Temporomandibular Joint Manual Therapy and Techniques- Lab

Question 1

ROM TMJ/ Cervical

Answer 1

• Cervical flexion 0-65 deg
• Cervical Extension 0-50 deg
• Cervical Lateral flexion 0-40 deg
• Cervical Rotation 0-40 deg
• Mouth Opening 40-50 mm
• Mouth Closing
• Lateral Excursion 8-10 mm
• Protrusion 3-5 mm
• Retrusion 3-5 mm

Question 2

TMJ palpation

Answer 2

• Masseter
• Temporalis
• Submandibular / hyoid musculature
• Lateral Pterygoids
• Suboccipitals

Question 3

TMJ manual techniques

Answer 3

• Caudal Glide
• Anterior Glide
• P-A mobilization
• A-P mobilization
• Ventrocaudal Translation
• Caudal-Retrusive Glide

Question 4

TMJ special tests

Answer 4

• Pain during AROM
• Pain during AAROM
• Pain during palpation
• Pain during resistive testing
• Limitations in ROM
• Deviation from symmetrical opening
• Audible sounds during opening
• Pain during joint play

Question 5

TMJ: other techniques

Answer 5

• Suboccipital Release
• Cheek Massage
• Lateral Pterygoid Positional Release
• Cranial Fascia Release
• Frontal Sinus Release

Question 6

Caudal Glide

Answer 6

Question 7

Anterior Glide

Answer 7

Question 8

P-A mobilization

Answer 8

Question 9

A-P mobilization

Answer 9

Question 10

Ventrocaudal Translation

Answer 10

Question 11

Caudal-Retrusive Glide

Answer 11

Question 12

TMD classification: Capsulitis/ Synovitis

Answer 12

• tender to palpation at TMJ lateral condyle or posterior compartment
• pain with biting on opposite site
• pain with retrusive overpressure
• pain with accessory motion testing

Question 13

TMD classification- Mastication Muscle Disorder

Answer 13

No joint sounds

Pain with palpation muscles of mastication

Inconsistent alterations in mandibular control

Parafunctional oral behaviors

Pain with biting on same side

Question 14

TMD classification- Capsular Fibrosis

Answer 14

Capsular pattern

Deviation toward limited side with opening and protrusion

Limited contralateral lateral excursion

Limited AROM mandibular dynamics

Limited mobility with TMJ accessory motion tests

No joint sounds

History of trauma or surgery

Question 15

TMD classification- Hypermobility

Answer 15

End range click with deviation away from hypermobile side

? Symptomatic

May lead to disc displacement condition

Excessive AROM with opening >40 mm

Joint sound at end range of opening

Hypermobility with accessory motion testing

Question 16

TMD classification- Articular Disc Displacement… With reduction

Answer 16

Reciprocal joint sound with opening and closing

“S” curve with opening

Full AROM (unless combined with acute capsulitis or muscle dysfunction)

Question 17

TMD classification- Articular Disc Displacement …Without reduction

Answer 17

History of joint sounds

Limited opening <25 mm if acute

Deviation of mandible with opening toward limited side

Question 18

TMD classification- Post ‐ Surgical TMJ

Answer 18

capsulitis/synovitis

Assess for underlying TMJ dysfunction

Question 19

TMD classification- Osteoarthritis

Answer 19

TMJ crepitus as noted with stethoscope

Pain with TMJ palpation

Radiographic evidence of osteoarthritis

Question 20

TMD PT goals

Answer 20

1. Restore Natural Motion of TMJ and Cervical Spine

2. Improve Postural Awareness

3. Improve Function (eating, talking, etc.)

4. Decrease Pain and Headaches

5.Teach Patients How to Prevent Future Occurrences of Head and Facial Pain

Question 21

Patient education

Answer 21

Limit parafunctional activities: nail biting, gum chewing, clenching and grinding teeth

Tongue position: at rest, the tip of the tongue should be at the ridge of the roof of the mouth with the front one third of the tongue on the roof of the mouth

Teeth position: the teeth should be 2 to 3 mm apart at rest

Lips should be lightly together with breathing through the nose

Keep the tip of the tongue up on the roof of the mouth when yawning

Avoid sleeping in the prone position

Do not rest chin in hands

Soft diet: avoid hard crunchy foods

Cut food up into small bites

Warm water rinses

Postural and TMJ exercises 5-6 times per day