S2L5: Cervical Region & TMJ

Question 1

PAIN-SENSITIVE STRUCTURES (8)

Answer 1

● Ligaments
● Facets’ capsules
● Periosteum of the vertebrae
● Muscles
● Anterior dura mater
● Dural sleeves
● Epidural areolar adipose tissue
● Walls of blood vessels

Question 2

COMMON ORTHOPEDIC CONDITIONS

Answer 2

● Cervical strain
● Cervical headache
● Cervical radiculopathy
● Cervical spondylosis

Question 3

OTHER CERVICAL CONDITIONS/INJURIES

Answer 3

● Whiplash injury
● Neck pain
● Impaired postural support from trunk muscles
● Impaired muscle endurance

Question 4

ligamentous injuries

Answer 4

Cervical Sprain

Question 5

muscle injury in the neck

Answer 5

Cervical Strain

Question 6

Occur from a variety of traumatic or atraumatic mechanism that result in irritation and compression of the cervical and upper back muscles (and pain sensitive areas causing neck pain)

Answer 6

Cervical strain

Question 7

Cervical strain impairments (5)

Answer 7

○ Pain, sti ffness, and tightness in the neck area
○ Tenderness
○ Muscle spasm

Question 8

Other terms to describe a cervical strain (4)

Answer 8

○ Whiplash
○ wry neck (an acute form of torticollis)
○ mechanical neck pain
○ trapezius strain

Question 9

Onset of cervical strain

Answer 9

incident of trauma or spontaneous

Question 10

Cervical strain conditions aggravated by flexion-based activities:

Answer 10

○ transverse and/or alar ligament sprain
○ supraspinous and interspinous ligament sprain
○ Fracture
○ disc protrusion
○ muscle strain

Question 11

Cervical strain conditions aggravated by extension-based activities:

Answer 11

○ central canal stenosis
○ facet joint dysfunction
○ Spondylolisthesis
○ muscle strain

Question 12

Cervical strain conditions aggravated by side bending-based activities:

Answer 12

○ alar ligament sprain
○ Fracture
○ lateral stenosis
○ facet joint dysfunction
○ uncovertebral joint dysfunction
○ muscle strain.

Question 13

T/F: Chronic symptoms do not require more investigation as symptoms are associated with a single tissue source

Answer 13

False: Chronic symptoms MAY require more investigation as symptoms MAY NOY BE associated with a single tissue source

Question 14

Cervical headache is also known as (4)

Answer 14

○ Cervicogenic headache
○ Occipital neuralgia
○ Tension headache
○ Cephalalgia

Question 15

Any headache beginning in the neck

Answer 15

Cervical headache

Question 16

Aggravated by specific neck movement or sustained
neck posture

Answer 16

Cervical headache

Question 17

T/F: Cervical headache is bilateral and accompanied by tenderness of the C2–3 articular pillars on the aff ected side

Answer 17

False: Unilateral

Question 18

Reports a dull aching pain of moderate intensity, which begins in the neck or occipital region and then spreads to include a greater part of the cranium

Answer 18

Cervical headache

Question 19

Treatment for cervical headache

Answer 19

postural training and manual therapy

Question 20

Caused by structural changes in the cervical IV discs

Answer 20

Cervical radiculopathy

Question 21

Structural changes in the cervical IV discs (4)

Answer 21

Bulge, protrusion, extrusion, or sequestration

Question 22

2 most common causes of cervical radiculopathy

Answer 22

○ Cervical arthritis
○ Herniated nucleus pulposus

Question 23

Diagnosis of cervical radiculopathy

Answer 23

Diagnosis is based on: History of radicular pain and paresthesia, neurological impairment, and correlating abnormalities on x-rays

Question 24

Impairments of cervical radiculopathy (5)

Answer 24

○ Pain (neck pain, arm pain, scapular pain)
○ Numbness or tingling in particular fingers
■ Depends on the nerve root aff ectation
■ Represented by the dermatomal level
○ Weakness
■ Based on the myotome
○ LOM of neck
○ Tenderness, muscle spasm

Question 25

Chronic degenerative condition of the cervical spine that affects the vertebral bodies and the intervertebral discs (IVDs) of the neck, as well as the contents of the spinal canal (nerve roots and/or spinal cord)

Answer 25

Cervical spondylosis

Question 26

Cervical spondylosis impairments (5)

Answer 26

○ Limited mobility of the cervical spine ○ Morning stiffness of the neck ○ Pain ○ Tenderness along the lateral neck ○ LOM of neck

Question 27

Sudden acceleration-deceleration of the head in space Sudden hyperextension followed by hyperflexion of the neck Common in motor-vehicular collisions

Answer 27

Whiplash

Question 28

Activity Limitations of cervical radiculopathy

Answer 28

○ Bed mobility in supine pos ○ Basic ADLs ○ Participation restrictions

Question 29

Treatment of whiplash (3)

Answer 29

Treatment should be in accordance to the phase of recovery: ○ Pain management ○ Bracing — if needed for protection ■ Soft collar ■ Rigid orthosis of the spine ○ Patient education on the diagnosis ■ Pt needs to know what is wrong with them ■ How long the injury will cure ■ What they should do at home ■ What are possible therapy, exercises, or plan of care after the injury

Question 30

Neck pain progression

Answer 30

Mechanical stress > Pain-sensitive structures > Neck Pain

Question 31

Occurs in the absence of an inflammatory reaction

Answer 31

Mechanical stress: neck pain

Question 32

Treatment of neck pain

Answer 32

Focus on relieving the stress to the pain-sensitive structure relieves the pain stimulus, and the person no longer experiences pain

Question 33

Mechanical stress to pain-sensitive structures, such as sustained stretch to ligaments or joint capsules or compression of blood vessels ○ causes distention or compression of the nerve endings ○ leads to the experience of pain

Answer 33

Neck pain

Question 34

EFFECT OF IMPAIRED POSTURAL SUPPORT FROM TRUNK MUSCLES

Answer 34

Leads to postural impairment + muscle strength and flexibility imbalances

Question 35

observed in muscles that are habitually in a stretched position ■ test weaker because of a shift in the length-tension curve

Answer 35

Stretch weakness

Question 36

Observed in muscles that are habitually in a shortened position ■ tend to lose their elasticity ■ strong only in the shortened position ■ weak as they are lengthened

Answer 36

Tight weakness

Question 37

Necessary to maintain postural control

Answer 37

Endurance

Question 38

T/F: If the muscle fatigues, the mechanics of performance begin to change, and the load is shifted to the inert tissues supporting the spine at the end-range

Answer 38

True

Question 39

T/F: With poor muscular support and a sustained load on the inert supporting tissues, creep and distention occur, causing mechanical stress.

Answer 39

True

Question 40

Type of joint: TMJ

Answer 40

Ginglymoarthrodial Joint ○ combination of a hinge and plane joint

Question 41

T/F: Injuries occur less frequently after a lot of repetitive activity or long periods of work and play when there is muscle fatigue

Answer 41

False: more frequently

Question 42

The TMJ is composed of:

Answer 42

○ Mandibular condyle ○ Articular disc ○ Glenoid fossa of the temporal bone

Question 43

Functions of the TMJ

Answer 43

○ Chewing ○ Talking ○ Yawning

Question 44

Motions of the TMJ

Answer 44

○ Mandibular depression (mouth opening) ■ condyle both rolls and slides anterior on the TM disc ○ Lateral deviation ■ ipsilateral TMJ spinning in place with the contralateral TMJ sliding anterior ○ Protrusion ■ both TMJs slide anteriorly

Question 45

Primary muscles of the TMJ

Answer 45

○ Temporalis ○ Masseter ○ Medial & lateral pterygoid

Question 46

3 Cardinal signs of TMJ dysfunction

Answer 46

1. Pain in the TMJ region, affected by movement 2. Joint noise during movement 3. LOM of jaw

Question 47

Causes of TMJ dysfunction (9)

Answer 47

● Trauma ● Poor posture / faulty movement patterns ● Poor oral hygiene ● Gum chewing ● Heavy kissing ● Bruxism ● Smoking ● Inflammatory conditions (RA) ● Open mouth breathing

Question 48

Goals for TMJ Dysfunction Management (6)

Answer 48

Reduction of pain and muscle guarding Increase facial muscle relaxation + tongue proprioception & control Improve strength and control of jaw muscles Increase mobility of the jaw Reduce upper quarter muscle imbalances and improve posture Patient education

Question 49

Intervention for Reduction of Pain and Muscle Guarding (3)

Answer 49

Modalities Extra- and intra-oral myofascial techniques Soft Tissue Techniques ○ can be performed by the therapist ○ incorporated into a HEP ○ Extra-oral massage — Perform using a circular motion technique in the region of either the masseter or temporalis muscle. ■ Use a gentle massaging motion to facilitate muscle relaxation

Question 50

Intervention for Increase facial muscle relaxation + tongue proprioception & control (3)

Answer 50

● Exercises ○ Place the tip of the tongue on the hard palate behind the front teeth and draw little circles or letters on the palate. ○ Place the tip of the tongue on the hard palate and blow air out to vibrate the tongue, making an “r r r r” sound. ● Air puffing ○ Fill the cheeks with air (mouth closed); then let the air out in a puff ● Tongue clicking ○ Make a “clicking” sound with the tongue on the roof of the mouth. When doing so, the jaw drops open quickly and returns with the teeth slightly apart, and the tongue usually rests on the hard palate behind the front teeth. ■ This is the resting position of the jaw and is also the first step in teaching relaxation exercises.

Question 51

Intervention for Improve strength and control of jaw muscles

Answer 51

Controlled opening and closing the jaw

Question 52

Intervention for Increase mobility of the jaw (2)

Answer 52

● Passive stretching ○ Begin by placing layered tongue depressors between the central incisors. ○ The patient can gradually work to increase the amount of tongue depressors used until he or she can open approximately far enough to insert the knuckles of the index and middle fingers ○ Self-stretching is carried out by placing each thumb under the upper teeth and the index or middle fingers over the lower teeth and pushing the teeth open ● Joint mobilization techniques ○ Unilateral distraction ○ Unilateral distraction with glide ○ Bilateral distraction ○ Self-manipulation

Question 53

Intervention for Reduce upper quarter muscle imbalances and improve posture (2)

Answer 53

● Stretching of the restricting postural muscles ● Relaxation techniques

Question 54

Intervention for Patient education (2)

Answer 54

● Avoid food requiring excessive jaw opening or firm biting and repetitive chewing motions ● Eat soft food