TMD and miscellaneous Flashcards
The jaw is controlled directly by the muscles of mastication and indirectly by?
The cervical muscles
The cartilage of the TMJ is made of?
Fibrocartilage
What is significant about knowing what kind of cartilage the TMJ is made of?
Fibrocartilage is easier to repair
Whast are the ligaments of the TMJ?
-Medial collateral
-Lateral Collateral
-Stylomandibular
-Sphenomandibular
What is the only structure that can pull the jaw posteriorly into the joint space?
Superior band of the retrodiscal tissue
What are mandibular opening muscles?
Primary:
-Inferior lateral pterygoid
-Digastric
Secondary:
-Stylohyoid
-Geniohyoid
-Mylohyoid
What are the mandibular closing muscles?
-Temporalis
-Masseter
-Medial Pterygoid
How does lateral movement of the jaw occur?
Combination of:
Same side temporalis
Opposite Pterygoids
What is the average amount of lateral movement of the jaw?
5-10 mm
What muscles perform mandibular protrusion?
-Masseter (superficial head)
-Medial Pterygoid
-Lateral Pterygoid (superior head)
What muscles perform mandibular retrusion?
-Temporalis
-Digastric
-Suprahyoid muscles including Stylohyoid, geniohyoid, and mylohyoid
What innervates the muscles of mastication?
Trigeminal nerve
What cervical levels refer to the TMJ?
C2 and C3
What are the two components of TMJ opening?
Rotation and translation
What is the normal amount of jaw opening?
40-60 mm
The rotational part of jaw opening is what amount of the opening?
The first 20-25 mm
What is the force couple of jaw closing?
The eccentric contraction of the superior lateral pterygoid and the release of passive tension in the retrodiscal tissue
TMD is also called?
Craniomandibular disorder
What are symptoms of craniomandibular disorder?
-Face or jaw pain
-Joint Sounds (29-66%)
-Limitation of jaw movement
-Muscle tenderness
-TMJ joint tenderness
-Headache
-Ear Symptoms
-Cervical spine disorders
What other systems are included in regional involvement of CMD?
-Stomatognathic
-Cervical Spine
-Shoulder Girdle
TMJ related issues can refer pain where?
Structures of:
-Facial
-Auditory
-Dental
What are the categories of TMD?
-Myofascial Pain
-Myofascial Pain with limitations in aperture
-Disc Displacement with reduction
-Disc Displacement without reduction and no limitation in aperture
-Disc Displacement without reduction and with limitation in aperture
-Arthralgia
-Osteoarthritis of the TMJ
-Osteoarthrosis of the TMJ
What is occuring with disc displacement with reduction TMD?
At rest, the dist lies anterior and when the mouth opens the condyle reduces back over the posterior region of the disc
What is characteristic of a unilateral disc displacement with reduction?
-One side of the TMJ will breifly be restricted upon opening
-Makes an “S” shape, -Deviating toward the involved side
-May hear a click upon opening and closing
What is going on with disc displacement without reduction in TMD?
The condyle is unable to move forward of the anteriorly placed disc due to the lost elasticity of the collateral ligaments and retrodiscal tissue.
What is characteristic of disc displacement without reproduction?
-No click since it’s blocked
-Jaw deviates toward the involved side
-Moves in a “C” shape
What is happening with condylar subluxation?
Hypermobility of the joint capsule causes the condyle and disc to translate over the articular eminence
What is characteristed of condylar subluxation?
-May have a “clunk”
-Deviation will be away from the affected side
What are general interventions for hypermobile TMD?
-Teach not to open wide
-Use tongue-up position
-Palpate at the lateral pole
-Isometric exercises
-Address muscle weakness
-Mandibular muscle relaxation / biofeedback
What are general interventions for hypomobile TMD?
-Manual mobilization
-Self-Mobilization
-Intraoral appliance/mobilizing splints
-Stretching
What factors are incorporated in the musculoskeletal response?
-Musculoskeltal
-Biopsychosocial
-Somatovisceral
-Neurophysiological
What does regional interdependence emphasize?
The need to evaluate joints above and below the area of symptoms - 2 joint rule
What is perceived with vertigo?
Either the world is moving and they are standing still or they are still and the world is moving
What is “dizziness?”
Feeling of being light-headed, foggy, unsteady, or off-balance sometimes associated with nausea, vomiting, or fainting
What are causes of dizziness?
-Blood pressure drop
-Cardiac disease: acute or chronic
-Hypovolemia
-Anemia
-Hypoglycemia
-Some anxiety disorders
-Endurance events in a high heat environment
What is the definition of orthostatic hypotension?
20 mmHg drop in systolic or 10 mmHg drop in diastolic withing 3 minutes of standing
What are findings along with dizziness that might clue you into a cardiac origin?
-Brady or tachy cardia
-Arrythmias
-Chest Pain
-Sweating
-Other symptomatic cardiac findings
What are symptoms of hypovolemia?
-Anxiety/agitation
-Cool/clammy skin
-Confusion
-Decreased or no urine output
-General weakness
-Pale Skin
-Rapid Breathing
-Low blood pressure regardless of position
-Rapid, weak, thready pulse
What are symptoms of anemia?
-Fatigue
-Weakness
-Pale/yellowish skin
-Irregular heartbeat
-SOB
-Chest Pain
-Cold hands/feet
-Headaches
When is a person in hypoglycemia?
Blood sugar below 70 mg/dL
What are symptoms of hypoglycemia?
-Sweating, chills, clammy skin
-Irritability and confusion
-Tachycardia
-Hunger
-Sleepy/weak/no energy
-Tingling of lips, tongue, cheeks
-Headaches
-Coordination issues
What are conditions included in central vertigo?
-Head Injuries
-Illness/Infection
-MS
-Migraines
-Brain Tumors
-Stroke/TIA
What are examples of peripheral vertigo?
-BPPV
-Vestibular Neuronitis
-Meniere’s Disease
-Labyrinthitis
-Perilymph Fistula
-Superior Semicircular canal dehiscence syndrome
What causes vestibular neuritis?
Most often a viral infection
What are characteristics of vestibular neuritis?
Sudden and severe:
-Nausea/vomiting
-Ear drum normal
-Horizontal nystagmus
-Neuro exam/hearing unremarkable
-Fully Resolves in 7 days
What are characteristics of Meniere’s Disease?
-Symptoms are unilateral and last minutes to hours
-Vertigo, hearing loss, and tinnitus
-Usually resolves within 24 hours
What differentiates Meneire’s Disease from BPPV?
BPPV does not have ear ringing or unilateral hearing loss
What is the most common type of BPPV?
Posterior canal
If a person is going to shift from one type of BBPV to another, what would it be?
From lateral to posterior
What should be recommeneded post BPPV treatment?
-Should NOT recommend postural restrictions
-May offer vestibular rehab
-Should NOT treat BPPV with vestibular suppressant medications such as antihistamines or benzos
-Educate on BPPV and their safety, potential for recurrence, and importance of follow up
-Encourage AWAY from Meclazine (suppresses vestibular system and does not fix crystals)
