1st to last
- Buccinator > Z. Major >
Orbicularis Oris > Frontalis
MUSCLES of the EYELID
- Orbicularis Oculi
- ______– closes gently & dilates lacrimal sac
(sleep)
- ______– closes eyes tightly; protection of eyeballs - Levator palpebrae superioris
- Works with ______
- ______% eye opening
(______ ms – 20% of eye opening)
- If weak, (+) ______ - Corrugator supercilli (CN ______)
- Frowning ms
- Orbicularis Oculi
- Palpebral – closes gently & dilates lacrimal sac
(sleep)
- Orbital – closes eyes tightly; protection of eyeballs - Levator palpebrae superioris
- Works with occipitofrontalis
- 80% eye opening
(Mueller’s ms – 20% of eye opening)
- If weak, (+) ptosis - Corrugator supercilli (CN 7)
- Frowning ms
MUSCLES OF FACIALEXPRESSION
grimace, plastic smile, sarcastic
Risorius
MUSCLES OF FACIALEXPRESSION
- ______– grimace, plastic smile, sarcastic
- ______– egad, grief, sadness, sorrow
- ______– distaste, yuck
- ______ – smile
- ______ – laugh
- ______ – kiss, whistle, suck
- ______- blow
- ______ – pout (lower only), sulk (upper and lower lips)
- ______ – sneer (contempt)
10.______ – irony, melancholy
- Risorius – grimace, plastic smile, sarcastic
- Platysma – egad, grief, sadness, sorrow
- Procerus – distaste, yuck
- Zygomaticus minor – smile
- Zygomaticus major – laugh
- Orbicularis oris – kiss, whistle, suck
- Buccinator- blow
- Mentalis – pout (lower only), sulk (upper and lower lips)
- Levator anguli oris – sneer (contempt)
10.Depressor labii inferioris – irony, melancholy
MUSCLES OF FACIALEXPRESSION
egad, grief, sadness, sorrow
Platysma
MUSCLES OF FACIALEXPRESSION
distaste, yuck
Procerus
MUSCLES OF FACIALEXPRESSION
smile
Zygomaticus minor
MUSCLES OF FACIALEXPRESSION
laugh
Zygomaticus major
MUSCLES OF FACIALEXPRESSION
kiss, whistle, suck
Orbicularis oris
MUSCLES OF FACIAL EXPRESSION
blow
Buccinator
MUSCLES OF FACIAL EXPRESSION
pout (lower only), sulk (upper and lower lips)
Mentalis
MUSCLES OF FACIAL EXPRESSION
sneer (contempt)
Levator anguli oris
MUSCLES OF FACIAL EXPRESSION
irony, melancholy
depressor labii inferioris
HYOID, THYROID, CRICOID
C3,4-5,6
SUP < OFSCAPULA
T2
ROOT OF SPINE OF SCAPULA
T3
INF < OF SCAPULA
T7
XIPHOIDPROCESS
T10
SC ENDS
L1
PLL TAPERS
L2
HEIGHT OF UMBILICUS, AORTA DIVIDES INTO COMMON ILIAC ARTERIES
L3 – L4
SPINOUS PROCESSES DON’T OVERLAP, GOOD LANDMARK TO LOCATE OTHER VERTEBRA
L4-L5
ILIAC CREST
L4
ILIAC TUBERCLE
L5
DIMPLES OF VENUS, PSIS
S2
STERNOCLEIDOMASTOID
Bilateral Contraction:
Unilateral Contraction:
Stretching:
Torticollis: Two ways of naming:
1. Laterality of shortened SCM
2. Rotation
Spastic torticollis v.s. Paralytic torticollis
Case: Px L LF, R Rot =
Spastic torticollis: I/L SCM affected
* L SCM affected (spastic) =
Paralytic torticollis: C/L SCM affected
* R SCM affected (paralyzed) =
Sternocleidomastoid
- bilateral contraction: flexion
- unilateral contraction: I/L lateral flexion, C/L rotation
- Stretching: C/L lateral flexion, I/L rotation
- Torticollis
- NAMING:
1. laterality of shortened SCM: R SCM - R torticollis
2. rotation: L SCM - Torticollis to the R
Case: Px L lateral flexion, R rotation = L SCM = L Torticollis
Spastic torticollis: I/L SCM affected
* L SCM affected (spastic) = L Spastic Torticollis
Paralytic torticollis: C/L SCM affected
* R SCM affected (paralyzed) = L Paralytic Torticollis
SCALENES
O:
Ant: TP of C3-C6
Middle: TP of C1-C6
Post: TP of lower cervical vertebra
I:
Ant and Mid: 1st Rib
Post: 2nd Rib
A:(B):
Unilateral:
Stretching:
Scalene
- Action:
(B): Flex
Unilateral: I/L LF and I/L rotate
- Stretching: treat it as SCM
Deep Ant Neck Muscles
Rectus Capitis Anterior – ______
Rectus Capitis Lateralis – ______
Longus Capitis – (B) ______, (U) ______
Longus Colli – ______
Rectus Capitis Anterior – Flexes head
Rectus Capitis Lateralis – stabilize head,
provides proprioceptive feedback
Longus Capitis – (B) Head and neck flex, (U)
lat flex and rot
Longus Colli – Cervical Flexion
Post Neck Muscles
Rectus capitis posterior (major and minor)
______
______
______
______
All: (B) ______ at ______joint
(U) ______ & ______joint ______
Rectus capitis posterior (major and minor)
Sup Oblique
Inf Oblique
Semispinalis Capitis
Semispinalis Cervicis
All: (B) ext head at AO joint
(U) lat flex & AO joint rotation
TRAPEZIUS & LEVATOR SCAPULAE
Trapz
- (B):
- (U):
Lev Scap
- (B):
- (U):
TRAPZ & LEVATOR SCAPULAE
- Trapz
(B) = ext
(U) = I/L LF, C/L Rot
- Lev scap
(B) = ext
(U) = I/L LF, I/L Rot
TRIANGLES OF THE NECK
Anterior Triangles:
1. Carotid triangle
- Common carotid artery
- ______– CVP measurement
- CN ______
- Deep cervical lymph nodes
- Muscular triangle
- ______
- ______
- ______
- ______ - Digastric triangle
- Submandibular gland & lymph node
- Facial artery & vein
Anterior Triangles:
1. Carotid triangle
- Common carotid artery
- IJV – CVP measurement
- CN 12
- Deep cervical lymph nodes
- Muscular triangle
- Thyroid gland
- Larynx
- Trachea
- Esophagus - Digastric triangle
- Submandibular gland & lymph node
- Facial artery & vein
Posterior Triangles:
- Arteries: Subclavian, superior cervical,
suprascapular, occipital
- Veins – EJV & their tributaries
- Nn – ______, CN______
Posterior Triangles:
- Arteries: Subclavian, superior cervical,
suprascapular, occipital
- Veins – EJV & their tributaries
- Nn – Brachial Plexus, CN 11
FORWARD HEAD POSTURE
- Upper cervical vertebra - ______
- Lower cervical vertebra – ______
- Mandible pulled ______& ______
- Tx: ______ (cervical ext c dorsal
glide) - N Values:
Occiput to wall = ______cm
Neck to wall distance = ______cm
Head & neck angle = ______ deg
- Upper cervical vertebra - ext
- Lower cervical vertebra – flex
- Mandible pulled inf & post
- Tx: Chin tucks (cervical ext c dorsal
glide) - N Values:
Occiput to wall = 0 cm
Neck to wall distance = 6 cm
Head & neck angle = 30-40 deg
TEMPOROMANDIBULAR JOINT
- ______deciduous or temporary teeth
- ______permanent
- Incisors – ______
- Canine – ______
- Molars & premolars – ______&
______ - Wisdom teeth = ______
- 20 deciduous or temporary teeth
- 32 permanent
- Incisors – cutting food
- Canine – to cut & tear meat
- Molars & premolars – crush &
breakdown food for digestion - Wisdom teeth = 3rd molar
TEMPOROMANDIBULAR JOINT
- Articulation between the convex condyles of the mandible, concave mandibular fossa and convex articular
eminence of the temporal bone - Synovial, condylar, modified ovoid, hinge type of joint with
fibrocartilaginous surfaces - Articular disc*
TEMPOROMANDIBULAR JOINT
- Articulation between the convex condyles of the
mandible, concave mandibular fossa and convex articular
eminence of the temporal bone - Synovial, condylar, modified ovoid, hinge type of joint with
fibrocartilaginous surfaces - Articular disc*
- Articular disc*
- Divides the jt into sup & inf cavities
- Serves as a cushion bet 2 bones
- Lacks nn ending & blood vessels (not sensitive to pain)
- Ant: attaches to lateral pterygoid
- Post: continues as retrodiscal lamina (fully supplied by BV & nn ->
sensitive to pain
- Articular disc*
- Divides the jt into sup & inf cavities
- Serves as a cushion bet 2 bones
- Lacks nn ending & blood vessels (not sensitive to pain)
- Ant: attaches to lateral pterygoid
- Post: continues as retrodiscal lamina (fully supplied by BV & nn ->
sensitive to pain
Articulating Disk - GDRIVE
GDRIVE
ARTHROKINEMATICS OF THE TMJ
Mouth Opening (TMJ ______)
- Post Roll → Ant translation
- Mandible moves into depression & protraction
- Mainly by ______
Mouth Closing (TMJ ______)
- Post translation → Ant roll
- Mandible moves into elevation & retraction
- ______, ______, ______
Mouth Opening (TMJ Depression)
- Post Roll → Ant translation
- Mandible moves into depression & protraction
- Mainly by lateral pterygoids
Mouth Closing (TMJ Elevation)
- Post translation → Ant roll
- Mandible moves into elevation & retraction
- Medial pterygoids, temporalis, masseter
Cardinal Features of TMJ Dysfunction
- ______
- ______
- ______
History
Pain with opening or closing?
In fully opened position – ______
When biting – ______
When chewing - ______
In opening – ______
- Orofacial pain
- Restricted jaw motion
- Joint noise (clicking)
History
Pain with opening or closing?
In fully opened position – extra-articular problem
When biting – intra-articular problem
When chewing - malocclusion
Limited motions
In opening – anteriorly displaced disc
TMJ Dysfunction CLICKING
Early➔ ______
Late➔ ______
Soft clicks➔ ______
Hard clicks➔ ______
Early➔ developing
dysfunction
Late➔ chronic
Soft clicks➔ muscle
incoordination
Hard clicks➔ joint
pathology
Disc Displacement c Reduction
❑ Aka: Reciprocal clicking
❑ 2 clicks upon opening &
closing
❑ Aka: functional dislocation
❑ D/t ant displaced disc
GDRIVE
Disc Displacement s
Reduction
❑ Aka: Closed Lock
❑ No clicks
❑ LOM on mouth opening
❑ When disc is too ant placed
Disc Displacement s
Reduction
❑ Aka: Closed Lock
❑ No clicks
❑ LOM on mouth opening
❑ When disc is too ant placed
Disc Incoordination
❑ Aka: Open Lock
❑ 4 clicks
❑ Post displacement of disc
Disc Incoordination
❑ Aka: Open Lock
❑ 4 clicks
❑ Post displacement of disc
FUNCTIONAL OPENING
Knuckle Test
- Place ______
- N opening = ______ mm
- Functional opening = ______ mm
- Retrusion = ______ mm
- Protrusion
- Closed = ______ mm
- Opened = ______ mm
- Lateral Deviation = ______ mm
- N EF:
- Opening: ______
- Closing: ______
Knuckle Test
- Place 2-3 flexed PIP jts
- N opening = 35-55mm
- Functional opening = 25-35mm
- Retrusion = 3-4mm
- Protrusion
- Closed = 3-6mm
- Opened = 6-9mm
- Lateral Deviation = 10-15mm
- N EF:
- Opening: Tissue stretch
- Closing: bone to bone
TMJ DYSFUNCTIONS
SYNOVITIS
CAPSULITIS
HYPERMOBILITY
DISC DISPLACEMENT WITHREDUCTION
DISC DISPLACEMENT WITHOUT REDUCTION (HYPOMOBILITY)
TRIGEMINAL PALSY
TMJ DYSFUNCTIONS
POSSIBLE CAUSES OF PAIN
Trauma to the joint
Excessive stress to the joint
Jaw abnormalities, missing teeth, poor
bite (malocclusion)
Resting the chin in the hand
Arthritis of the TMJ
Myofascial pain dysfunction
Postural abnormalities
Whiplash injury
Prolonged mouth and upper respiratory breathing
Thumb sucking
Ligamentous laxity
Birth/Congenital trauma
Trauma to the joint
Excessive stress to the joint
Jaw abnormalities, missing teeth, poor
bite (malocclusion)
Resting the chin in the hand
Arthritis of the TMJ
Myofascial pain dysfunction
Postural abnormalities
Whiplash injury
Prolonged mouth and upper respiratory breathing
Thumb sucking
Ligamentous laxity
Birth/Congenital trauma
TMJ DYSFUNCTIONS
Clicking or popping with opening or closing
Pain at rest or with opening/closing of jaw
Decreased ability to open the jaw
Neck pain
Tooth sensitivity
Dry or burning sensation in mouth
Uncomfortable bite
Forehead or temple headache
Buzzing or ringing in ears
Hearing loss
Clicking or popping with opening or closing
Pain at rest or with opening/closing of jaw
Decreased ability to open the jaw
Neck pain
Tooth sensitivity
Dry or burning sensation in mouth
Uncomfortable bite
Forehead or temple headache
Buzzing or ringing in ears
Hearing loss
TMJ DYSFUNCTIONS
PT GOALS
* Decrease pain & muscle spasm
* Correct muscle imbalance
* Teach control of jaw muscles
* Increase ROM, if necessary
HABIT MODIFICATION-Intraoral splint to allow resting position of
mouth, cut food into smaller pieces
DIET MODIFICATION –soft food
MEDS TO CONTROL PAIN
HOT/COLD COMPRESSES
DENTAL APPLIANCES
POSITIONING
STRESS MANAGEMENT
POSTURE
PT GOALS
* Decrease pain & muscle spasm
* Correct muscle imbalance
* Teach control of jaw muscles
* Increase ROM, if necessary
