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OCS Studying > TMJ > Flashcards

TMJ Flashcards

1
Q

Opening: Normal vs functional vs excessive opening

A
  • Normal: 40-45mm males; 45-50mm females
  • Functional: 35mm (3fingers/2knuckles dominant) or 4 fingers/3knuckles nondominant)
  • Excessive:>55mm
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2
Q

Arthrokinematics of opening:

A
  • posterior rotation predominates in 1st 1/2 motion (~11-25mm)–> inferior cavity
  • Anterior translation predominates in last 1/2 motion (>25mm) opening–>superior cavity

**pattern reverses with closing

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3
Q

Lateral deviation: normal range

A

1/4 opening; ~10mm

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4
Q

Lateral deviation: arthrokinematcs

A

Rotation/spinning of I/L condyle and horizontal translation of C/L condyles

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5
Q

Protrusion and retrusion norms

A

P: 6-9mm
R: 3 mm

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6
Q

Joint capsule properties and areas of looseness/tightness

A
  • Highly vascular and innervated
  • Firm medially
  • loose anterior/posterior to allow movement
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7
Q

superior vs inferior cavity; what goes on here and what divides them?

A

disk divides joint into superior and inferior cavities

  • -rotation occurs in INFERIOR cavity
  • -translation occurs in SUPERIOR cavities
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8
Q

TMJ innervation

A

Mandibular division of trigeminal nerve (anterior and medial TMJ = deep and masseteric branches, posterior and lateral = auriculotemporal nerve

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9
Q

Muscles of elevation:

A
  1. Masseter
  2. Temporalis
  3. medial Pterygoid
  4. superior fibers of lateral pterygoid to stabilize disk
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10
Q

Muscles of depression:

A
  1. inferior lateral ptrygoid
  2. digastric
  3. infrahyoids
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11
Q

Muscles of protrusion

A
  1. superficial masseter
  2. medial pterygoid
  3. lateral pterygoid
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12
Q

Muscles of retrusion:

A
  1. deep masseter
    2, temporalis
  2. suprahyoid
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13
Q

Muscles of lateral deviation:

A
  1. I/L temporalis
  2. I/L masseter
  3. C/L pterygoids
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14
Q

ADDwR

A
  • Disc displaced anterior with mouth closed,
  • opening reduces disk back ontop of C.head (1st click)
  • @ beginning of closing disk-condyle complex translates together posteriorly
  • @ end of closing disc displaces anteriorly again (2nd click) **due to excessive contraction of superior head of Lat. pterygoid and decreased elasticity of posterior striatum fibers
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15
Q

ADDwoR

A
  • no clicks, disks permanently stays in front of condyle

- opening may be limited (closed lock)

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16
Q

Posterior disc displacement (PDD)

A
  • rare, can be due to prolonged wide opening or stretch of lateral pterygoids
  • closing limited (open lock)
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17
Q

Dislocation:

A

unable to close, can be due to hypermobility, trauma, genetic (EX: ehlers-danlos)

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18
Q

Subluxation:

A

excessive lateral protrusion of involved condyle with opening

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19
Q

Ankylosis:

A

Restricted ROM/opening limited with deviation to involved side (may be secondary to polyarthritis, inflammation, etc)

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20
Q

Myofascial pain: s/sx, common trigger points

A

-Masseter TrP: refer to lower teeth
-Temporalis TrP: refer to upper teeth
S/Sx: TrP = hallmark; HA, facial pain, jaw/neck pain, tinnitus, earache, dizziness, swallowing difficulty, TMJ noises

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21
Q

Myositis

A

Acute inflammation; palpable tenderness with limited opening

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22
Q

Trismus

A

spasm in masseter muscle

  • Hx is major clue
  • Opening <25mm typically
  • Overuse (chew hard food/gum), dental procedure (overstretch)
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23
Q

Dystonia:

A

CNS dysfunction

-Need botox or medical Tx

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24
Q

Arthrides

A

inflammation of joint (EX OA); crepitus, limited and painful ROM

**With RA and psoriatic arthritis, joint protection and inflammation control are of primary importance

25
Q

Capsulitis:

A

“C” curve with deflection and protrusion to involved side

-presents similarly to synovitis

26
Q

Why can you get ear Sx/cervical Sx with TMJ disorder

A
  • Trigeminocervical Nucleus (neuron pool in basal ganglia) and Auriculotemporal Nerve
  • synapse of CNV, VII, IX, X, XI and C1-C3 spinal nerves
27
Q

Trigeminal neuralgia:

A

electric/stabbing pain at V2-3 (trigeminal); intermittent and abates in seconds/minutes

28
Q

Poster Herpetic Neuralgia:

A

CONSTANT electric/stabbing pain at V1 (trigeminal)

29
Q

Temporal arthritis:

A

subacute inflammation

  • severe U/L or B HA
  • jaw claudication with pain/stiffness
  • *MUST eval opthamologically due to risk of vision loss–refer back to MD in this case**
30
Q

Atypical Odontalgia

A
  • Phantom Tooth pain
  • Constant burning/pressure like pain after endodontic/dental distraction procedures due to disruption of neural pathways to alveolar or pulp
31
Q

Miniere’s disease:

A

Combo of vertigo, tinnitus, aural fullness

–studies show benefit with concurrent Tx to TMJ and C-spine regions in PT

32
Q

C curve vs S curve

A

C curve: capsular; deviates to involved side; If capsular tightness will demonstrate I/L concurrent deflection and protrusion and limited lateral excursion to C/L side

S curve: NM coordination problem

33
Q

Cause of deflection to I/L side without return

A

disk involvement

34
Q

Occlusal measurement/classes

A

-Normal overjet: 3-6mm
-Class II: >6mm
Class III: negative with edge to edge occlusion

35
Q

Cotton Roll Test

A

Patient bite down on cotton Roll

  • If Sx decrease on I/L side, think joint
  • if Sx increase on I/L side, think musce
36
Q

Normal TMJ HEP programs

A
  1. c-spine involvement
  2. 6x6 controlled opening (every 2 hrs)
  3. Isometrics with fingers: NOT for strength but for stabilization
  4. tongue blades: for increasing postop hypomobility
37
Q

Condylar remodeling program: (for ADD)

A
  • use .5 in surgical tubing
  • theoretically improves stabilization and disc/condylar congruency
  • Used in conjunction with ionto, mobilization with good results
    1. deviate C/L then return to center. If pain free add Bite but release bite prior to returning to center
    2. Perform #1 but maintain bite to center
    3. Perform with protrusion vs. lateral deviation at next phase
    4. Isometric contraction can be introduced with tubing in place via stabilization or tubing distraction
38
Q

Tx: Clicking due to ADDwR

A
  1. Open maximally with opening click and close along protruded path
  2. contact teeth with protrusion, then retrude just prior to closing click (disc repositioning mandibular position)
  3. Open mouth maximally without opening click
    * *Perform 5 min after meals and maintain repositioning position all day; goal is to recapture disc
39
Q

Tx: PDD:

A

-use same strategies as ADD, but avoid max mouth opening with submax ROM ex

40
Q

Tx: Myofascia pain disorder:

A
  • Spray and stretch–inject if this isn’t successful
  • Aerobic exercise and stress management important
  • multidisciplinary approach most important due to need to address multiple factors
41
Q

Tx: Trismus

A
  1. active opening with head (?)
  2. Relaxation and diaphragmatic breathing
  3. US or TENS for spasm
  4. soft diet 1-2 weeks
  5. STM and passive stretches
42
Q

Postop-

A
  • arthrocentesis perferred for severe pain if conservative Tx doesn’t solve issues
  • Ice, NMES, US followed by STM and gentle joint mobs
  • Graded opening with tongue blades
43
Q

TX: ear Sx

A

TMJ and C1-C3 mobilization

44
Q

TX: Headache

A
  • Acupressure
  • 6x6 postural exercises
  • relaxation and aerobic exercise
45
Q

Repositioning splint

A

recapture anteriorly displaced disc and/or manage disc/ condyle discoordination
-worn 24/7
-worn weeks–>months
Goal: reposition disc

46
Q

Resting splint

A

Relaxing and balancing soft tissue

  • worn day/night only to decrease stress with clenching/bruxing
  • don’t wear with eating
47
Q

Night Splint

A

Acrylic resin interocclusal

-helps with muscle relaxation and protects teeth while clenching at night (prevents wear to enamel)

48
Q

Arthroscopic surgery

A

good results to decrease pain if conservative treatment fails
-purpose: improve kinematics of disc condyle component through release of soft tissue adhesions and capsular fibrosis

49
Q

Arthrocentesis surgery

A

Lavage of joint w/o viewing joint space

50
Q

TM ligament

A

AKA lateral ligament: supports lateral wall of JC

  • Superficial oblique fibers: limit condylar head rotation during jaw opening
  • Deep horizontal fibers: limit posterior displacement of condyle (protects retrodiscal pad)
51
Q

Collateral LIgaments

A

Restrict excessive medial and lateral movement of disk so disk centered on top of condyle and moves as unit in AP direction

52
Q

Masseter muscle functions

A

U/L: lateral deviation to same side

B: mandibular elevation

53
Q

Temporalis muscle functions

A

U/L: lateral deviation to same side

B: elevate and retract mandible

54
Q

Medial Pterygoid muscle functions:

A

U/L: C/L deviation

B: elevation and protrusion of mandible

55
Q

Lateral Pterygoids muscle functions

A

U/L: C/L deviation

B: protrusion

56
Q

Centric Relation:

A

position where condyle sits most superiorly and posteriorly in mandibular fossa with articular disk stabilized in b/t
-AKA open pack; all connective tissues at ease

57
Q

TMJ movement with cervical flexion vs extension vs. SB/rotation

A

C-flexion: mandible moves superiorly and anteriorly
C-extension: mandible moves inferiorly and posteriorly
C SB/Rotation: max occlusion occurs on I/L side

58
Q

Trigeminal nerve (CN V): sensation and reflex

A

Sensation: midline of forehead and face
DTR: chin reflex

59
Q

Chvostek sign (Weiss sign)

A

for facial nerve (CN VII)
-patient sitting, PT taps parotid gland overlying mass of muscle, if facial muscles twitch (nose/lips) + for hypocalcemia with hyperexcitability of nerves

OCS Studying (10 decks)

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