TMJ Flashcards
what muscle is very important for guiding the disc via eccentric control?
lateral pterygoids (superior head)
describe how the condyle moves on both sides during lateral deviation
ipsi condyle: rotation
contra condyle: translation
normal opening ROM
40-60 mm
function opening ROM
35 mm
normal lateral deviation ROM
1/4 of opening
10 mm
normal protrusion ROM
5-10 mm
normal retrusion ROM
3 mm
how many fingers wide should normal opening be?
4
what is occulsion?
functional relationship between maxillary and mandibular teeth (close)
what is grinding of the teeth called?
bruxism
what muscles are overactive with clenching?
masseter and temporalis
what is freeway space?
space b/w occluding surfaces of teeth when mandible is in physiologic resting position
normal freeway space
2-4 mm
overbite vs over jet
bite - vertical
jet - horizontal
what is it called when a portion of the mandibular center incisor is covered by the maxillary center incisor?
overbite
how is over jet measured?
horizontal distance b/w the maxillary arch and the mandibular arch in full occlusion
normal: 3-6 mm
the TMJ is a _____ joint with ____cartilage covering the surface
synovial
FIBROcartilage
what 2 structures keep the TMJ in place?
post-glenoid spine
articular tubercle
where does rotation vs translation occur?
inferior cavity - rotation
superior - translation
disc attaches posteriorly to ___ and anteriorly to ____ & _____
post - retrodiscal tissue
ant - superior lateral pterygoid & joint capsule
which part of the disc is avascular and aneural?
intermediate
retrodiscal tissue is _____ & ____ (nerve and blood supply)
vascular and nociceptive
what is the main pain generator for TMJ?
retrodiscal lamina (highly vascularized and innervated)
what structure is the switch b/w rotation and translation?
tempomandibular ligament
what is the only muscle action the lateral pterygoid does not do?
retrusion
what motions does the suprahyoids do?
depression
retrusion
what actions does the infrahyoids do?
stabilize the hyoid bone
speech, swallow, tongue movements
T/F: lateral pterygoids are the only contractile tissue that attaches to the disc
T
generally, the TMJ issues will be ____ in closing and ____ in opening
tight closing
weak opening
in resting position, the disc should sit ____ to the condyle
slightly anterior
convex/concave rule for TMJ
convex condyle moving on concave disc
when does rotation occur during opening?
1st 20-25 mm of motion
condyles roll ___ and glide ___ during opening
roll anterior
glide inferior
condyles roll ___ and glide ___ during closing
roll posterior
glide superior
the mandible slides slightly ____ during protrusion and ___ during retrusion
protrusion - down
retrusion - up
what other segment should be assessed when pt complains of TMJ pain?
C spine
possible issues with anterior disc displacement with reduction
stretched temporomandicular ligament
overactive superior lateral pterygoid
issue or morphology of retrodiscal lamina
_____ and _____ act as guide wires in position of the disc
superior lateral pterygoids
retrodiscal lamina
for ADDwR, treat muscles that affect the ______ pressure
interarticular
diff dx?
no clicking
decreased ROM
anterior disc displacement w/o reduction
______ is lost in the posterior ligaments and retrodiscal tissue in ADDwoR
elasticity
if there is limited opening in ADDwoR, what is occuring?
disc is blocking condylar head
if there is no limitation in opening in ADDwoR, what is occuring?
disc is completely displaced anteriorly (2/2 continuous stretching)
what are 2 main sx to ask about with TMD?
HAs
neck pain
C shape jaw opening indicates?
capsular pattern
S shape jaw opening indicates?
lack of motor control
deflection w/ jaw opening indicates?
anterior disc displacement
to which side is the disc displaced if the jaw deflects to the R during opening?
R
if pain increases during cotton roll test, what is the issue?
muscular origin
if pain decreases during cotton roll test, what is the issue?
joint origin
how to confirm joint prob with cotton roll test?
perform test on non painful side and pain is still reproduced
what muscle lengths should be checked for TMJ issues?
pec major (T)
pec minor (Y)
lats (full overhead flex)
order of the mandibular neurodynamic test
capital flexion
laterally flex upper C spine contralaterally
lateral glide of mandible contralaterally
how to palpate medial and lateral pterygoid
medial - posterior to back molar along mandibular teeth
lateral - inside of external auditory meatus
where is the force for the centric relation provocation test?
anterior-superior
which MET is used to increase opening?
resisted closing
where should PT stand for mobs?
contra side
which mob should be done 1st?
distraction
what mob helps with anterior disc displacement?
anteriomedial mob with rotation
How many patients with neck pain also present w/ temporo-mandibular dysfunction?
1/3
