Module 1: TMJ Flashcards
fixing underlying problems is essential for
stability of spine, axial skeleton, and extremities
TMJ, rib, and shoulder girdle have relationship with
cervical spine and upper extremity stability
Anterior disc
Superior, Lateral TMJ
Posterior Disc
Anterior, Inferior TMJ
if loading on a particular bone increases, the bone will remodel itself over time to become stronger to resist sort of loading
Wolff’s Law
what part of the bone gets thicker according to Wolff’s Law?
external periosteum
why do bones lose strength if not under load
no stimulus to maintain mass, less metabolically costly to maintain
Davis Law used to describe
muscle-length relationship
predict rehab and postural distortion outcomes as far as muscle length
Davis Law
how soft tissues model along imposed demands (how a muscle with lengthen in response to stretching)
law of reciprical innervation states that the muscle inhibition usually generates hypertonicity/tightness in antagonist muscles
Sherrington Law
abnormal muscle inhibition is as neurologically important as
over facilitation in patients with pain and dysfunction
what may cause fixated joints
joint adhesions or mechanoreceptor inhibition
hypermobilization may be due to
trauma or long term stretching of ligaments in joint that have healed in pathological position
adjust hypermobile joints before stabilizing due to
proprioception/mechanoreception
there is a build up of tissue where there is
stress/friction over time
when activated under extreme conditions, mechanoreceptors
inhibit adjacent muscle activity
mechanoreceptors are located
in every synovial joint
nociceptors are
slow adapting, high threshold
Type IV are
nociceptors
slow adapting, low threshold
capsules
stress for postural control, conscious proprioception
rapid adapting, low threshold
synovium
slow adapting, high threshold
ligaments
analyzes stretch reflex
muscle spindle
stretch reflex and recruit adjacent muscle fibers to increase strength called
autogenic excitation
causes autogenic inhibition-opposite of muscle spindles, causes relaxation with stretch
golgi tendon
nociceptors activate
sympathetic nervous system
joints and muscles acting on them have the same nerve supply
Hiltons Law
neuromuscular phenomenon that occurs when a joint dysfunction inhibits muscles that surround the joint
arthrokinematic inhibition
segments misalign to
proximal segment
1 in 3 patients that suffer whiplash will experience
TMJ symptoms
TMD affects what percent of the populaton
10-40% of general population
How long does it take to decrease TMD pain
at least 4 weeks
for every year of TMD, how long under care
1 month
TMJ depends on what 3 things
teeth size, position, occlusal surface alignment
TMJ Assessment involves
ROM (active, passive, active resisted)
observe deviation, pain, clicks, catches, etc.
why should you observe TMJ while seated
gravity and proprioception
when checking TMJ fossa, avoid pressing firmly due to
patient sensitivity
what are you feeling in TMJ palpation
glenoid fossa
finger falling in second is the
involved side
side the jaw initially deviates to is
involved side
measurement of left and right deviation
> 7mm
protrusion and retraction measurement is
> 6mm
on protraction and retraction RMT, what is the side of weakness
side that the mandible deviates to
what can be used for bilateral weakness o TMJ
helmet chin strap
TMJ is one of the most
muscle imbalanced areas in the human body (chewing on one side)
while muscle testing what are we looking for
weakness, failure to “lock”
usually side with greater motion is involved side because opposite side disc is
not impeding condyle’s forward glide
know the 12 signs of TMS
look at packet
clenching involves what muscle
temporalis
grinding involves
pterygoid
what does the pterygoid do to the disc
pulls it forward
equal spacing of condyle in fossa means
neutral jaw
receeding gums due to
teeth grinding, leads to cavities
disc displacement due to
direct trauma
intubation
dental work
big bite
long time muscle imbalances due to
chewing on one side
AHS
sleep posture
resting head on hands
what can TMJ issues be disguised as
ear infection fullness in ear headache, toothache C1 subluxation sinus infection
superior posterior lateral TMJ
disc moved anterior inferior allowing condyle to occupy space
SPL ROM
jaw towards side of involvement until condyle bumps against anterior disc; may click
if there is clicking at the end of ROM
do not adjust. hypermobility. fix with exercises
TMJ with less than 3 signs/symptoms has
TMD
patient with 3 or more signs/symptoms has
TMS
SPL jaw LOD
Anterior, inferior, medial
pathonomonic sign of anterior inferior condyle (posterior disc)
inability to close the teeth together on side of involvement
anatomy of posterior disc/anterior condyle
disc displaced posterior, moving the condyle anterior, limiting closing mechanism
symptoms of posterior disc
malocclusion, may have sudden ear pain, can open more than 20 mm, do 2-3x
Bruxism mouthguard stages
- ) teeth guard from drug store
- ) heat moldable guard
- ) custom one from dentist
acute injury
pain usually on involved side 2-3 months
chronic injury
pain is opposite side of problem
when should referral be considered
not getting better after 6 visits
post adjustment management
avoid foods tough to chew, icing with dixie cup 5 minutes 3x a day, exercises first two weeks twice a day in direction of weakness
what muscles should be considered
deep neck flexor weakness and SCM shortness
causes of grinding
misalignments, muscle imbalance, stress, parasites, posture, cervical issues
what muscles should be checked for shortening
SCM, scalenes, upper traps, masseter, pterygoids, temporalis
