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PCE > Msk TMJ And cervical > Flashcards

Msk TMJ And cervical Flashcards

1
Q

What are the three ligaments of the temporomandibular joint?

A

1-lateral ligaments ( helps restrain the jaw mov)
2-stylomandibular lig
3-sphenomandibular lig

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2
Q

What are some signs/symptoms of Osteoarthritis of the TMJ?

A

Degenerative changes
Diffuse pain
Decrease ROM
Stiffness on waking
Atrophy and weakness of mm of mastication
Crepitus

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3
Q

What are some signs/symptoms of disc displacement with reduction of the TMJ?

A
  • Clicking w movement
  • Double click:
    1- reduction of disc
    2-dislocation of disc
    -anterior disc displacement most common
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4
Q

What are some signs/symptoms of disc displacement without reduction of the TMJ?

A

Jaw does not full open or fully close

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5
Q

How is the jaw Closed lock?

A

Locking on opening. Jaw cannot fully open more then 30mm. ( normal is 50mm)
Anterior displacement of disc

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6
Q

How is the jaw Open lock?

A

Locking on closing. Jaw can not close
Posterior displacement of disc

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7
Q

What is the sign for Hypomobility syndrome of TMJ?

A

Deviation towards affected side -ipsilateral
Decreased ROM
Signs of contracture

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8
Q

What is the sign for Hypermobility syndrome of TMJ?

A

Increased ROM
Pain w opening
Deviation towards unaffected side (contra lateral)
Noise at end range

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9
Q

What are the TMJ normal values for
Functional opening:
Maximal opening:
Lateral deviation:
Protrusion:
Retrusion:

A

Functional opening: 40mm
Maximal opening:50mm
Lateral deviation:9mm
Protrusion:9mm
Retrusion:1-2mm

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10
Q

What is the special test for functional opening of the Jaw?

A

The “ Knuckle test”.

Functional opening =2 flexed prox interphalangeal joint within open mouth

Maximal opening =3 flexed prox interphalangeal joint within open mouth

Positive test: if there is inability to fit the fingers

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11
Q

What are some interventions for TMj?

A

Education
Fascial m relaxation
Tongue proprioception and control
Jaw proprioception and control
Strengthening (can do isometric)
Manual therapy
Modalities ( us,laser,tens)

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12
Q

How is the joint manipulation technique for Anterior displacement disc?

A

Pull jaw down and foward

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13
Q

How is the joint manipulation technique for Posterior displacement disc?

A

Pull jaw down and back

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14
Q

How many cervical vertebrae?

How many nerve roots we have in the cervical?

How many intervetebral discs we have in the cervical?

A

7 cervical vertebrae

8nerve roots (c1-c8) nerve roots exit ABOVE the corresponding disc

6 intervertebral discs. No disc between C0-C1 and C1-C2.

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15
Q

What is cervical radiculopathy?

A

Group of signs and symptoms related to a compressed or irritaed nerve root.

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16
Q

Why should u test the dermatome or myotome?

A

If u wanna rule out nerve compression

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17
Q

How is performed the dematome procedure?

A

-area to be tested has to be exposed

-test an unrelated body party (face/leg) to check pt understanding

-ask pt to close eyes

-test the entire dermatome,proximal to distal

-test bilaterally at the same time

-start with light touch and if impaired progress to test with sharp/dull or cold/hot

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18
Q

Which muscles are activate when your jaw deviates to the LEFT?

A

Contralateral: pterygoides
Ipislateral: masseter and temporallis

So jaw deviate to Left side is left masseter and temporalis and right pterygoids.

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19
Q

Jaw deviation and muscles…

A

Contralateral of deviation: pterygoides
Ipislateral: masseter and temporallis

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20
Q

How to test the myotome?

A

To test the muscular function.

-pt is positioning usually sitting

-PT position joint to be tested in neutral position

-“hold this position and don’t let me move u”

-PT applies manual resistance for 5-8seconds while pts resists movement

-test bilaterally whenever possible

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21
Q

What is the position to test the Myotomes for C1-C2?

A

C1-C2: neck forward flexion

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22
Q

What is the position to test the Myotomes for C3?

A

Neck side flexion

23
Q

What is the position to test the Myotomes for C4?

A

Shoulder elevation

24
Q

What is the position to test the Myotomes for C5?

A

Shoulder abduction

25
Q

What is the position to test the Myotomes for C6?

A

Elbow flexion or wrist extension

26
Q

What is the position to test the Myotomes for C7?

A

Elbow extension and wrist flexion

27
Q

What is the position to test the Myotomes for C8?

A

Thumb extension or ulnar deviation

28
Q

What is the position to test the Myotomes for T1?

A

Finger abduction/adduction

29
Q

Which deep tendon to test for C5 ?

A

Deltoid

30
Q

Which deep tendon to test for C6?

A

Biceps /Brachioradialis

31
Q

Which deep tendon to test for C7?

A

Triceps

32
Q

Which deep tendon to test for C8?

A

Pronator quadratus

33
Q

Which deep tendon to test for T1?

A

Abductor digiti minimi

34
Q

What is the Jendrassik maneuver?

A

Distraction technique
LEs: ask pt to cross their leg and try to isometric Abducts the les

UEs: ask pt to clasp their hands and try to pull it apart

35
Q

What is the DTR(deep tendon) reflexes grading?

A

0: no response
1+: decreased response
2+:normal response
3+: exaggerated response
4+: clonus/very brisk

36
Q

What are the 4 cervical special tests?

A

1- Cervical distraction test

2- Spurling’s or foraminal compression test

3- upper limb tension tests (medial nerve,radial nerve and ulnar nerve

4- Sharp purser test ( subluxation of c1/c2)

37
Q

What is the purpose of the Cervical distraction test and how it’s performed?

A

The is used when pt is CURRENTLY experiencing radicular symptoms.

PT places one hand under chin and the other hand around the occiptus, lifts upwards to apply a traction to the c spine.

Positive test: radicular symptoms decreased or abolished

38
Q

What is the purpose of the Spurling’s (foraminal compression )test and how it’s performed?

A

PT applies axial load by pressing straight down on pt’s head.
If no symptoms: side flexion to affected side

Positive test: reproduction of radicular symptoms.

39
Q

What is the purpose of the upper limb tension (neurodynamic) test and how it’s performed?

A

Pt is supine

Test unaffected side first

Order of limb position: shoulder-forearm-wrist -elbow

Sensitizing test: contralateral cervical side flexion

Relieving: ipislateral side flexion

40
Q

What is the purpose of the Sharp purser test?

A

To detemine subluxation of C1 on C2

41
Q

What are the two most common brachial plexus injuries?

A

1-Erb duchene paralysis
2-Klumpke’s paralysis

42
Q

What is the Erb duchene paralysis? What is the typical position?

A

Injury to the upper nerve roots c5-c6( upper brachial plexus)

Typical position: waiter’s tip

Arm hanging by the side
Shoulder internal rotation
Elbow extension
Forearm pronation

43
Q

What is the Erb duchene paralysis treatment?

A

Immobilization initially
Positioning
Splinting
gentle ROM
functional training

44
Q

What is the Kumpke’s paralysis? What is the typical position?

A

Injury to the lower nerve roots C8-T1 causing weakness and paralysis in the muscles of the forearm,hand and triceps.

Position: elbow flexion,forearm supination,wrist and MCP extension,PIP and DIP flexion.

Cause “claw hand”

45
Q

What are the muscles involved in Erb duchene paralysis?

A

Deltoid,
Teres minor
Supra and infra spinatus
Biceps and brachialis

46
Q

While examining the alignment of the pt upper extremity, which of the following is not a component of ideal postural alignment?

a. One third of the head of the humerus protrudes in front of the acromion.

b. The inferior pole of the scapula is held flat against the thorax.

C.Antecubital creases face anterior and olecranon face posterior.

d. The root of the scapula is at the level of T6.

A

D
• The root of the scapula should be at the level of T3.

47
Q

You determine the patient needs to improve her sitting posture. Which of the following would be an appropriate ergonomic change to her desk setup?

a. Adjust the top of the screen so it is just below eye level and ½ arms distance length away.
b. Adjust the backrest so it is in an erect position or a 5-degree tilt forward.
c. Wrist position on the keyboard should be adjusted to sit in slight flexion.
d. The chair height should be adjusted so that the knees are at or below hip level.

A

D

48
Q

You prescribe the patient an isometric subscapularis exercise. Which of the following innervates the subscapularis muscle?
a. Upper and lower subscapular nerves
b. Upper subscapular nerve
c. Lower subscapular nerve
d. Suprascapular nerve

A

A

49
Q

You perform Spurling’s test. Which of the following is a positive finding for nerve root compression?

a. Pain radiates into the opposite arm to which the head is side flexed during compression.
b. Neck pain is felt but there is no pain radiating into the shoulder or arm.
c.. Pain radiates into the arm toward which the head is side flexed during compression.
d. All of the above are positive findings of the Spurling’s test.

A

C

• Pain radiates into the opposite arm to which the head is side flexed during compression -Incorrect
This is called reverse Spurling’s sign and is indicative of muscle spasm in conditions such as tension myalgia and WADS

• Neck pain is felt but there is no pain radiating into the shoulder or arm - Incorrect
• This does not constitute a positive test.

50
Q

Next, you perform upper limb tension tests. Which of the following statements is false regarding brachial plexus tension testing?

a. The upper limb tension tests are equivalent to the straight leg raise in the lumbar spine.
b. Each test begins by testing the good side first and positioning the shoulder, followed by the elbow, forearm, wrist, and fingers.
c. These tests are designed to stress neurological tissues, but they also stress some contractile and inert tissues.
d. Upper limb tension test are contraindicated in an acute phase of injury and if caudal equina or spinal cord lesions are present.

A

B

51
Q

Which of the following most closely represents the estimated average rate of peripheral nerve regeneration?

a. 1mm per month.
b. 1mm per day.
c. 1mm per year.
d. All of the above are positive findings of the Spurling’s test.

A

B

52
Q

Your 6 weeks post concussion patient returns to see you for reoccurring headaches and jaw pain.
In sitting, his tongue is placed on the roof of his mouth, teeth are together, and lips are closed. On palpation, he reports tenderness over the angle of the mandible, temples and suprahyoid muscles.

Which of the following is the proper resting position of the tongue, mouth and jaw?

a. Tongue up, teeth apart, lips closed.

b. Tongue down, teeth together, lips slightly open.

c. Tongue up, teeth together, lips slightly open.

d. Tongue down, teeth apart, lips closed.

A

A

53
Q

Your 6 weeks post concussion patient returns to see you for reoccurring headaches and jaw pain.
In sitting, his tongue is placed on the roof of his mouth, teeth are together, and lips are closed. On palpation, he reports tenderness over the angle of the mandible, temples and suprahyoid muscles.

Which of the following muscles attaches to the articular disc?
a. Inferior head of lateral pterygoid.
b. Masseter.
c. Superior head of lateral pterygoid.
d. Medial pterygoid.

A

C

54
Q

Which of the following is the most appropriate force to produce vertebral separation of the cervical vertebrae?

a. 1% of body weight.
b. 3% of body weight.
c. 5% of body weight.
d. 10% of body weight.

A

D

PCE (30 decks)

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