TMJ

Question 1

What things are you looking for in observation/posture for the TMJ?

Answer 1

Assymetry of the face & neck (hypertrophy of masseter or SCM)
Forward head, scoliosis, cock-robin posture

Question 2

What is normal jaw opening?

What is considered hypermobile jaw opening?

Answer 2

2-2.5 knuckles between upper and lower teeth.

hypermobile = 3 knuckles plus (more than 50mm)

Question 3

The mandible of a hypermobile joint will deviate which way laterally? hypomobile joint?

Answer 3

hyper: contralaterally
hypo: ipsilateral

Question 4

What muscles perform lateral movement of the jaw?

Answer 4

ipsilateral side: masseter

contralateral side: pteregoids

Question 5

What is the closed pack position of the TMJ

Answer 5

slightly open

Question 6

What motions do you test in resisted tests of the TMJ?

Answer 6

opening
closing
lateral movement
protrusion
retrusion

Question 7

How do you perform joint play of the TMJ?

Answer 7

pt. position: seated
Therapist: standing beside pt.
PT places gloved thumb in pt’s mouth over lower molars, remainder of hand over exterior mandible.
Other hand stabilizes pt’s forehead against chest
Therapist moves condyle down and laterally

Question 8

How do you palmate the lateral joint?

Posterior joint?

Answer 8

lateral: index finger anterior to tragus of ear. On max jaw opening, depression will be felt. If inflammed this will be warm and very tender
posterior: tip of little finger (gloved) into ext. auditory canal fingernails post. Stand in front of pt and do both jts at same time. Pressure exerted ant as pt opens/closes mouth several times.

Question 9

How do you perform a caudal glide/traction of the TMJ?

Answer 9

pt. position: supine
Therapist: stand on side of intended traction.
Put post. thumb over lower molars with index finger under mandible with other hand stabilizing contralat. mastoid.
Traction applied caudally.

Question 10

How do you perform an anterior glide of the mandibular head.

Answer 10

pt. position: supine
Therapist: stand on side of intended traction.
Put post. thumb over lower molars with index finger under mandible with other hand stabilizing contralat. mastoid.
Mandible glided ant.

Question 11

How do you perform a combined glide of the mandibular head.

Answer 11

pt. position: supine with mouth open 1cm
Therapist: stand on side of intended traction.
Put post. thumb over lower molars with index finger under mandible with other hand stabilizing contralat. mastoid.
Combine caudal glide and ant. or post. glide