Temporomandibular Joint Flashcards
1
Q
The tempomandibular joint is anterior or posterior to the ear tragus?
A
Anterior
2
Q
The TMD joint is made out of what bones?
A
- Temporal bone
- Mandible (condyle) bone
3
Q
The TMJ joint is a complex synovial joint, what are the 5 components of a synovial joint?
A
- Articular Cartilage
- Joint Space
- Fibrous Cartilage
- Synovial Membrane
- Synovial Fluid
4
Q
The disc involved in the TMJ has what kind of vascularity and is made out of what kind of cartilage?
A
- Avascular except at the periphery
- Fibrocartilage
5
Q
What is the function of fibrocartilage?
A
- Shock Absorption
- Stability
- Guides Motion
6
Q
The disc in TMJ is attached to what 4 things?
A
- Muscles
- Capsule
- Condyle
- Ligament
7
Q
The joint structures, disc, and direct contacting muscles that make up the TMJ are mostly innervated by branches of what nerve?
A
Trigeminal Nerve
8
Q
What are the 8 areas that you can experience Trigeminal nerve symptoms?
A
- Ears
- Tongue
- Eyes
- Teeth
- Neck
- Head
- Face
- Jaw
9
Q
What two things are the capsule in TMJ attached to?
A
- Muscle
- Disc
10
Q
What ligaments are a part of the TMD joint?
A
- Sphenomandibular
- Temporomandibular or Lateral
- Stylomandibular
11
Q
What does the sphenomandibular ligament do?
A
- Prevents excessive opening
- Recoils for closing
12
Q
What does the Temporomandibular or Lateral ligament do?
A
- Prevents posterior condyle displacement
- Initiates opening
13
Q
What does the Stylomandibular ligament do?
A
- No motion restraint
14
Q
What is the resting or open pack position of the jaw?
A
- Lips closed
- Teeth not touching
- Tongue resting on the roof of the mouth
- 2 mm overbite
- Greater than or equal to 2 mm overjet or overjut beyond overbite
15
Q
What is the closed packed position of the jaw?
A
Unknown
16
Q
Do the mandibular condyles move together in the same or different direction?
A
Both
17
Q
What is the kaltenborn’s rule?
A
Mandibular condyle is convex on concave fossa
18
Q
What are the 5 functions of the mandible?
A
- Depression
- Elevation
- Lateral Deviation
- Protrusion
- Retrusion
19
Q
What is the normal width of the jaw?
A
About 3 knuckles width
20
Q
If there is less than or equal to one knuckle width of an opening in someones jaw what does this mean?
A
URGENT referral to a dentist/ oral surgeon
21
Q
What direction do the mandibular condyles glide when opening the jaw?
A
Anterior
22
Q
Is bilateral clicking on opening considered normal?
A
Yes
23
Q
What muscles preform opening of the jaw?
A
- Main: digastric
- Lateral Pterygoid
- Hyoids
24
Q
What direction do the mandibular condyles glide when closing the jaw?
A
Posterior
25
What muscles close the jaw?
- Temporalis
- Masseter
- Medial Pterygoid
- Lateral Pterygoid
26
What muscles preform lateral deviation?
- Masseter
- Pterygoids
- Temporalis
27
What primarily acts to move the mandible medial for grinding food?
Same side medial and lateral pterygoids
28
What are history signs and symptoms of TMD?
Oral Habit History:
- Thumb sucking
- Nail/ ice biter
- Excessive teeth grinder
- Gum/ smokeless tobacco chewer
29
What does a morning headache that goes away with ADLs represent?
Excessive teeth grinding - If the headache is from the neck it would most likely get worse with the ADLs
30
Is some grinding normal with sleep?
Yes
31
What are observation signs and symptoms with TMD?
FHP
32
What are big picture signs and symptoms with TMD?
- Localized pain and or crepitus
- Possible Trigeminal nerve sensitization
- Impaired motion/ function
33
What is an earlier deviation without loss of functional opening due to?
Greater laxity with history of trauma
34
What are signs and symptoms with a earlier deviation without loss of functional opening?
- Minimal to no pain unless irritated
- Deviation away from unilateral hypermobile TMJ
- Click at end range that indicates a larger displacement
35
What is an end range deviation without loss of functional opening due to?
Due to gradual onset from FHP and less laxity or trauma
36
What are signs and symptoms of end range deviation without loss of functional opening?
- Minimal to no pain unless irritated
- Deviation with bilateral hypermobile TMJ, possibly inconsistent
- Click at end range indicating a larger displacement
37
What is an early deviation with loss of functional opening due to?
- Acute with recent trauma
- Chronic with fibrotic TMJ
38
What are signs and symptoms of early deviation with loss of functional opening for an acute trauma?
- Deviation towards painful TMJ
- Limitation due to inflammation/ unwillingness to move
39
What are signs and symptoms of early deviation with loss of functional opening for a chronic fibrotic TMJ?
- Deviation towards hypomobile TMJ
- Limitation due to joint hypomobility
40
An early unilateral clicking upon opening indicates what?
Indicates smaller displacement
41
An inconsistent clicking indicates what?
Hypermobility
42
Reciprocal clicking (consistent) means that the condyle is moving ...
Ahead of the disc on opening and behind the disc on closing
43
If you feel crepitus in the TMJ joint this means?
TMJ and/ or disc damage
44
What does a FHP cause/ influence with TMD?
- Increased tension on digastic/ hypoid muscles, because the hyoid bone becomes further away from the mandible and clavicles
- Mouth opens
45
With a FHP it puts increased tension on what?
The sphenomandibular ligament
46
With FHP the mandibular condyle may displace what direction?
Anterior to the disc
47
What is the FHP assessment for TMD?
Have the patient swallow in neutral and in a FHP. It is WNL if there is no excessive neck motion. If there is excessive neck motion this indicates a cervical hypermobility/ instability.
48
What is another way besides swallowing that you can assess FHP of the TMD?
Have the patient open their mouth in neutral and in a FHP. It is WNL if if motions in neutral and the FHP position are the same. If they are less this could be a possible posterior displacement.
49
What is a posterior displacement of the TMJ?
The mandibular condyle is posterior to the disc
50
What is the history of a posterior displacement of the TMJ?
Trauma with sudden closing
51
What are signs and symptoms of a posterior displacment of the TMJ?
- Likely pain and limitation on opening
- Full closing
52
What is the Rx for a posterior displacement of the TMJ?
- Distraction with an anterior glide to reposition the mandibular condyle anteriorly to the disc
- Sleep with small neck roll for slight neck extension and opening
- Avoid excessive or hard chewing/ grinding
- Possible night splint to maintain slight opening
- MET stabilization of TMJ and neck
53
What is an anterior displacement of the TMJ?
Mandibular condyle is anterior to the disc
54
What is the history of an anterior displacement of the TMJ?
- Prolonged opening (I.e. FHP/ mouth breather)
- Trauma with sudden opening
- Excessive opening (I.e yawning/ dentistry)
55
What are signs and symptoms of an anterior displacement of the TMJ?
- Full opening/ no deviation
- Likely pain and limitation on closing
56
What is the anterior displacement of the TMJ RX?
- Distraction with posterior glide to reposition the mandibular condyle posteriorly to the disc
- Avoid wide opening with diet and yawning
- Correct posture
- Sleep with neck flexed and chin tucked
- MET for stabilization of TMJ and neck
57
Are upper or lower cervical dysfunction signs and symptoms more common with TMD?
Upper
58
What is the general Rx for TMD?
- POLICED
- STM (intra and extraorally)
- Modalities for pain/ guarding
- Postural education (sit tall, maintain open packed position)
59
What is the PT Rx for TMD?
- Diaphragmatic breathing training
- Activity modification (oral habit alterations, dietary changes, motion extremes, sleep modifications)
- MT: Joint mobilizations of the TMJ and neck for hypomobility and displacement reproduction
60
What will your METs for TMD involve?
- TMJ, typically isometrics, plus neck exercises
- Practice resting and talking with cork in between teeth
- Cervical stabilization
61
What is the dentist or other MD Rx for TMD?
- Splints
- Orthodontics
- Surgery
62
What is the prognosis for TMD?
Very good if proper mechanics, posture, and breathing patterns restored
