Temporomandibular Joint

Question 1

which gender affected by TMD most often?

Answer 1

Women (4:1) (seek care more anyways)

Question 2

common S&S of TMD

Answer 2

HA
orofascial pn
earache/hearing changes
neck pain

Question 3

psychological behavior/factors of TMD

Answer 3

anxiety/depression
drug abuse
failed conventional therapy
major life events/crisis
vague report of pain, inconsisten/inappropriate pain
overdramatization of symptoms

Question 4

what type of cartilage is disc?

Answer 4

fibrocartilage (not as strong as hyaline) not thought of as a WB joint

Question 5

what structures attach to disc?

Answer 5

medial & lateral collateral ligs
post mandibular fossa
lateral pterygoid

Question 6

muscles of mastication

Answer 6

medial pterygoid
lateral pterygoid
temporalis
masseter

Question 7

nerve innervation of muscles of mastication

Answer 7

CN V-trigeminal

mandibular portion

Question 8

movements of masseter M

Answer 8

opening

Question 9

movements of temporalis M

Answer 9

retraction
closing
side to side grinding

Question 10

movements of lateral pterygoid M

Answer 10

protrusion
opening
contralateral deviation
anterior rotates disk on condyle during closing

Question 11

movemnts of medial pterygoid M

Answer 11

closing

deviation to opposite side

Question 12

during opening, what motion occurs first?

Answer 12

rotation, then translation

Question 13

what happens during mouth closing?

Answer 13

translation, then rotation (opposite of opening)

Question 14

degree of rotation and translation

Answer 14

25 deg rotation

15 deg translation

Question 15

during opening, what direction is rotation?

Answer 15

anteriorly,

translation inferiorly and laterally

Question 16

what position is dysfunction in single click dysfunction?

Answer 16

2-3 most common

Question 17

what position is dysfunction for dislocation/reduction?

Answer 17

4

Question 18

what position is dysfunction for reciprocal click?

Answer 18

2 and 8

Question 19

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?

Answer 19

partial anterior displacement (subluxation)

Question 20

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?

Answer 20

disc displacement with reduction

Question 21

special tests for TMD

Answer 21

2-3 finger/Functional knuckle test 
Centric relation Pn Test
Measured Opening
TMJ Reflex
Auscultation of TMJ 
Cranial Nerves

Question 22

describe 2-3 finger test

Answer 22

2-3 finger of own PIP

want 45-48 mm

Question 23

Describe Centric Relation Pain Test

Answer 23

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

Question 24

what is max mouth opening?

what is fxnal mouth ROM?

Answer 24

50 mm max

35 mm=fxnal

Question 25

TMJ reflex

Answer 25

lightly tap chin

mouth should close

Question 26

what CN specifically should be tested?

Answer 26

V and VII

Question 27

Is it acceptable to perform Grade V manipulations of TMJ?

Answer 27

NO

Question 28

Differentiate active TrP vs laten TrP

Answer 28

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.

Question 29

Describe TrP Ischemic Compression treatment?

Answer 29

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.

Question 30

how does myofascial release help TMD pts?

Answer 30

Accomplished by relaxing contracted muscles, increasing circulation and lymphatic drainage, and stimulating the stretch reflex of muscles and overlying fascia

Question 31

Describe Post-Isometric Relaxation

Answer 31

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

Question 32

home exercises for TMD

Answer 32

Cervical Spine exercises Self PIR
Rest Position
Forceful tongue
Forceful tongue with opening
Proper opening
Proper opening with resistance

Question 33

Describe Self Post-Isometric Relaxation

Answer 33

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.

Question 34

Describe PIT Pterygoids

Answer 34

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.

Question 35

Relax postion

Answer 35

leave constant reminders (on cell phone, remote etc) to keep mouth in relaxed position