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OCS > TMJ > Flashcards

TMJ Flashcards

1
Q

Stats

A
  • 35% of population
  • 5-10% seek treatment
  • ages: 20-40
  • women>men
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2
Q

Comorbid conditions

A
  • whiplash or associated trauma
  • severe headache
  • moderate headache
  • neck pain
  • LBP
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3
Q

TMD causes

A
  • dental
  • msk
  • psychosocial
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4
Q

3 axes of research diagnostic criteria

A

Axis 1: clinical/diagnosis
Axis 2: behavior/psychosocial (poorer prognosis)
Axis 3: prognosis

We primarily treat axis 1

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5
Q

Areas to examine

A
  1. cervical screening
  2. look for concordant sign
  3. OA and AA assessment
  4. TMJ mobility assessment
  5. Jaw opening/deviation
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6
Q

Treatment options

A
  1. splinting/orthoses - OTC=custom, minimal effectiveness
  2. Joint mobs - caudal, AP, PA, regional interdependence
  3. Soft tissue intervention - manual, TDN
  4. Exercise - posture, relaxed jaw position, breathing, DNF retraining
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7
Q

Opening- normal value

A

30mm

2 knuckles, 3 fingertips

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8
Q

TMJ bite test

A

1 cm width applied to molars

  • tongue depressors
  • TMJ ipsilateral side UNLOADED
  • contralateral side is LOADED
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9
Q

Protrusion normal value

A

8mm

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10
Q

Lateral deviation normal values

A

8-10 mm

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11
Q

TMJ accessory motions

A
  • inferior distraction
  • inferior/anterior
  • caudal (inferior/posterior)
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12
Q

TMJ Anatomy

A
  • diarthrodial
  • temporal bone and mandibular bone joined through fibrocartilagionous disk, ligaments, and joint capsule
  • TMJ and disk are covered with fibrocartilage that has a reparative property
  • inferior and superior cavities
  • rotation of condyle occurs in the inferior cavity and translation occurs in superior cavity
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13
Q

Superior cavity

A

between the temporal fossa and superior aspect of disc

-translation

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14
Q

Inferior cavity

A

between inferior aspect of disk and mandibular condyle

-rotation

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15
Q

Disc

A
  • biconcave shape
  • allows congruency of TMj during ROM
  • provides lubrication to articular surfaces
  • transmits force
  • stabilizes joint
  • endures long term stress
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16
Q

Disc divisions

A
  1. anterior - attached to superior condylar neck, ant. capsule, sup. lat. pterygoid, temporal bone
  2. intermediate
  3. posterior - bilmainar connective tissue connecting to bone
    A&P have innervation and vascular supply
    -Densest area is bw condylar head and articular eminence
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17
Q

Capsule

A
  • capsule thickens inferiorly due to medial and lateral collateral ligaments
  • more mobility in the AP direction than ML
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18
Q

Temporomandibular ligament

A
  • supports lateral wall of capsule

- limits rotation of condylar head during jaw opening

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19
Q

Collateral ligaments

A
  • attach to medial and lateral borders

- restrict excessive m/l movement of disc

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20
Q

Stylomandibular ligament & Sphenomandibular ligament

A
  • limited function other than assisting in suspending the mandible from the cranium and preventing excessive protrusion
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21
Q

Masseter

A

Origin: anterior 2/3 of zygomatic arch
Insertion: lateral border of mandibular angle
Action:
1. Unilateral contraction - causes lateral deviation to same side
2. Bilateral contraction - elevation of mandible with force added for chewing/grinding hard foot
3. Bilateral superficial fibers = protrusion
4. Bilateral deep fibers = retraction

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22
Q

Temporalis

A

Origin (proximal): entire temporal fossa
Insertion (distal) : coronoid process and medial border of mandibular ramus
Action:
1. Bilateral contraction - elevate and retract mandible
2. Unilateral contraction - lateral excursion/deviation to same side

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23
Q

Medial pterygoid

A

Large head:
Origin (proximal): medial surface of lateral pterygoid plate of sphenoid bone
Small head:
Origin (proximal): tuberosity of maxilla
Insertion (distal): Both insert on medial surface of mandibular angle
Action:
1. Bilateral contraction - elevation and protrusion
2. Unilateral contraction - contralateral deviation

24
Q

Lateral pterygoid

A

Superior head:
Origin (proximal): from greater wing of sphenoid bone
Insertion (distal): anterior aspect of disk
Inferior head:
Origin (proximal): lateral border of lateral pterygoid plate of sphenoid
Insertion (distal): condylar neck
Action:
1. Unilateral - contralateral deviation
2. Bilateral - protrusion
3. Inferior head - depression of mandible
4. Superior head - contracts eccentrically during mouth closing to monitor disc and avoid displacement

25
Q

Suprahyoids

A

Digastric, mylohyoid, geniohyoid, stylohyoid.

All are responsible for depression and retrusion when the hyoid bone is fixed.

26
Q

Infrahyoids

A

sternohyoid, sternothyroid, thyrohyoid, omohyoid.
Action:
stabilize hyoid and form a firm base for suprahyoid muscles.

27
Q

Innervation

A
  • Mandibular division of trigeminal nerve
  • Deep temporal nerve
  • masseter nerve
  • auriculotemporal nerve
28
Q

Normal values for movement

A

Depression: 40-45mm for males, 45-50mm for females (approximately 4 finger width of nondominant hand)

  • Functional opening = 3 fingers, 35 mm
  • Lateral deviation: 1/4 opening range
  • Protrusion: 6mm to 9mm
  • Retrusion: 3mm
29
Q

Depression arthrokinematics

A
  • rotation and translation occur simaltaneously
  • posterior rotation of the condyle (condylar head moves anterior, body posterior) in early depression
  • anterior translation occurs in late phase of opening
  • disc rotates posteriorly
30
Q

Elevation

A
  • initiated by tension of retrodiscal lamina that retracts disc
  • condylar head translates posteriorly w/ disc, condyle body rotates anteriorly
  • at end range - disc rotates slightly anterior
31
Q

Protrusion

A

-mandibular condyle head and disk translate anterior and inferior

32
Q

Retrusion

A

-mandibular condyle and disc translate posterior

33
Q

Lateral deviation

A

-rotation of ipsilateral condyle and horizontal translation of contralateral condyle

34
Q

Causes of pathology

A
  • imbalance of soft tissue
  • mechanical derangement
  • both
35
Q

2 major classifications of disc derangement

A
  1. anterior disc displacement with reduction

2. anterior disc displacement without reduction

36
Q

Anterior disc displacement with reduction

A
  • the disc rests in front of the condylar head while mouth is closed
  • during opening, it “reduces” back to the top of the condylar head causing a click and then translates anteriorly with the condyle
  • at end of closing range disc displaces again causing a 2nd click
  • “reciprocal clicks”
  • limited opening
  • mandible deflects to ipsilateral side
  • “c” or “s” curve
37
Q

Anterior disc displacement without reduction

A
  • disc will stay displaced in front of condyle and not be able to return to normal resting position
    -no clicking during opening/closing
    -pateint may have limited opening (when disc is blocking condylar head)
    OR no limitation in opening (when disc is completely anterior)
    -hx of reciprocal joint noises
    -limited opening
    -deflection and pain
38
Q

Posterior disc displacement

A
  • very rare
  • usually occurs after wide opening of mouth (aka yawn)
  • inability to close the mouth (open-lock)
  • may report closing clicks if reduction occurs
39
Q

Disc-condyle incoordination-internal derangement

A
  • localized mechanical fault in snovial joint that interferes with smooth action
    1) anterior disc displacement w/ reduction
    2) “ “ w/o reduction
40
Q

Subluxation/discloation of condyle

A
  1. Dislocation - mouth is kept in open position
    - may be caused by trauma, muscular hyperactivity, connective tissue disorder, hypermobility
  2. Subluxation - temporary dislocation.
    - systemic laxity
    - systemic hypermobility
41
Q

Ankylosis

A
  • restricted mandibular mobility and ROM
  • limited translation of involved side
  • deviation to ipsilateral side is observed with opening
42
Q

Masticatory muscle disorder

A
  • caused by direct or indirect macrotrauma
  • forward head posture
  • psychosocial factors
43
Q

Myofascial pain disorder

A

-trigger points

44
Q

Myositis

A
  • acute inflammation of muscle

- palpable tenderness, pain during ROM, limited opening of jaw

45
Q

Myospasm

A
  • spasm of masticatory muscles caused by overstretching, trismus (spasm of masster muscle) from a dental proecdure
  • can also be cause by overuse (excessive gum or hard foods0
46
Q

Dystonia

A
  • neurological condition
  • CNS
  • unable to voluntarily control movement of the jaw, lips, tongue
  • function of chewing/swallowing/speech affected
  • botox injection may be beneficial
47
Q

Capsulitis

A
  • caused by trauma or poor oral habits
  • inflammatory process
  • pain upon palpation and with jaw movement
  • “C” curve opening with deflection and protrusion towards ipsilateral side (tight/stretched side)
48
Q

Objective assessment

A
  • thorough upper quadrant screen
  • posture
  • abdominal and cervical muscles
  • postural retraining recommended
49
Q

“S” curve

A
  • mandible deviates in “s” shape with opening
  • without pain may indicate muscle imbalance or improper muscle coordination
  • if painul or with limited opening, may indicate involvement of disc or capsule
50
Q

“C” curve

A
  • mandible deviates to one side in middle of opening and returns to center at end of opening
  • indicative of capsular pattern
51
Q

Deflection

A
  • mouth deflects to one side during opening and does not return to center at end range
  • indicative of ipsilateral disc involvement
  • limited opening, protrusion to ipsilateral side, and limited lateral excursion to C/L side also common
52
Q

Clinical progression of internal derangement

A
  1. reciprocal clicks
  2. absent joint noise with limited opening (locked joint)
  3. osteoarthrosis
53
Q

Cotton roll test

A
  • used to differentiate between muscular and joint involvement
  • bite down on an object with back molars = gap in ipsilateral side and compress contralateral side
  • have patient bite down on side of complaint
  • PAIN INCREASE: cause is muscular
  • PAIN DECREASE: cause is joint related
54
Q

Ultrasonography

A

-reliable in IDing internal derangement, condylar erosion, articular effusion, degenerative OA

55
Q

Intervention

A
  • relaxation
  • postural correction
  • oral habit modifiation (resting position of tongue)
  • soft diet
  • modalities for pain control
  • AVOID IONTOPHORESIS due to skin breakdown in the facial area
  • STM
  • joint mobs
  • dry needling

OCS (13 decks)

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