Temporomandibular Joint Manual Therapy and Techniques- Lab Flashcards
ROM TMJ/ Cervical
- 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
TMJ palpation
- Masseter
- Temporalis
- Submandibular / hyoid musculature
- Lateral Pterygoids
- Suboccipitals
TMJ manual techniques
- Caudal Glide
- Anterior Glide
- P-A mobilization
- A-P mobilization
- Ventrocaudal Translation
- Caudal-Retrusive Glide
TMJ special tests
- 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
TMJ: other techniques
- Suboccipital Release
- Cheek Massage
- Lateral Pterygoid Positional Release
- Cranial Fascia Release
- Frontal Sinus Release
Caudal Glide
Anterior Glide
P-A mobilization
A-P mobilization
Ventrocaudal Translation
Caudal-Retrusive Glide
TMD classification: Capsulitis/ Synovitis
- 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
TMD classification- Mastication Muscle Disorder
No joint sounds
Pain with palpation muscles of mastication
Inconsistent alterations in mandibular control
Parafunctional oral behaviors
Pain with biting on same side
TMD classification- Capsular Fibrosis
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
TMD classification- Hypermobility
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
TMD classification- Articular Disc Displacement… With reduction
Reciprocal joint sound with opening and closing
“S” curve with opening
Full AROM (unless combined with acute capsulitis or muscle dysfunction)
TMD classification- Articular Disc Displacement …Without reduction
History of joint sounds
Limited opening <25 mm if acute
Deviation of mandible with opening toward limited side
TMD classification- Post ‐ Surgical TMJ
capsulitis/synovitis
Assess for underlying TMJ dysfunction
TMD classification- Osteoarthritis
TMJ crepitus as noted with stethoscope
Pain with TMJ palpation
Radiographic evidence of osteoarthritis
TMD PT goals
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
Patient education
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
