Temporomandibular Joint Flashcards
which gender affected by TMD most often?
Women (4:1) (seek care more anyways)
common S&S of TMD
HA
orofascial pn
earache/hearing changes
neck pain
psychological behavior/factors of TMD
anxiety/depression drug abuse failed conventional therapy major life events/crisis vague report of pain, inconsisten/inappropriate pain overdramatization of symptoms
what type of cartilage is disc?
fibrocartilage (not as strong as hyaline) not thought of as a WB joint
what structures attach to disc?
medial & lateral collateral ligs
post mandibular fossa
lateral pterygoid
muscles of mastication
medial pterygoid
lateral pterygoid
temporalis
masseter
nerve innervation of muscles of mastication
CN V-trigeminal
mandibular portion
movements of masseter M
opening
movements of temporalis M
retraction
closing
side to side grinding
movements of lateral pterygoid M
protrusion
opening
contralateral deviation
anterior rotates disk on condyle during closing
movemnts of medial pterygoid M
closing
deviation to opposite side
during opening, what motion occurs first?
rotation, then translation
what happens during mouth closing?
translation, then rotation (opposite of opening)
degree of rotation and translation
25 deg rotation
15 deg translation
during opening, what direction is rotation?
anteriorly,
translation inferiorly and laterally
what position is dysfunction in single click dysfunction?
2-3 most common
what position is dysfunction for dislocation/reduction?
4
what position is dysfunction for reciprocal click?
2 and 8
If the disc sticks or is bunched slightly, opening causes the condyle to move abruptly over the disc and into its normal position, resulting in a single click there may be?
partial anterior displacement (subluxation)
a click may occur if the disc is displaced anteriorly and/or medially, causing the condyle to override the posterior rim of the disc later than normal during mouth opening. This is referred to as?
disc displacement with reduction
special tests for TMD
2-3 finger/Functional knuckle test Centric relation Pn Test Measured Opening TMJ Reflex Auscultation of TMJ Cranial Nerves
describe 2-3 finger test
2-3 finger of own PIP
want 45-48 mm
Describe Centric Relation Pain Test
Identify pain caused by malposition
Load TMJ in stable position
Pain=possible structural problem (disc torn) & co-mgmt is needed
No pain = likely functional cause that we can treat
what is max mouth opening?
what is fxnal mouth ROM?
50 mm max
35 mm=fxnal
TMJ reflex
lightly tap chin
mouth should close
what CN specifically should be tested?
V and VII
Is it acceptable to perform Grade V manipulations of TMJ?
NO
Differentiate active TrP vs laten TrP
Active TrP should refer pain to another area
Latent TrP corresponds to TrP charts but do not refer pain. Local pain will be present.
Latent TrP should produce a ‘snap’ or reflexive response when palpated.
Describe TrP Ischemic Compression treatment?
Therapy where blockage of blood occurs so a resurgence of local blood flow will occur upon release.
Find TrP compress, with a large but tolerable amount of force, for 15-30 secs and release.
Re-palpate to see if change made.
how does myofascial release help TMD pts?
Accomplished by relaxing contracted muscles, increasing circulation and lymphatic drainage, and stimulating the stretch reflex of muscles and overlying fascia
Describe Post-Isometric Relaxation
Position the patient/client appropriately for the muscle to be treated
Passively lengthen the tense muscle to the point at which the first slight increase in resistance is felt (barrier)
Have the patient/client contract the muscle gently (10%) for 6-10 secs and breathe in while you resist with equal counterforce (isometric)
Have them breathe out, “let go” and relax the muscle fully. Wait for relaxation and move to the next barrier
Repeated 3-5 times
Eye movements can be used to facilitate contraction
home exercises for TMD
Cervical Spine exercises Self PIR Rest Position Forceful tongue Forceful tongue with opening Proper opening Proper opening with resistance
Describe Self Post-Isometric Relaxation
Relax your jaw. Gently bite down resisting with your hand.
Hold for 10 secs and then yawn while relaxing.
Let your jaw relax and open wider.
Repeat 4-5 times. Repeat 3-4 times a day.
Describe PIT Pterygoids
Start seated with one elbow on a table or on your knee. The same arm supports your forehead.
Place the web of the other hand on your chin.
Gently push your chin into your hand.
Take a deep breath in and hold for 10 secs.
As you exhale, relax your jaw and let it sink back.
Repeat 4-5 times. Repeat 3-4 times a day.
Relax postion
leave constant reminders (on cell phone, remote etc) to keep mouth in relaxed position
