The Temporomandibular Joint Flashcards
What are the actions of the Lateral Pterygoid muscle?
- assists with mouth opening & guides the articular disc
- protrusion / lateral deviation
What are the actions of the Medial Pterygoid muscle?
- assists Masseter with jaw closing
- protrusion / lateral deviation
List 4 signs associated with the diagnosis of muscular TMD
- pain in jaw, temple, face, in front of or in ear
- tenderness to palpation of masseter and/or temporalis
- pain in masseter or temporalis during maximal opening
- can occur with or without limited opening (<40mm)
What is considered normal ROM for jaw opening?
40mm
List 3 functions of the temporomandibular articular disc.
- increases lubrication
- decreases wear on the joint
- increases joint congruity
Describe the motion of the TMJ articular disc during jaw opening.
rotates posteriorly on the condyle and the disc-condyle glides anteriorly and inferiorly on the articular eminence of the temporal bone
What is the most common age range for TMD?
20-40 years old
What are the 3 general types of non-specific temporomandibular joint dysfunction?
- muscular
- articular
- combination
What are the 2 subtypes of muscular non-specific TMD?
- myofascial pain without limited jaw opening
2. myofascial pain with limited jaw opening
What are the 5 subtypes of articular non-specific TMD?
- disc displacement (with or without reduction)
- osteoarthritis/osteoarthrosis
- arthralgia
- adhesion / ankylosis
- hypermobility
List the 4 muscles involved in TMJ elevation (closing)
- masseter
- temporalis
- medial pterygoid
- superior fibers of lateral pterygoid (stabilize the disc)
List the 3 muscles involved in TMJ depression (opening)
- inferior fibers of lateral pterygoid
- suprahyoids
- infrahyoids (indirectly)
List the 3 muscles involved in TMJ protrusion
- superficial masseter
- medial pterygoid
- lateral pterygoid
List the 3 muscles involved in TMJ retrusion
- deep fibers of masseter
- temporalis
- suprahyoids (digastrics)
List the 4 muscles involved in TMJ lateral excursion (deviation)
Ipsilateral:
- temporalis
- masseter
Contralateral:
- medial pterygoid
- lateral pterygoid
What is normal ROM of TMJ lateral excursion?
about 1/4th of the opening range
What is the normal ROM of TMJ protrusion?
6mm-9mm
List 3 reasons why TMJ ROM may be reduced
- capsular tightness
- masticatory muscle spasm
- fear of movement due to pain
What does a jaw opening pattern that is “S”-shaped without pain indicate? With pain?
- without pain, may indicate muscle imbalance or muscle incoordination
- with pain and/or limited opening, there may be involvement of the disc or capsule
What does a jaw opening pattern than is “C”-shaped usually indicate?
- usually indicative of a capsular pattern
- there is decreased anterior glide of the TMJ, so the jaw deviates to the ipsilateral side
List the 4 components of the TMJ capsular pattern.
- limited opening
- deflection to ipsilateral side
- protrusion to the ipsilateral side
- limited lateral excursion to the contralateral side
Describe the purpose and performance of the Cotton Roll test for TMJ pain.
- 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
List 4 signs that indicate TMJ anterior disc displacement with reducation
- reciprocal joint sounds during opening and closing
- limited opening with or without pain
- mandible deflects to ipsilateral side during opening
- “C”- or “S”-shaped curve on opening
What relatively rare condition of the TMJ can occur following dental procedures or excessive yawning/laughing? What is the primary impairment?
- posterior disc displacement
- inability to close the mouth
List 6 signs that indicate involvement/tightness of the TMJ capsule.
- palpable tenderness over the lateral TMJ capsule
- pain with opening
Capsular Pattern:
- limited opening
- “C” curve opening (deviation to ipsilateral side)
- lateral excursion limited to contralateral side
- protrusion toward ipsilateral side
What is the most prevalent form of TMD?
myofascial pain
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
What range of jaw opening is considered hypomobile?
< 30mm
What range of jaw opening is considered hypermobile?
> 50mm
What is trismus?
acute closed lock or limited opening of the jaw after a dental procedure caused by masseter muscle spasm
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)
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
What percentage of people with TMJ anterior disc displacement are symptomatic?
only 20-30%
List 5 alternate differential diagnoses that may present with symptoms similar to TMD.
- tooth pain
- ear infection
- trigeminal neuralgia
- cancer
- dental occlusion
What is the general prognosis for TMD?
regardless of classification/diagnosis, TMD is thought to be ‘self-limiting’ with a good prognosis
List 8 education items that you might discuss with a patient with TMD
- posture
- resting position of tongue/jaw
- oral habits (gum chewing, nail biting, hard foods, clenching, grinding)
- sleep position
- avoid resting chin on hand
- relaxation techniques
- use of heat/cold
- reassurance of good prognosis
List 5 exercises outside of the Rocabado 6x6 that you might use to treat TMD
- postural correction (forward head, mandibular protrusion)
- motor control exercise (DNF, scapular stab.)
- cervical muscle stretching
- diaphragmatic breathing
- aerobic exercise
List the 6 items in Rocabado’s 6x6 exercise program for TMD
- resting position of tongue
- opening/closing
- rhythmic stabilization in resting position
- cervical retraction
- shoulder retraction/depression
- upper cervical nods (with/without hands clasped behind neck
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:
- TMJ joint sounds
- deviation during opening
- extra-oral muscle pain at minimum of 2 tender points in the masseter and temporalis
- pain during passive mouth opening
