Lecture 9: TMJ Flashcards
What type of joint is the TMJ?
synovial bi condylar joint, cant work alone if problem at one side will affect other side
What type of cartilage is the TMJ disc comprised of?
fibrocartilage
What are three zones of TMJ disc?
- posterior/bilaminar zone- richly innervated (pain), highly elastic
- middle/intermediate- not innervated , weight bearing surface of bones
- anterior portion- innervated
What is the only muscle that connects to the tmj disc?
lateral pterygoid
What nerve is responsible for supplying sensory and motor innervation to TMJ?
trigeminal CN 5
What is the open packed position of the TMJ?
tongue on roof of mouth, lips closed but teeth not touching
What is closed packed position of TMJ
clenched mouth
What motion occurs during first 1/3 of motion?
rotation of inferior compartment approx: 20 mm
What motion occurs at TMJ during last 2/3 of motion?
translation of superior compartment of disc and condyle
approx 20-30 mm
If one side of TMJ is hypomobile during opening which side will it deflect to?
the side that is hypomobile
What are some subjective questions to ask during a TMJ eval?
- pain with opening or closing?
- pain with eating or yawning?
- what side do they eat on?
- locking or clicking?
- any CN sx?
- have you seen a dentist lately
What are red flags during a TMJ eval?
- infection- inability to open or recent surgery
- fracture- ecchymosis, signifcant pain with clenching
- bleeding under tongue
What are two major components of an oral health screen?
observe face, lips gums, teeth, lateral borders, beneath tongue
palpate neck for glands or lymph nodes, floor of mouth
What areas of TMJ should be palpated during an exam?
joint line for edema and symmetry
masseter, temporalis and medial pterygoid
What are the 4 directions of ROM needed to obtain for TMJ?
- hinge- should account for 1/3 of motion, open with tongue on roof of mouth
- depression- 40-50 mm fill opening
- lateral deviation- should be 1/4 of depression, approx 10 mm
- protrusion- able to put bottom teeth in front of top
What components of neuro assessment should be examined for TMJ?
sensation, CN, reflexes
What are you looking for during a strength assessment for TMJ?
resisted isometric movements, are they symmetrical ?
What are three special test for TMJ?
- bite- bite on left loads right joint
- posterior loading- indicates retro discal or extra capsular dysfunction
- superior loading- indicates intra articular or discal dysfunction
What diagnostic criteria will help rule in internal derangement or within joint?
ROM, muscle joint palpation, joint sounds, single test, reciprocal click (disc involvement)
What diagnostic criteria will help rule in internal derangement with out reduction or no disc involvement?
crepitation, deflection, pain, limited mouth opening (hypomobility)
What are 4 types of joint mobs for TMJ?
longitudinal, posterior/anterior glide, medial glide, lateral glide
What is longitudinal distraction used for?
to improve mandibular depression (opening) and inferior compartment rotation
only mob to address rotation
What is the posterior/anterior glide used for?
improve depression for the superior compartment anterior glide and protraction
What interventions can be done for an inflamed TMJ?
US- 3mhZ, 0.5 w/cm2, for 5 mins pulsed
5 min ice massage, TENS
What interventions can be done for an hypomobile TMJ?
joint mobs, MWM, self mobs, AAROM, contract relax PNF, sustained stretches
What interventions can be done for an hypermobile TMJ?
muscle re-ed, guided motions, visual feedback with mirrors always, isometrics, loaded movement, posture
