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Spine Test 1 > Jaw lecture 12 > Flashcards

Jaw lecture 12 Flashcards

1
Q

Who is more likely to have jaw issues, males or females?

A

females 2:1

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2
Q

Whats more likely - neck pain causing jaw pain or jaw pain causing neck pain?

A

Neck pain causing jaw pain is much more likely (so look at the neck as well!!! [upper c-spine])
* note: the inverse is not true - if we had neck pain we don’t need to asses the jaw typically

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3
Q

KNOW: Muscles can often cause jaw pain as well

A
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4
Q

What two muscles are most likley to be causing jaw pain?

A

Upper Trap tenderness / Temporalis tenderness

(Temporalis is found by palpaiting temple and bighting down)

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5
Q

How would you know that that achy pain in their jaw is coming from their neck?

A

Mess w/ the cervical spine and if it brings on jaw pain then I’m thinking cervical spine

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6
Q

Is Masseter tenderness associated w/ TMJ?

A

No

So you have to make sure when palpating TMJ that its joint line tenderness and not masseter tenderness

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7
Q

KNOW: There is a disc that sits in the TMJ joint - its very strong because we need to be able to eat to live

A
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8
Q

arthrokinematics of TMJ joint?

A

Convex on Concave

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9
Q

Why are the ligaments around the TMJ taut ant protective?

A

Because a dislocated jaw can’t eat and doesnt allow for survival

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10
Q

KNOW: The ligaments / disc around the TMJ are rich w/ blood supply

So if theres injury there it will swell up like crazy

A
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11
Q

what two muscles is the lateral pterygoid made up of?

A

Superior / inferior lateral pterygoid

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12
Q

where do the superior / inferior head of the lateral pterygoid attach?

A

Attaches to the anterior surface of the mandibular condyle and has attachments to the anterior portion of the disc

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13
Q

What is the TMJ disc made from?

A

fibrocartilage = so it allows for flexibility and compression

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14
Q

KNOW: The TMJ disc seperates the joint cavitity into superior and inferior
* superior joint space = above the disc
* inferior joint space = below the disc

A
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15
Q

what is right under the disc?

A

articular cartilage of the mandibular condyle

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16
Q

Does the jaw allow for more sagital motion or transverse motion?

A

Sagittal - we can depress and elevate our jaw (open mouth) wider than back and forth

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17
Q

What do the collateral ligaments do at the TMJ

A

keep us from deviating to far altearlly or medially

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18
Q

How does the masseter muscle help at the TMJ? (does it stabilize)

A

Provides anterior stability

KNOW: Posterior is very stable as well because theres bone right there (temporalis / external auditory canal)

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19
Q

What are the muscles of mastication? (4)

A

Maseter
Temporalis
Medlial / lateral pterygoid

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20
Q

KNOW: theres really only 3 motions at the TMJ joint that needs muscular help because gravity assists w/ depression

A
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21
Q

What are the elevators in the TMJ complex? (elevates the jaw)

A

Temporalis, masseter, medial pterygoid, superior fibers of latearl pterygoid (all 4 muscles of masication)

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22
Q

What muscles are jaw depressors?

A

Inferior fibers of the latearl pterygoid
suprahyoid
infrahyoid

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23
Q

What muscles assest w/ lateral excursion (deviation) at the jaw (def a test question or 2 - know ipsilatearl / contralateral)

A

Ipsilatearl = temporalis / masseter
contralateral = medial and lateral pterygoids

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24
Q

If I deviate my jaw to the right what muscles are working?

A

Right side = temporalis / masseter (ipsilateral)
* think jaw closing muscles

Left side = medial / lateral pterygoids (contralatera)
*

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25
Q

Whats muscles do protrusion?

A

Superficial masseter
medial pterygoid
latearl pterygoid

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26
Q

Retrusion

A

Deep fibers of masseter
temporalis
suprahyoids

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27
Q

as we depress the mandible what are the arthrokinematics?

A

Roll = posterior
Glide = anterior

NOTE: For any of that to occur we must have an inferior pull - we have to distract the DMJ a little bit (keeps us from pinching up the disc)

note: this is opening the jaw

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28
Q

What are the arthokinematics of elevating jaw (closing mouth)

A

Roll = anterior
Glide = posterior

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29
Q

Arthrokinematics are latearl excursion (test question here)

A

Spine = ipsilatearl
Anterior glide = contralateral

notice in the picture the teeth coming forward
* do it in own mouth and see how teeth come forward

will also need to know all the muscles involved

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30
Q

which muscle refers to the ipsilatearal year then above both eyes?

A

SCM - clavicular portion

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31
Q

Which muscle refers to the back of the head - and makes an opposite U shap around the eye?

A

SCM - sternal portion

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32
Q

which muscle refers pain to the ipsilatearl jaw line area and up the back of the skull, along with the front 4 teeth

A

Digastric muscle

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33
Q

which muscle refers to the ipsilatearl top row of teeth - above eyebrow and over the side of the latearl head?

A

temporalis muscle

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34
Q

How would you know if a muscle is reffering to create tooth aches?

A

resist the muscle / poke the muscles and see if that pain is brough on

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35
Q

KNOW: tooth aches normally encompases one - two teetch - however, if an entire row of teeth just randomly start aching thats when we start thinking its being reffered from a muscle (but also make sure to rule out infection)

A
36
Q

What muscle refers to the jaw mostly but can also present as an ear ache (with pain sometimes on the eyebrow)

A

Masseter

37
Q

What muscles (3) present w/ reffered pain to the ear?

A

Masseter
medial pterygoid
latearl pterygoid

38
Q

What muscle refers pain to just the ear?

A

medial pterygoid

39
Q

What muscle refers pain to the ear / zygomatic bone?

A

lateral pterygoid

40
Q

What 3 nerves are in the trigeminal nerve?

A

Opthalamic
Maxillary
Mandibular

41
Q

where does the opthalmic nerve provide sensation

A

forehead

42
Q

where does the maxillary n innervate

A

middle of face

43
Q

where does the mandibular n innervate

A

jaw

44
Q

KNOW: TMJ joint is highly innervate - so anytime the disc gets pinched we really feel it

A
45
Q

**depression arthrokinematics cont’d

explain the complex version of jaw depression**

A

NOTE: This is opening mouth

First 50% of depression = posterior roll

Second 50% = of depression = anterior glide

NOTE: The disc and the mandibular condyle move together

46
Q

What is an anterior disc displacement w/ reduction?

A

As they open their mouth the disc reduces back onto the condylar head which creates that clicking sensation

the disc starts dislocated then moves into a relocated position which creates the click

NOTE: often audiable for the pt and not us - which is why palpation is important - can also be very audiable. There will 2 clicks - one is when it opens and the disc reduces and the second is when they close and the disc re dislocates anterior (as shown below)

47
Q

What causes the disc to dislocate anterior on anterior disc displacement w/ reduction?

A

Excessive contraction of the latearl pterygoid (reciprocal click)

KNOW: medial ptyerygoid assests in opening mouth while latearl pterygoid assests in closing (which is what is happening above)
* medial pterygoid = saying it opens mouth more = its what opens mouth
* Lateral pterygoid = doesnt open mouth much = closes mouth

48
Q

**Test question: **psyologically whats occur for the pt w/ anterior disc displacement w/ reduction during the reciprocal click?

A

lateral ptyergoid is contracting and pulling that disc ANTERIORLY keeping it in that dislocated posittion (pulling to hard and dislocating it)

opening = disc goes back where it belongs
closing = disc dislocates anteriorly

49
Q

is there a click w/ anterior disc displacement w/o reduction? why?

A

No clicking
because that disc is perminantly dislocated anteriorly so it never slides in and out of place (which is what causes that click)

50
Q

Why would an anterior disc displacement w/o reduction have limited opening? why would disc displacement w/ reduction not have limited opening

A

because w/o displacement means that disc is hanging out anterior - so when i open my mouth that disc is blocking is from fully opening - HOWEVER - if that disc is extremely anteriorly dislocates you will not have limited opening because that disc is so far anterior that it will not block the joints anterior glide

Disc displacement w/ reduction does not have limited opening because when they open their mouth the disc relocates into the TMJ joint space (click) and does NOT block anterior

51
Q

KNOW: myogenic = muscle is reproducing jaw pain (or myoalgia)

A
52
Q

KNOW: arthrogenic = jaw pain coming from joint
* do a posititve joint compression test (compressing joint - think superior glide which is compressing the joint causing pain)

A
53
Q

If I have creptitis w/ moving joint (opening / closing mouth) am I thinking its myogenic, arthrogenic or cervical spine involvement?

A

arthrogenic - the joint is whats causing the pain (reffered jaw pain coming from joint if clicking is involved)

54
Q

KNOW: You absoulety can have mutiple issues at the same time (think having TMJ w/ C spine issues)

A
55
Q

What part of the cervical spine is most involved in TMJ

A

Upper (c1-3)

56
Q

What part of the cervical spine is involved in cervicogenic HA’s?

A

Upper

57
Q

What part of the cervical spine is involved w/ cervical radiculopathy?

A

lower (c6-7)

58
Q

what part of the cervical spine is involved in cervicogenic dizziness?

A

Upper

59
Q

What is bruxism?

A

Grinding teeth

60
Q

Why would it be important to know if jaw pt has sleep apnea

A

because if they did they would proably sleep w/ mouth opening = elongation of jaw depressor muscle (think latearl ptyerygoid etc..)

61
Q

Why would a TMJ have issues w/ psycological problems

A

because they can’t eat

62
Q

What would we need to rule out for TMJ pts? (red flags)

A

C-spine instability
UMN lesions
Vertebrobasilar insufficiency

63
Q

What 3 tests help us rule out upper cervical spine instability

A

Alar ligament
Sharps purser
transverse ligament stress test

64
Q

What are tests for an UMN lesion? (4)

A

Hoffman
Babinski
Inverted supinator sign
Clonus

65
Q

If were screening a joint what two things are we gonna do?

A

ROM
Then OP

66
Q

KNOW: if pt starts to have symptoms above the EOP and up into the skull I’m going to start doing cranial nerve testing at that point

A
67
Q

KNOW: When screening for TMJ you should look at the middle teeth and make sure they stay in line when opening jaw. also look for opening and closing patterns (S pattern ir C pattern)

A
68
Q

If I distract a joint and it feels better is it more likely intra-articular or periarticular?

A

Intra

69
Q

Opening mouth is how many mm

A

35-55

70
Q

Functional mouth opening range

A

25-35 mm

71
Q

Protrusion mm

A

3-6mm

72
Q

Retrusion mm

A

3-4mm

73
Q

deviation mm

A

10-15mm

74
Q

Whats a good way to measure functional opening of someones mouth?

A

3 fingers in mouth

75
Q

With an S curve or a C curve does a pts teeth end aligned

A

S = ends alligned (goes out then comes back)

76
Q

Do teeth end alligned in a c curve?

A

misassligned

77
Q

for your TMJ displacements which way do they deviate?

A

Towards the side w/ the displacement (doesnt matter if the a reduction or non-reduction displacement type)

ipsialtearl deviation for disc displacements

78
Q

What thing are S curves typically due to? (2). What kind of mobility

A

loss of neurmuscular control issues / muscular weakness

KNOW: neuromuscular control can be a muscle in pain that does not work the way it should
* if the muscle has been hurting they might present that way

normally hypermobility

79
Q

Someone w/ a C curve has what kind of issues? what kind of mobility?

A

Capsular issues
often hypomobility (often that hypomibility goes toward the side of disfucntion)

80
Q

KNOW:
S curve = hypermobility
C curve = hypomobility

A
81
Q

Which side is the disfunction on?

A

deviates to their left = left sided dysfunction

82
Q

What is a loaded bite test?
* w/ biting down which side is approximated and which side is gaping?

A

Take 3-4 tongue depressors and keep them stacked on one another and go to the side of pain.

The side they are bitting down on is actually distracted while the contralatearl side is approximated

If they bite down on the right and theres still ipsilatearl right pain im not really thinking its joint pain because the joint is distracted (even though they’re biting down on that right side the joint is distracted)
* I’m thinking its more muscular pain because the joint is not involved anymore

if you then go over to the left side and have them bite down and it hurts on the right side we now think its joint pain because the right is now approximating while the left is gaping
* so you would have to switch sides and have them bite to appromiate the painful side

Ipsilatearl pain = muscular
contralatearl pain = joint related

83
Q

KNOW: T-spine normally hypomobile
* note: this can limit extension of LOWER cervical spine

A
84
Q

Chin to throat = capital flexion
Whats up nod = capital extension

A
85
Q

With jaw pain whats the first thing you should do? (place you should work)

A

Start by messing w/ the upper cervical spine

86
Q

KNOW: order of opperation for TMJ pts:
1) Upper cervical spine
2) Mid/lower cervical spine
3) TMJ complex
4) Clavicle and 1st rib
5) upper throacic spine and ribs 2-4

A
87
Q

How would you explain to a pt the reason you’re looking at neck instead of jaw

A

theres a lot of connections between the neck and the jaw. A lot of the time the main thing thats causing the problem is your neck and not actually your jaw. I just want to take a good luck at everything just to make sure we don’t miss anything and get you feeling better soon.

Don’t go into all the fine detail - the most basic explaination is normally enough

Also reasure them that were going to look at jaw as well - were just going to start from a top down appraoch starting w/ their jaw

Spine Test 1 (14 decks)

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