TMJ Flashcards
TMJ prevalence
Females 25-44 yr W or w/o trauma Bruxing Iatrogenic
TMJ closing muscles
Masseter
Temporalis
medial pterygoid
TMJ opening muscles
Initially gravity followed by digastric for forceful
TMJ retrusion muscles
Post temporalis
Assisted by deep masseter
TMJ protrusion muscles
Bilateral heads of lateral pterygoid
Assisted by medial pterygoid
TMJ laterotrusion muscles
Contralateral contraction of lateral and medial pterygoid
Ipsi contraction of temporalis and masseter
Masseter
Elevation of mandible to close mouth and chew
Temporalis
Chewing: elevating and returning
Medial pterygoid
Mastication
Mandibular elevator and protrudes w/ mastication and active in speech
Digastric
Depresses mandible and raises hyoid bone
Part of suprahyoid bone
Fixate or depress hyoid bone and thyroid cartilage for swallowing
Lateral pterygoid
Mastication
Active in mouth opening
Near final closure
Espy during transition from true hinge movement to combined rotation and translation
TMJ opening - rotation occurs
0-26 mm
TMJ opening - ant translation occurs
After 26 mm
Laterotrusion
Ipsilateral condyles rotates and contralateral condyle translates
Protrusion
Both condyles translate
Occlusion
Bringing of opposing surfaces of teeth into contact
Occlusion class 1
Normal
2mm overbite
2mm overjet
Medial buccaneers 1st molar
Occlusion class 2
Overbite
>2mm overbite and overreact
Cusp contact lies in front of groove
Occlusion class 3
Underbite
>2mm overjet
Cusp is behind of groove
Anterior open bite
RA
Split induced
Posterior open bite
Splint induced
Cross bite
Asymmetrical mandibular growth
Bite stick
Contra pain - joint
Ipsi or bilateral pain = muscles
Myofascial pain criteria
Taut band Tender nodule Recognition of pain Local twitch response Referred sensory sign Limited ROM Painful contraction and weakness
Indication for splint
Myofascial Pain when wakes up with pain and PT has not helped
Severe OA pain
Biofeedback to stop clenching
Best tests for TMJ
Palpation
Pain during movement
Maximal mouth opening deficit/asymmetrical
Active widest opening
TMJ exercises
Isometrics in neutral - proprio and strength
Hold/relax - ROM, tension
Painful/catch clicking avoided
TMJ disc classification
“Anterior disc displacement w/“
Reduction - click
Incoordination - click/lock
Without reduction - lock
TRISMUS
Lock jaw/ cant open wide
TMJ inflammation
Ice and later heat Massage - MLD Gentle exercise NSAIDS Injection
TMJ DJD
Exercises: hinge. Midline open Joint protection: diet, sleep position NSAIDS Stabilization splint Injection
TMJ acute myalgia
Ice, massage to tx pain, inflammation
Rest
Gradual mobilization exercises
TMJ trismus and splinting
Modalities
Vigorous mobes
Stretching exercises
The rabbits or easy flex
TMJ dyskinesia
Coordation excersie AROM w/ and w/o cutes Isometrics Mild resistance Mirror, palpation, etc
TMJ hypermoblility
Avoidance
Limited ROM - hinge axis, Madeline open
Resistive/isometric w/in restricted range
TMJ hypomobility
Modalities increase tissue ext.
vigorous mobes
A and PROM
TMJ functional ranges
Open 36mm
Laterotrusion and protrusion 6mm
TMJ opening range
> 40 mm or 3 fingers at DIP
TMJ norm laterotrusion
6-8mm or about one tooth width
TMJ norm protrusion
6-8 mm
Deviation vs deflection
Deviation S curve
Deflection stays to side
