Orthopedic clinical exam (Cleland) Basic Anatomy of TMJ and Shoulder Flashcards
TMJ: Ligaments (3)
- Temporomandibular
- Sphenomandibular
- Stylomandibular
Attachment and function of temporomandibular ligament
- Temporomandibular- thickening of anterior joint capsule extending from neck of mandibe to zygomatic arch (strengthens the TMJ laterally)
Attachment an function of Sphenomandibular ligament (TMJ)
- Sphenoid bone to mandible (serve as a fulcrum and reinforcement to TMJ motion)
Attachment and function of Stylomandibular ligament (TMJ)
- Styloid process to angle of the mandible
Temporalis muscle (TMJ)
- Prox- temporal fossa
- Dist- Coronoid process and anterior ramus of mandible
- Nerve and segmental level- Deep temporal branches of mandiular nerve
- Action- Elevate mandible

Masseter
- Prox- Inferior and medial aspects of zygomatic arch
- Dist- Coronoid process and lateral ramus of mandible
- Nerve and segmental level- Mandibular nerve via masseteric nerve
- Action- Elevate and protrude mandible

Medial Pterygoid (TMJ)
- Prox- Medial surface of lateral pterygoid plate and tuberosity of maxilla
- Dist- Medial aspect of mandibular ramus
- Nerve and segmental level- Mandibular nerve via medial pterygoid nerve
- Action- Elevate and protrude mandible

Lateral Pterygoid (TMJ)
- Prox- (Superior head) Lateral surface of greater wing of sphenoid bone/ (Inferior head) Lateral surface of lateral pterygoid plate
- Dist- Neck of mandible, articular disc, and TMJ capsule
- Nerve and segmental level- Mandibular nerve via lateral pterygoid nerve
- Action- Acting bilaterally: protrude and depress mandible. Acting unilaterally: laterally deviate mandible

Digastric muscle (TMJ)
- Prox- (Anterior belly) Digastric fossa of mandible/ (Posterior belly) Mastoid notch of temporal bone
- Dist- Intermediate tendon of hyoid bone
- Nerve and segmental level- Mylohyoid nerve (anterior) and Facial nerve (posterior)
- Action- Depresses mandible, raises and stabilizes hyoid bone

TMJ nerves
- Mandibular (motor-temporalis, masseter, lateral and medial pterygoid, digastric, mylohyoid/sensory-skin of inferior third of face)
- Nerve to mylohyoid (motor- mylohyoid/no sensory)
- Buccal (no motor/ sensory-cheek lining of gingiva))
- Lingual (no motor/ sensory- anterior tounge and floor of mouth)
- Maxillary (no motor/ sensory- skin of middle third of face)
- Opthalmic (no motor/ sensory-skin of superior third of face)

TMJ Exam History:
Jaw crepitus and pain during mouth opening and closing
- OA
- Capsulitis
- Internal derangement consisting of anterior disc displacement without reduction
TMJ Exam History:
Patient reports jaw clicking and pain during opening and closing of the mouth
- Internal deragement consiting of anterior disc displacement with reduction
TMJ Exam History:
Patient reports limited motion to about 20 mm with no joint sounds
- Capsulitis
- Internal deragement consiting of an anterior disc displacement without reduction
Shoulder joints (4)
- Glenohumeral
- Sternoclavicular
- AC
- Scapulothoracic
Shoulder:
Closed packed positions
- GH- Full abduction and ER
- SC- Arm abducted to 90 degrees
- AC- Arm abducted to 90 degrees
- ST- NA
Shoulder:
Capsular Patterns
- GH- ER <abd>
</abd><li>SC- NR</li><li>AC- NR</li><li>ST- NR</li>
</abd>
Shoulder:
Ligaments (8)
- Glenohumeral
- Coracohumeral
- Coracoclavicular (trapezoid & conoid)
- Acromioclavicular
- Coracoacromial
- Sternoclavicular
- Interclavicular
- Costoclavicular
Glenohumeral igament (shoulder)
- Attach- glenoid labrum of humerus
- Function- reinforce anterior GH joint capsule

Coracohumeral ligament (shoulder)
- Attach- Corocoid process to greater tubercle of humerus
- Function- strengthen superior glenohumeral joint capsule

Coracoclavicular ligament (shoulder)
- Attach- (trapezoid) superior aspect of coracoid process to inferior aspect of clavicle/ (conoid) coracoid process to conoid tubercle on inferior clavicle
- Function- Anchor clavicle to corocoid process

Acromioclavicular ligament (shoulder)
- Attach- acromion to clavicle
- Function- Strengthen AC joint superiorly

Coracoacromial ligament (shoulder)
- Attach- coracoid process to acromion
- Function- Prevent superior displacement of humeral head

Sternoclavicular ligament (shoulder)
- Attach- clavicular notch of manubrium to medial base of clavicle anteriorly and posteriorly
- Function- reinforce SC joint anteriorly and posteriorly

Costoclavicular ligament (shoulder)
- Attach- superior aspect of costal cartilage of 1st rib to inferior border of medial clavicle
- Function- Anchor medial end of clavicle to 1st rib
Upper trapezius
Middle trapezius
Lower trapezius
Levator scapulae
Rhomboids
Latissimus Dorsi
Serratus anterior
Deltoid
Pectoralis Major
Pectoralis Minor
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
Teres major
Radial nerve
Segmental levels- C5-T1
Sensory- Posterior aspect of forearm
Motor- Triceps brachii, anconeus, brachioradialis, extensor mm of forearm
Ulnar nerve
Segmental levels- C7, C8, T1
Sensory- Medial hand including medial half of 4th digit
Motor- Flexor carpi ulnaris, medial half of flexor digitorum profundus, and most of small muscles in hand
Musculocutaneous nerve
Segmental levels- C5, C6, C7
Sensory- Becomes lateral antebrachial cutaneous nerve
Motor- Coracobrahialis, biceps brachii, brachialis

Axillary nerve
Segmental levels- C5, C6
Sensory- Lateral shoulder
Motor- Teres minor, deltoid

Suprascapular nerve
Segmental levels- C4, C5, C6
Sensory- No sensory
Motor- Supraspinatus, Infraspinatus
Dorsal scapular nerve
Segmental levels- ventral rami, C4, C5
Sensory- No sensory
Motor- Rhomboids, levator scapulae
Lateral pectoral nerve
Segmental levels- C5, C6, C7
Sensory- No sensory
Motor- Lateral and Medial pectoralis

Medial pectoral nerve
Segmental levels- C8, T1
Sensory- No sensory
Motor- Pectoralis minor
Long thoracic nerve
Segmental levels- Ventral rami, C5, C6, C7
Sensory- No sensory
Motor- No serratus anterior

Upper subscapular nerve
Segmental levels- C5, C6
Sensory- No sensory
Motor- Subscapularis
Lower subscapular nerve
Segmental levels- C5, C6
Sensory- No sensory
Motor- Teres major, Lower subscapularis
Medial cutaneous nerve of forearm
Segmental levels- C8, T1
Sensory- Medial arm
Motor- No motor

Shoulder exam history:
Patient reports lateral/anterior shoulder pain with overhead activities or deomonstration of a painful arc
- possible subacromial impingement
- possible tendonitis
- possible bursitis
Shoulder exam history:
Patient report of instability, apprehension, and pain with activities most often when shoulder is abducted and externally rotated
- shoulder instability
- possible labral tear if clicking present
Shoulder exam history:
Decreased ROM and pain with resistance
- possible rotator cuff or long head of the biceps tendonitis
Shoulder exam history:
Patient reports of pain and weakness with muscle loading, night pain, age >60
- possible rotator cuff tear
Shoulder exam history:
Patient complaints of poorly located shoulder pain with occasional radiation into elbow. Pain is usually aggravated by movement and relieved by rest. Age >45. Females often affected more than males.
- possible adhesive capsulitis
Shoulder exam history:
Patient reports of a fall on the shoulder followed by pain over AC joint
- possible AC sprain
Shoulder exam history:
Patient complaints of UE heaviness or numbness with prolonged postures and when lying on involved side
- possible TOS
- possible cervical radiculopathy