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OCS - Current Concepts of Ortho PT > TMJ > Flashcards

TMJ Flashcards

1
Q

What are 5 causes of TMJ dysfunction?

A
  1. Macrotrauma (e.g. whiplash, direct blow, iatrogenic dental procedures)
  2. Microtrauma from parafunctional clenching and bruxing
  3. Degenerative OA
  4. Systemic conditions
  5. Mental health disorders
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2
Q

What population is at highest risk for TJM dysfunction?

A

Women around reproductive age

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3
Q

TMJ is what type of joint?

A

Bilateral diarthrodial (synovial) joint

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4
Q

TMJ articular surfaces and the disk are covered in what?

A

Fibrocartilage that has superior reparative potential and resistance to wear/tear

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5
Q

During mouth opening what movement occurs?

A

Superior cavity: translation
Inferior cavity: rotation of the condyle

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6
Q

What is the shape of the disk in the TMJ?

A

Biconcave (“bow-tie”)

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7
Q

What parts of the TMJ articular disks have innervation/vascularization?

A

Anterior & posterior

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8
Q

What is the function of the temporomandibular ligament aka “lateral” ligament?

A

Limits rotation of the condyle and posterior displacement

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9
Q

What is the function of the collateral ligaments?

A

Restrict excessive medial/lateral movement of the disk

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10
Q

What are the 2 accessory ligaments of the TMJ?

A

Stylomandibular and sphenomandibular ligaments

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11
Q

What is the function of the accessory ligaments in the TMJ?

A

Restrict excessive protrusion

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12
Q

What are the muscles of mastication?

A
  1. Masseter
  2. Temporalis
  3. Lateral pterygoid
  4. Medial pterygoid
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13
Q

What is the action of the masseter muscle? (both unilat & bilat contraction)

A

Unilat: slight ipsilat excursion
Bilat: superficial = protrusion, deep = retraction

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14
Q

What is the insertion of the temporalis muscle?

A

Coronoid process and medial border of the mandibular ramus

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15
Q

What is the action of the temporalis muscle? (both unilat & bilat contraction)

A

Unilat: ipsilat lat excursion
Bilat: elevation/retraction of mandible

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16
Q

What is the function of the medial pterygoid?

A

Unilat: contralat excursion
Bilat: elevation/protrusion

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17
Q

What is the function of the lateral pterygoid?

A

Unilat: contralat excursion
Bilat: protrusion

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18
Q

What are the suprahyoid muscles (4)?

A

anterior/posterior belly of the digastric, mylohyoid, geniohyoid, and stylohyoid

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19
Q

What are the infrahyoid muscles (4)?

A

sternohyoid, sternothyroid, thyrohyoid, and omohyoid

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20
Q

Muscles involved in TMJ elevation (closing)

A

Masseter, temporalis, medial pterygoid, lateral pterygoid (SUPERIOR)

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21
Q

Muscles involved in TMJ depression (opening)

A

Lateral pterygoid (INFERIOR), suprahyoids, infrahyoids

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22
Q

Muscles involved in TMJ protrusion

A

Massater (SUPERFICIAL), lateral pterygoid, medial pterygoid

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23
Q

Muscles involved in TMJ retrusion

A

Massater (DEEP), temporalis, suprahyoids

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24
Q

Muscles involved in TMJ lateral excursion

A

IPSILAT: masseter, temporalis
CONTRALAT: medial/lateral pterygoids

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25
Q

Innervation of the TMJ

A

Mandibular division of the trigeminal nerve (CN V3)

Ant/medial: deep temporal and masseteric nerve

Post/lat: auriculotemporal nerve

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26
Q

Normal amount of TMJ depression

A

40-45mm Males
45-50mm Females

aka 4 fingers width

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27
Q

FUNCTIONAL amount of TMJ depression

A

35mm or 3 fingers width

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28
Q

Lateral excursion normal movement (measurement)

A

1/4 opening amount

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29
Q

Protrusion amount

A

6-9mm

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30
Q

Retrusion amount

A

3mm

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31
Q

Primary arthrokinematics movement in first 25-50% of opening

A

Anterior rotation of condylar head

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32
Q

Primary arthrokinematic movement in LATE opening

A

Anterior translation of condylar head and disk

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33
Q

2 classifications of internal derangement of the disk-condyle complex

A
  1. Anterior disk displacement WITH reduction (ADDwR)
  2. Anterior disk displacement WITHOUT reduction (ADDwoR)
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34
Q

Where is the resting position of the TMJ disk when mouth is closed?

A

Just anterior to condyle

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35
Q

What type of clicks in ADDwR?

A

reciprocal clicks (can be single though)

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36
Q

If ADDwR is not treated, it may become?

A

ADDwoR = no clicking, limited opening ROM

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37
Q

What is open-lock?

A

Disk displaced posterior, lateral pterygoid is overly stretched

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38
Q

How many teeth in the mouth?

39
Q

Orthognathia

A

Dentist who deals with the malposition of bones of the jaw

40
Q

Stomatognatic system

A

Includes the structure of mouth, teeth, jaw, and associated soft tissues

41
Q

Overbite

A

Portion of the mandibular central incisors that are covered by the maxillary central incisors
- NORMAL: 1/3rd of mandibular incisors

42
Q

Overjet

A

Horizontal distance between maxillary arch and mandibular arch when in max occluded position

  • NORMAL: 3-6mm
43
Q

What does the “C” curve indicate during opening?

A

capsular pattern

44
Q

What does the “S” curve indicate during opening?

A

Poor motor control (muscular imbalance) or asymmetry of condylar head rotation or translation, ADDwR

45
Q

Deflection

A

Mandible deflects to one side w/o returning to center at end of opening
- CAUSE: capsular restriction or unilat hypomobility

46
Q

Classes of occlusion

A

I: normal (overjet 3-6mm)
II: excessive overjet >6mm
III: underbite

47
Q

Open-bite

A

Maxillary front teeth don’t make contact while mouth is closed

48
Q

Crossbite

A

central incisors not aligned when mouth is closed

49
Q

Centric relation

A

Position where the condyle sits most sup/post in mandibular fossa
(aka “Open packed position”)

50
Q

Bruxism

A

Excessive teeth grinding

51
Q

3 Classifications of TMD (according to AAOP)

A
  1. Articular disorders
  2. Masticatory muscle disorders
  3. Arthritides (capsulitis, OA, synovitis, RA)
52
Q

Recommended questionnaires (Harrison et al) for TMD

A
  1. Patient health questionnaire for depression and anxiety
  2. Graded chronic pain scale
53
Q

Type of imaging that can confirm clinical suspicion of anterior disk displacement with or without reduction

A

Kinematic MRI

54
Q

Deflection can be due to..?

A
  1. ADDwoR
  2. Limited capsular mobility
  3. Unilateral hypermobility
55
Q

Scalloping of the tongue could indicate?

A

Nocturnal bruxism

56
Q

T/F: Joint sounds and deviations of the jaw do not indicate significiant pathology?

57
Q

Cotton roll test: Pain increases = ?
Pain decreases = ?

A

Increases = muscular in origin

Decreases = joint (can confirm by biting down on contralat side - should cause pain on involved side due to loading of the joint on that side)

58
Q

T/F: US (diagnostic) is NOT reliable in identifying internal derangement

A

False
Also helpful: MRI, XR, CT

59
Q

Cluster to diagnose chronic ADDwoR (5/7 = +)

A
  1. Joint provocation test (mouth opening w/ pain)
  2. Deviation test (deflection to ipsilat side at end-range opening)
  3. Laterotrusion test (limited lat excursion <9mm to contralat side)
  4. Joint mobility test (reduced ant translation of condylar head w/ palpation)
  5. Joint sounds test (absent or crepitus)
  6. Dental stick test/cotton roll test
  7. Isometric test (resist lat excursion contralat, + painful)
60
Q

What can cause open lock?

A

Prolonged opening (dentist), excessive yawning/laughing

61
Q

Hypomobility with opening (in mm)

62
Q

Hypermobility with opening (in mm)

A

> 55mm (usually with “S” deviation)

63
Q

T/F: myofascial pain is the most prevalent cause/form of TMD?

64
Q

Trismus

A

Acute closed lock of the jaw after a dental procedure

65
Q

Interventions for dystonia in TMJ muscles

A

botox & medication

66
Q

T/F: Vertigo is more prevalent in those with TMD

67
Q

Trigeminal neuralgia symptoms

A

Sudden/paroxysmal, unilat, electric-like, stabbing pain, intermittent, abates in seconds-minutes
- Involves maxillary/mandibular divisions of the trigeminal nerve

68
Q

3 branches of the trigeminal nerve

A

Ophthalmic (V1), maxillary (V2), and mandibular (V3) nerves

69
Q

Meniere’s disease symptoms

A

Vertigo, tinnitus, aural fullness, facial-TMJ pain

70
Q

What is the first line for TMJ treatment?

A

Non-surgical options: PT, medication, occlusal adjustment, splint therapy, chiro, cognitive behavioral therapy

71
Q

Sleep posture that should be avoided in pt’s with TMD

72
Q

Diet recommended for TMD

A

Soft or semi-solid until symptoms subside

73
Q

Is TENS okay to use for TMD?

A

Yes, it is superior to a placebo

74
Q

T/F: manip of TMJ is indicated for acute closed lock (ADDwoR) or dislocation

75
Q

Evidence for dry needling in TMD

A

Positive effect

76
Q

KT taping in conjunction with what is shown to be effective

A

KT in combo w/ exercise & counseling was MORE effective then counseling and exercise alone

77
Q

Directions of joint mobilization of TMJ

A
  • Longitudinal distraction
  • Anteromedial translation
  • Medial glide (rarely performed)
  • Lateral glide
78
Q

Tongue-controlled mouth opening exercises can be helpful for __?

A

hypomobility, hypermobility, incoordination, and inflammatory conditions

79
Q

Recommended sets/reps for tongue controlled mouth opening exercises

A

3 x 6 reps, 6x/day

Progress to wider opening without tongue on palate when opening pattern no longer shows deviations or deflections

80
Q

Controlled opening should be progressed to –> ___?

A

Isometrics

81
Q

Recommended reps/hold time for TMJ isometrics

A

10” hold x 6 reps each session

82
Q

What is spray and stretch and how is it helpful?

A

Use of Ethyl-Chloride or Flouri-Methane vapocoolant spray; thought that coolant can abolish superficial stretch reflex of the fascia

83
Q

Treatment of myofascial pain disorder syndrome should focus on what?

A

Elimination of trigger points, reduction of precipitating and perpetuating factors

84
Q

What is the most effect approach to tx of myofascial pain disorder?

A

Multidisciplinary, cognitive behavior therapy and patient education are key

85
Q

When is persistent pain deemed chronic

86
Q

First choice medication for arthritide TMD

A

Acetaminophen, can use NSAIDS for inflammation

87
Q

What topical medication is demonstrated to be effective in reducing TMJ pain?

A

Topical diclofenac

88
Q

What is the evidence of use of acupuncture in TMD?

A

Limited, weak

89
Q

Is occlusal adjustment a good tx for TMD?

A

Not recommended as first line, efficacy has not been proven

90
Q

2 schools of thought on TMJ splinting

A
  1. Stabilization theory (Michigan type splint)
  2. Repositioning theory (Farar type, Gelb type)

Better vs no tx, but not super effective

91
Q

What is the connection pathway between TMD and ear symptoms

A

Trigeminocervical nucleus

92
Q

T/F: Upper cervical spine mobs are important in the management of non-otological tinnitus

A

True, C1-C3 nerves are located in the trigeminocervical nucleus

OCS - Current Concepts of Ortho PT (12 decks)

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