TMJ

Question 1

TMJ Anatomy

Answer 1

Diarthrodial joint
Fibrocartilagenous disc, ligaments, and capsules
Articular disk is biconcave
Anterior and Posterior portions of disc are innervated and vascular
Capsule is firm medial to lateral and loose anterior to posterior

Question 2

TMJ Arthrokinematics

Answer 2

Rotation and Translation of the condylar-disk complex during open and close
Translation anterior and posterior during protrusion retrusion
Lateral movement is ipsilateral rotation and translation contralaterally

Question 3

Mouth locked closed

Answer 3

Anterior disc derangement

Question 4

Mouth locked open

Answer 4

Post disc derangement

Question 5

TMJ red flags

Answer 5

Ringing in the ears (Too much aspirin)
Dizziness/light headed (Orthostatic hypotension)
5 D’s (Vertebral artery dissection)
Headaches

Question 6

Link between cervical spine and TMJ

Answer 6

Link between C1-C3 and TMJ through trigeminocervical nucleus
Neck pain associated with TMD
Tinnitus and Vertigo in TMD

Question 7

TMJ Exam

Answer 7

Head alignment
Dental exam
Facial alignment
Tongue position at rest

Question 8

TMD Incidence

Answer 8

50-75%
All ages and genders
Symptoms fluctuate and may be self limiting

Question 9

Specific TMJ Questions

Answer 9

Pain opening or closing?
Pain chewing, biting, yawning?
Clicking, popping, snapping?
Morning tightness/stiffness?
Bad habits?
Painful or sensitive teeth?
Missing teeth?

Question 10

Bruxism

Answer 10

Teeth grinding

Question 11

Treatment differences w/ neck pain versus without

Answer 11

Cervical Screen before TMJ treatment

Question 12

Number of teeth

Answer 12

32 (28 without wisdom teeth)

Question 13

Signs of clenching

Answer 13

Linea alba (white line on cheek inside)
Tongue Scalloping

Question 14

AROM TMJ

Answer 14

Mouth opening (35-50 mm)
Quality of movement

Question 15

S shaped curve opening

Answer 15

Muscle imbalance

Question 16

C shaped curve opening

Answer 16

Capsular pattern

Question 17

Deflection during opening

Answer 17

Anterior disk displacement

Question 18

AROM Lateral excursion

Answer 18

10-15 mm

Question 19

AROM Protrusion

Answer 19

6-9 mm

Question 20

AROM Retrusion

Answer 20

3-4 mm

Question 21

Functional opening

Answer 21

25-35 mm

2-3 PIPs between incisors

Question 22

TMJ PROM

Answer 22

Examiner takes Pt through:
opening
protrusion/retrusion
Lateral excursion
End feel and Pt response

Question 23

Passive Accessory Motion Testing TMJ

Answer 23

Pt Supine
Externally (A/P, P/A, Medial glide)
Internally (Longitudinal distraction, w/ ant glide, w/ post glide)

Question 24

Muscle Performance Testing TMJ

Answer 24

Resisted Isometrics

Deep Neck Flexors

Question 25

Resisted Isometric Testing TMJ

Answer 25

Mandibular Depression Mandibular elevation Lateral Deviation

Question 26

TMJ Neurological screen

Answer 26

DTR (Tapping chin) Myotomes Sensation CN Testing

Question 27

TMJ Special Test

Answer 27

Auscultate (Listening for click) | Bite maneuver

Question 28

Bite Maneuver

Answer 28

Pt bites with cotton ball on one side Determine which side, then... Distraction Pain on bite side: Extracapsular Distraction Pain on opposite side: Intracapsular

Question 29

TMJ Palpation

Answer 29

``` TMJ through external auditory meatus Condyle anterior to ear open/closed Coronoid Process Muscles (Tone, symptom reproduction) Bony Structures Cervical Spine ```

Question 30

Disk Displacement

Answer 30

Acute Joint sounds Limited opening or closing Deviation C shape towards painful side

Question 31

Myofacial TMD

Answer 31

Chronic Limited opening Deviation noted later in range J shape Poor posture

Question 32

Interventions for reduced derangement

Answer 32

``` Manual therapy for arthrokinematics Motor learning activity Stabilization Pt education Referral to specialist ```

Question 33

Interventions for non-reduced derangement

Answer 33

``` Manual therapy to recapture the disc Motor learning activity Stabilization exercise Pt education Referral to a specialist ```

Question 34

Interventions for Hypomobility

Answer 34

``` Pt education PROM and Joint mobes Soft tissue mobes and stretching of Connective tissue AROM Posture Cervical spine mobes Motor learning ```

Question 35

Interventions for hypermobility

Answer 35

``` Pt Education Local Modalities Motor learning Stabilization activities Postural strength/endurance ```

Question 36

Interventions for inflammatory conditions

Answer 36

``` Local Modalities Education Joint moves Gr I and II AROM in pain free range Mobility classification when improved ```

Question 37

Interventions for Myofacial Conditions

Answer 37

Pt Education Postural Training Cervical Spine treatment Deep neck flexor and scapular muscle strengthening