Temporomandibular Joint-Lab

Question 1

Evaluation

Answer 1

• ROM: Cervical / TMJ / B shoulders
• Cervical clearing tests
• B cheek massage
• Opening mechanics
• Posture / Observation
• BUE gross strength
• Palpation
• Special tests

Question 2

Observation/ Posture assessment

Answer 2

• Divide face into thirds
• Vertical dimension
  
  • Distance from lateral edge of eye to the corner of the mouth equals the distance from nose to point of chin
    
    • • = If the second measurement is smaller than the first by 1mm or more, there has been a loss of vertical dimension, which may have resulted from loss of teeth, overbite, or TMD.

Question 3

Face shape

Answer 3

A: Orthognathic

B: Slight retrognathic

C: Retrognathic

D: Prognathic

Question 4

Normal ROM for TMJ

Answer 4

• Elevation (bite down): Looking for symmetry with bite
• Mouth opening: 40-50 mm (measure from bottom of top teeth to top of bottom teeth
• Protrusion: 3-5 mm (measure using same landmarks)
• Retrusion: 3-5 mm (same landmarks)
• Lateral excursion: 8-10 mm (measure midline to midline)

Question 5

Opening mechanics

Answer 5

• Deviation: Is any movement away from midline with normal opening that corrects itself by the end of range
• Deflection: Any shift of the midline to one side that becomes greater with opening and does not disappear at maximal opening (Due to restricted movement in one joint)
  
  • –Usually deviates to the affected side

Question 6

Functional assessment/Clicking

Answer 6

• Reciprocal clicking: occurs when mouth opens and closes (condyle is slipping over disc and then self reducing)
• On opening the later the click is heard, the more anterior the disc is
• The later the opening click, the more the disc is displaced anteriorly and more likely it is to lock
• Closing click: Usually caused by loosening of the structures attaching to the disc to the condyle
• Clicking is more like to occur with hypomobilie joints.

Question 7

Audible sounds

Answer 7

• Grating noise (crepitus): indicative of degenerative joint disease or perforation of the disc
• Painful crepitus= Disc eroded
• Condyle bone and temporal bone rubbing together
• Fibrocartilage has been lost.
  
  • ***Each movement should be done 4 or 5 times to ensure correct diagnosis

Question 8

Manual techniques

Answer 8

1. Caudal Glide
2. Anterior Glide
3. P-A mobilization
4. A-P mobilization
5. Ventrocaudal Translation
6. Caudal-Retrusive Glide

Question 9

Examination

Answer 9

Pain during AROM

Pain during AAROM

Pain with palpation

Pain during resistive testing

Limitations in ROM

Deviation from symmetrical opening

Audible Sounds during opening

Pain during joint play

Question 10

Manual therapy/ Treatment

Answer 10

• Suboccipital Release
• Cheek Massage
• Lateral Pterygoid Positional Release
• Cranial Fascia Release
• Frontal Sinus Release
• Distraction / Joint mobilizations
• Use of graston tools
• Joint mobilizations

Question 11

Treatment of TMD

Answer 11

• Controlled Opening Exercises
• lMET / Contract-Relax Exercises
• Cervical Retractions
• Cheek Massage - 1st one given for HEP
• Other- Functional Dry Needling
  
  • Works well due to the amount of trigger points patients have

Question 12

Modalities for TMD

Answer 12

• Iontophoresis
  
  • Acute in nature
  • 4mA if they can tolerate
  • Hybresis patch is the easiest to use
• Ultrasound
  
  • 3.3 MHz, 0.7-0.9 output
  • 6-8 min per side