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The Temporomandibular Joint Flashcards

1
Q

What are the actions of the Lateral Pterygoid muscle?

A
  • assists with mouth opening & guides the articular disc

- protrusion / lateral deviation

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2
Q

What are the actions of the Medial Pterygoid muscle?

A
  • assists Masseter with jaw closing

- protrusion / lateral deviation

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3
Q

List 4 signs associated with the diagnosis of muscular TMD

A
  1. pain in jaw, temple, face, in front of or in ear
  2. tenderness to palpation of masseter and/or temporalis
  3. pain in masseter or temporalis during maximal opening
  4. can occur with or without limited opening (<40mm)
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4
Q

What is considered normal ROM for jaw opening?

A

40mm

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5
Q

List 3 functions of the temporomandibular articular disc.

A
  1. increases lubrication
  2. decreases wear on the joint
  3. increases joint congruity
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6
Q

Describe the motion of the TMJ articular disc during jaw opening.

A

rotates posteriorly on the condyle and the disc-condyle glides anteriorly and inferiorly on the articular eminence of the temporal bone

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7
Q

What is the most common age range for TMD?

A

20-40 years old

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8
Q

What are the 3 general types of non-specific temporomandibular joint dysfunction?

A
  1. muscular
  2. articular
  3. combination
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9
Q

What are the 2 subtypes of muscular non-specific TMD?

A
  1. myofascial pain without limited jaw opening

2. myofascial pain with limited jaw opening

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10
Q

What are the 5 subtypes of articular non-specific TMD?

A
  1. disc displacement (with or without reduction)
  2. osteoarthritis/osteoarthrosis
  3. arthralgia
  4. adhesion / ankylosis
  5. hypermobility
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11
Q

List the 4 muscles involved in TMJ elevation (closing)

A
  1. masseter
  2. temporalis
  3. medial pterygoid
  4. superior fibers of lateral pterygoid (stabilize the disc)
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12
Q

List the 3 muscles involved in TMJ depression (opening)

A
  1. inferior fibers of lateral pterygoid
  2. suprahyoids
  3. infrahyoids (indirectly)
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13
Q

List the 3 muscles involved in TMJ protrusion

A
  1. superficial masseter
  2. medial pterygoid
  3. lateral pterygoid
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14
Q

List the 3 muscles involved in TMJ retrusion

A
  1. deep fibers of masseter
  2. temporalis
  3. suprahyoids (digastrics)
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15
Q

List the 4 muscles involved in TMJ lateral excursion (deviation)

A

Ipsilateral:

  1. temporalis
  2. masseter

Contralateral:

  1. medial pterygoid
  2. lateral pterygoid
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16
Q

What is normal ROM of TMJ lateral excursion?

A

about 1/4th of the opening range

17
Q

What is the normal ROM of TMJ protrusion?

18
Q

List 3 reasons why TMJ ROM may be reduced

A
  1. capsular tightness
  2. masticatory muscle spasm
  3. fear of movement due to pain
19
Q

What does a jaw opening pattern that is “S”-shaped without pain indicate? With pain?

A
  • without pain, may indicate muscle imbalance or muscle incoordination
  • with pain and/or limited opening, there may be involvement of the disc or capsule
20
Q

What does a jaw opening pattern than is “C”-shaped usually indicate?

A
  • usually indicative of a capsular pattern

- there is decreased anterior glide of the TMJ, so the jaw deviates to the ipsilateral side

21
Q

List the 4 components of the TMJ capsular pattern.

A
  1. limited opening
  2. deflection to ipsilateral side
  3. protrusion to the ipsilateral side
  4. limited lateral excursion to the contralateral side
22
Q

Describe the purpose and performance of the Cotton Roll test for TMJ pain.

A
  • used to differentiate between muscular and joint involvement
  • biting down on a cotton roll with back molars gaps joint, but engages musculature
  • pain = ipsilateral muscle involvement
  • pain decreases = joint pain
23
Q

List 4 signs that indicate TMJ anterior disc displacement with reducation

A
  1. reciprocal joint sounds during opening and closing
  2. limited opening with or without pain
  3. mandible deflects to ipsilateral side during opening
  4. “C”- or “S”-shaped curve on opening
24
Q

What relatively rare condition of the TMJ can occur following dental procedures or excessive yawning/laughing? What is the primary impairment?

A
  • posterior disc displacement

- inability to close the mouth

25
List 6 signs that indicate involvement/tightness of the TMJ capsule.
1. palpable tenderness over the lateral TMJ capsule 2. pain with opening Capsular Pattern: 3. limited opening 4. "C" curve opening (deviation to ipsilateral side) 5. lateral excursion limited to contralateral side 6. protrusion toward ipsilateral side
26
What is the most prevalent form of TMD?
myofascial pain
27
What is myofascial pain disorder syndrome (MPDS)?
pain that originates from the muscle/fascia structure that is characterized by trigger points (tender points that refer pain) in the affected muscles
28
What range of jaw opening is considered hypomobile?
< 30mm
29
What range of jaw opening is considered hypermobile?
> 50mm
30
What is trismus?
acute closed lock or limited opening of the jaw after a dental procedure caused by masseter muscle spasm
31
What structure is the proposed connection between the temporomandibular joint to ear symptoms
the trigemino-cervical nucleus (cranial nerves V, VII, IX, X, and XI and cervical nerves 1-3)
32
Compare/contrast TMJ osteoarthritis/osis vs arthralgia.
Similar: pain in one or both joint during palpation AND/OR pain in the joint at rest or movement Different: palpable or audible crepitus with osteoarthritis/osis only
33
What percentage of people with TMJ anterior disc displacement are symptomatic?
only 20-30%
34
List 5 alternate differential diagnoses that may present with symptoms similar to TMD.
1. tooth pain 2. ear infection 3. trigeminal neuralgia 4. cancer 5. dental occlusion
35
What is the general prognosis for TMD?
regardless of classification/diagnosis, TMD is thought to be 'self-limiting' with a good prognosis
36
List 8 education items that you might discuss with a patient with TMD
1. posture 2. resting position of tongue/jaw 3. oral habits (gum chewing, nail biting, hard foods, clenching, grinding) 4. sleep position 5. avoid resting chin on hand 6. relaxation techniques 7. use of heat/cold 8. reassurance of good prognosis
37
List 5 exercises outside of the Rocabado 6x6 that you might use to treat TMD
1. postural correction (forward head, mandibular protrusion) 2. motor control exercise (DNF, scapular stab.) 3. cervical muscle stretching 4. diaphragmatic breathing 5. aerobic exercise
38
List the 6 items in Rocabado's 6x6 exercise program for TMD
1. resting position of tongue 2. opening/closing 3. rhythmic stabilization in resting position 4. cervical retraction 5. shoulder retraction/depression 6. upper cervical nods (with/without hands clasped behind neck
39
What are the 4 criteria that Von Piekartz et al used to rule in TMD in patient with cervicogenic headache?
At least one of the found signs: 1. TMJ joint sounds 2. deviation during opening 3. extra-oral muscle pain at minimum of 2 tender points in the masseter and temporalis 4. pain during passive mouth opening

OCS (13 decks)

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