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OCS > The Temporomandibular Joint > Flashcards

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?

A

6mm-9mm

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
Q

List 6 signs that indicate involvement/tightness of the TMJ capsule.

A
  1. palpable tenderness over the lateral TMJ capsule
  2. pain with opening

Capsular Pattern:

  1. limited opening
  2. “C” curve opening (deviation to ipsilateral side)
  3. lateral excursion limited to contralateral side
  4. protrusion toward ipsilateral side
26
Q

What is the most prevalent form of TMD?

A

myofascial pain

27
Q

What is myofascial pain disorder syndrome (MPDS)?

A

pain that originates from the muscle/fascia structure that is characterized by trigger points (tender points that refer pain) in the affected muscles

28
Q

What range of jaw opening is considered hypomobile?

A

< 30mm

29
Q

What range of jaw opening is considered hypermobile?

A

> 50mm

30
Q

What is trismus?

A

acute closed lock or limited opening of the jaw after a dental procedure caused by masseter muscle spasm

31
Q

What structure is the proposed connection between the temporomandibular joint to ear symptoms

A

the trigemino-cervical nucleus (cranial nerves V, VII, IX, X, and XI and cervical nerves 1-3)

32
Q

Compare/contrast TMJ osteoarthritis/osis vs arthralgia.

A

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
Q

What percentage of people with TMJ anterior disc displacement are symptomatic?

A

only 20-30%

34
Q

List 5 alternate differential diagnoses that may present with symptoms similar to TMD.

A
  1. tooth pain
  2. ear infection
  3. trigeminal neuralgia
  4. cancer
  5. dental occlusion
35
Q

What is the general prognosis for TMD?

A

regardless of classification/diagnosis, TMD is thought to be ‘self-limiting’ with a good prognosis

36
Q

List 8 education items that you might discuss with a patient with TMD

A
  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
Q

List 5 exercises outside of the Rocabado 6x6 that you might use to treat TMD

A
  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
Q

List the 6 items in Rocabado’s 6x6 exercise program for TMD

A
  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
Q

What are the 4 criteria that Von Piekartz et al used to rule in TMD in patient with cervicogenic headache?

A

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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