TMJ Flashcards
T/F Joint sounds alone cause you to have TMJ pain.
F
only muscle attached to the disc
lateral pterygoid mm
Important thing to remember about the trigemical cervical nucleaus
refferred pain from trigeminal nerve afferents (pain in face) to upper cervical spine (C1-C3)
mandibular Lateral excursion
ipsilateral temporalis, contralateral lateral pterygoid.
normative values for opening
M- 45-50 mm, F-40-45 mm
normative values for lateral excursion
10 mm bilaterally
normative values for protursion
5-10 mm
If same eye, angle of mouth are elevated
craniovertebral jt problem
If eye and opposite angle of mouth are elevated
craniomandibular problem
4 points of palpation
anterior/posterior and inferior/superior synovium
disc displacement typically pulls
medial
Typical age for TMJD
20-40. average 35.9
comorbid conditions that increase risk factors of TMJD
LBP, fibromyalgia, sleep apnea, depression
TMJ nor tooth wear __ ____ do not predict incidence
in isolation
systemic ___ _____ is likely a causitive factor
ligamentous hyperlaxity
what divides the jt into superior and inferior components
articular disc
posterior attachment of the articular disc to the
temporal bone through a section of loose retrodiscal tissue
anterior attachment of the articular disc to the
capsule and the superior lateral pterygoid mm
inserts to the neck of the condyle
middle, inferior lateral pterygoid
attached to the medial aspect of the disc, stabilizes disc against the articular eminence of the temporal bone
superior lateral pterygoid
three general movements
depression, elevation, lateral excursion
depression
suprahyoid mm
elevation
masseter, temporalis, med & lat pterygoid, buccinator
lateral excursion
ipsilateral temporalis, contralateral lateral pterygoid
STMJ is the only joint that that’s resting position is dictated by other bones..
Teeth (occlusion is the last link in the kinetic chain)
1st 15-25 mm of opening occurs ________
primarily as a rotational motion of the condyle in the inferior joint space
once the collateral ligaments tauten, the opening continues as primarily a _____ ______ in the upper joint space until ____ mm is reached and the posterior and collateral ligaments are taut
translatory gliding, 35
opening greater than 35 mm results from _________ and further stretching applied to the posterior and collateral lig
further translation with over-rotation
lateral excursion occurs when the condyle and the disc of the _____ side are pulled _______ along the articular eminence
contralateral, forward downward and medially
during lat excursion, the condyle on the ipsilateral sid performs a minimal ____
rotation around a vertical axis and a slight lateral shift
where do lat excursion motions take place primarily
upper joint space
lat excursion:
contraction of contralateral lat pterygoid, and ipsilateral temporalis. the temporalis holds the rest position of the condyle to prevent the mandible from deviating anteriorly
increased FHP placs the mandible in a
more retruded position
if same eye, angle of mouth are elevated
craniovertebral jt problem
if eye and opposite angle of mouth are elevated
craniomadibular problem
how to palpate medial pterygoid
from the inferior edge of the ramus in supine
which mm should you not try to palpate
Lat pterygoid
why is it so important to get the temporal bone on the horizontal
mandible motions cannot normalize on an unstable base
Pain 1
anterior inferior synovium
why pain 1
inflammation, excessive anterior translation of the condyle, exaggerated mouth opening; condyle compresses the anterior synovium
Pain 2
anterior superior synovium
why pain 2
inflammation, excessive anterior translation of condyle past the inferior edge of the articular eminence; leads to chondromalacia
Pain 3
lateral collateral ligament
why pain 3
tenderness of the LCL suggests joint effusion, disc hypermobility, and possible medial disc displacement/excessive lateral condylar positioning
Pain 4
temporomandibular ligament
why pain 4
tenderness suggest progressed (moderate) hypermobility of disc, hyperactivity of the temporalis mm
Pain 5
posterior inferior synovium
why pain 5`
contact the neck of the condyle against the posterior temporal wall, dental occlusal issue, parafunctions, check C1-2!, predictive of DJD
Pain 6
posterior superior synovium
why pain 6
contact of the neck of the condyle against the posterior temporal wall, posterior synovium, AND posterior dense portion of disc, predictive of chondromalacia and DJD
Pain 7
posterior ligament
why pain 7
pain indicates anterior position of the disc, compression and insult to the posterior ligament where it is attached to the posterior dense portion of the disc, arteries. progressed anterior disc displacement, DJD
Pain 8
retrodiscal tissue
why pain 8
pain indicates anterior subluxation of the disc, progressed DJD, inflammation, bleeding, effusion (intracapsular). can lead to intra-articular adhesions that disallow reduction of the disc. disc can also be displaced medially or laterally
excessive anterior translation causing stretching of capsule, leading to inflammation
Pain 1, 2
sprain of the lateral collateral ligament or temporomandibular ligament, some degree of jt hypermobility
pain 3, 4
excessive posterior position of the mandible; the neck of the condyle contacting the temporal fossa
pain 5, 6
posterior ligament sprain and compression inside the jt; disc displacement
pain 7, 8
pain with resisted mouth opening strongly points to
non-reducing disc
in the absence of trauma to the head/mandible, the problem typically starts with
the craniovertebral spine
synovitis is tender to palpation at TMJ
lateral condyle or posterior compartement
pain with biting on opposite side
synovitis
how to treat synovitis
treat with long axis distractions, re-ed for controlled opening, modalities, active rest
T/F masticatory muscle disorders typically have joint sounds
F. they also have no history of joint sounds
pain with biting on the same side
masticatory muscle disorders
how to treat masticatory muscle disorders
controlling opening, myofascial release, POSTURAL CORRECTION of the craniocervical spine, dry needling, education on parafunction, active rest
what does parafunction mean
A para-functional habit or parafunctional habit is the habitual exercise of a body part in a way that is other than the most common use of that body part.
elongated collateral lig and retrodiscal tissues
disc displacement with reduction
disc lies in a medial, anterior, or lateral position at rest
disc displacement with reduction
condyles are posterior to the posterior region of the disc
disc displacement with reduction
on opening the condyle reduced back of the posterior region of the disc
disc displacement with reduction
