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MSK Final (Fall) > Temporomandibular Joint > Flashcards

Temporomandibular Joint Flashcards

1
Q

The tempomandibular joint is anterior or posterior to the ear tragus?

A

Anterior

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2
Q

The TMD joint is made out of what bones?

A
  • Temporal bone
  • Mandible (condyle) bone
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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
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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
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5
Q

What is the function of fibrocartilage?

A
  • Shock Absorption
  • Stability
  • Guides Motion
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6
Q

The disc in TMJ is attached to what 4 things?

A
  • Muscles
  • Capsule
  • Condyle
  • Ligament
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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

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8
Q

What are the 8 areas that you can experience Trigeminal nerve symptoms?

A
  • Ears
  • Tongue
  • Eyes
  • Teeth
  • Neck
  • Head
  • Face
  • Jaw
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9
Q

What two things are the capsule in TMJ attached to?

A
  • Muscle
  • Disc
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10
Q

What ligaments are a part of the TMD joint?

A
  • Sphenomandibular
  • Temporomandibular or Lateral
  • Stylomandibular
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11
Q

What does the sphenomandibular ligament do?

A
  • Prevents excessive opening
  • Recoils for closing
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12
Q

What does the Temporomandibular or Lateral ligament do?

A
  • Prevents posterior condyle displacement
  • Initiates opening
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13
Q

What does the Stylomandibular ligament do?

A
  • No motion restraint
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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
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15
Q

What is the closed packed position of the jaw?

A

Unknown

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16
Q

Do the mandibular condyles move together in the same or different direction?

A

Both

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17
Q

What is the kaltenborn’s rule?

A

Mandibular condyle is convex on concave fossa

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18
Q

What are the 5 functions of the mandible?

A
  • Depression
  • Elevation
  • Lateral Deviation
  • Protrusion
  • Retrusion
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19
Q

What is the normal width of the jaw?

A

About 3 knuckles width

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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

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21
Q

What direction do the mandibular condyles glide when opening the jaw?

A

Anterior

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22
Q

Is bilateral clicking on opening considered normal?

A

Yes

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23
Q

What muscles preform opening of the jaw?

A
  • Main: digastric
  • Lateral Pterygoid
  • Hyoids
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24
Q

What direction do the mandibular condyles glide when closing the jaw?

A

Posterior

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25
Q

What muscles close the jaw?

A
  • Temporalis
  • Masseter
  • Medial Pterygoid
  • Lateral Pterygoid
26
Q

What muscles preform lateral deviation?

A
  • Masseter
  • Pterygoids
  • Temporalis
27
Q

What primarily acts to move the mandible medial for grinding food?

A

Same side medial and lateral pterygoids

28
Q

What are history signs and symptoms of TMD?

A

Oral Habit History:
- Thumb sucking
- Nail/ ice biter
- Excessive teeth grinder
- Gum/ smokeless tobacco chewer

29
Q

What does a morning headache that goes away with ADLs represent?

A

Excessive teeth grinding - If the headache is from the neck it would most likely get worse with the ADLs

30
Q

Is some grinding normal with sleep?

A

Yes

31
Q

What are observation signs and symptoms with TMD?

A

FHP

32
Q

What are big picture signs and symptoms with TMD?

A
  • Localized pain and or crepitus
  • Possible Trigeminal nerve sensitization
  • Impaired motion/ function
33
Q

What is an earlier deviation without loss of functional opening due to?

A

Greater laxity with history of trauma

34
Q

What are signs and symptoms with a earlier deviation without loss of functional opening?

A
  • Minimal to no pain unless irritated
  • Deviation away from unilateral hypermobile TMJ
  • Click at end range that indicates a larger displacement
35
Q

What is an end range deviation without loss of functional opening due to?

A

Due to gradual onset from FHP and less laxity or trauma

36
Q

What are signs and symptoms of end range deviation without loss of functional opening?

A
  • Minimal to no pain unless irritated
  • Deviation with bilateral hypermobile TMJ, possibly inconsistent
  • Click at end range indicating a larger displacement
37
Q

What is an early deviation with loss of functional opening due to?

A
  • Acute with recent trauma
  • Chronic with fibrotic TMJ
38
Q

What are signs and symptoms of early deviation with loss of functional opening for an acute trauma?

A
  • Deviation towards painful TMJ
  • Limitation due to inflammation/ unwillingness to move
39
Q

What are signs and symptoms of early deviation with loss of functional opening for a chronic fibrotic TMJ?

A
  • Deviation towards hypomobile TMJ
  • Limitation due to joint hypomobility
40
Q

An early unilateral clicking upon opening indicates what?

A

Indicates smaller displacement

41
Q

An inconsistent clicking indicates what?

A

Hypermobility

42
Q

Reciprocal clicking (consistent) means that the condyle is moving …

A

Ahead of the disc on opening and behind the disc on closing

43
Q

If you feel crepitus in the TMJ joint this means?

A

TMJ and/ or disc damage

44
Q

What does a FHP cause/ influence with TMD?

A
  • Increased tension on digastic/ hypoid muscles, because the hyoid bone becomes further away from the mandible and clavicles
  • Mouth opens
45
Q

With a FHP it puts increased tension on what?

A

The sphenomandibular ligament

46
Q

With FHP the mandibular condyle may displace what direction?

A

Anterior to the disc

47
Q

What is the FHP assessment for TMD?

A

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
Q

What is another way besides swallowing that you can assess FHP of the TMD?

A

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
Q

What is a posterior displacement of the TMJ?

A

The mandibular condyle is posterior to the disc

50
Q

What is the history of a posterior displacement of the TMJ?

A

Trauma with sudden closing

51
Q

What are signs and symptoms of a posterior displacment of the TMJ?

A
  • Likely pain and limitation on opening
  • Full closing
52
Q

What is the Rx for a posterior displacement of the TMJ?

A
  • 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
Q

What is an anterior displacement of the TMJ?

A

Mandibular condyle is anterior to the disc

54
Q

What is the history of an anterior displacement of the TMJ?

A
  • Prolonged opening (I.e. FHP/ mouth breather)
  • Trauma with sudden opening
  • Excessive opening (I.e yawning/ dentistry)
55
Q

What are signs and symptoms of an anterior displacement of the TMJ?

A
  • Full opening/ no deviation
  • Likely pain and limitation on closing
56
Q

What is the anterior displacement of the TMJ RX?

A
  • 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
Q

Are upper or lower cervical dysfunction signs and symptoms more common with TMD?

A

Upper

58
Q

What is the general Rx for TMD?

A
  • POLICED
  • STM (intra and extraorally)
  • Modalities for pain/ guarding
  • Postural education (sit tall, maintain open packed position)
59
Q

What is the PT Rx for TMD?

A
  • 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
Q

What will your METs for TMD involve?

A
  • TMJ, typically isometrics, plus neck exercises
  • Practice resting and talking with cork in between teeth
  • Cervical stabilization
61
Q

What is the dentist or other MD Rx for TMD?

A
  • Splints
  • Orthodontics
  • Surgery
62
Q

What is the prognosis for TMD?

A

Very good if proper mechanics, posture, and breathing patterns restored

MSK Final (Fall) (15 decks)

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