TMJ Flashcards
mandible
condyle coronoid process mandibular notch ramus angle body
dental alveolar joints
teeth
movements of the mandible
elevation depression protraction retraction lateral gliding combinations
muscles
temporalis masseter medial pterygoid lateral pterygoid digastric mylohyoid genohyoid omohyoid
ligaments
medial collateral (spenomandibular and stylomandibular)
lateral collateral (temporomandibular)
retrodiscal lamina
fibrocartilagenous disc
TMJ joints
superior joint cavity
inferior joint cavity
muscles of mandible elevation
masseter
temporalis
medial pterygoid
muscles of mandible depression
geniohyoid
mylohyoid
stylohyoid
digastric
muscles of mandible protrusion
lateral and medial pterygoid (bilaterally)
masseter
muscles of mandible retraction
temporalis
digastric
muscles of lateral excursion
ipsil: temporalis and masseter
contra: pterygoids
kinetics
TMJ, teeth and c-spine are intimately related
cervical posture affects mandibular path of closure
- FHP=posterior occlusion
- retracted c-spine= anterior occlusion
forward head posture link
increases passive tension of
- suprahyoid
- infrahyoid
pulls mandible:
-inferiorly and posteriorly
early phase kinematics
first 50% of ROM
20-25 mm opening
rotation in inferior joint space
increase tension in oblique portion of lateral ligament
-transition to late phase
late phase kinematics
last 50% of ROM
last 20-25 mm of opening
anterior translation in superior joint space
increase tension in superior retrodiscal lamina
closing
- reverse of opening
- *also 2 phases
posterior translation in superior joint space
-disc pulled back by tension in superior retrodiscal lamina, posterior fibers of temporal is; controlled by eccentric lateral pterygoid
rotation in inferior joint space
-muscles of mastication
exam and eval subjective
onset of symptoms
incidence of joint locking-open or close
presence of joint noise
- joint click hallmark of disc derangement
- click on opening
- click on closing
history of surgery
pain (intensity, frequency, location)
outcome measure
-TMD disability index
pain examination (palpation)
mandible, hyoid, TMJ
-palpate posterior TMJ and capsule (through ear)-tender w/ swelling
relevant joints of upper quadrant, cervical and upper thoracic spine
muscles
relevant trigger points and tender points
mobility impairment exam
active and passive physiologic ROM of cervical and thoracic spine
TMJ: A/PROM- vertical opening, lateral excursion, protrusion
TMJ translation and rotation SYMMETRY!!
joint play assessment (distraction, medial and lateral glide, compression)
muscle tests (length, test, control)
mobility of nervous system (if indicated)
classification of TMDs
- capsulitis/synovitis
- capsular fibrosis
- disorders of the muscles of mastication
- hypermobility
- anterior disc displacement w/ reduction
- anterior disc displacement w/out reduction
capsulitis/synovitis S/S
=micro/macro trauma
- tender to palpate lateral condyle or post compartment
- pain w/ contralat biting
- pain w/ retraction OP
- pain w/ end range accessory motion testing
capsulitis/synovitis Rx
- ionto (dex or xylocane)
- manual therapy (STM, non-thrust mobs)
- postural and TMJ proprioception ex
capsular fibrosis
=chronic inflammation, trauma, immobilization, entrapped disc
capsular fibrosis S&S
- typically <25mm opening
- limited accessory motion
- no joint sounds
- ipsilateral deviation of mandible when opening
capsular fibrosis Rx
- heat
- TMJ mob/manip, prolonged stretching
- AROM, proprioception exercise
disorders of muscles of mastication
- commonly tendonitis of temporalis muscle
* overuse
mastication muscle disorder S/S
- painful to palpate muscles (TrP may be present
- possible alteration in mandibular active control
- parafunctional oral behaviors
- pain w/ ipsilateral biting
mastication muscle disorder rx
- heat
- controlled opening/closing muscle re-ed
- intraoral and extraoral STM
- pt ed., activity mod (gum chewing, grinding)
hypermobility
- opening >40 mm w/ click at end range opening
- can be asymptomatic
- collaterals loosen
- hypothesized pre-cursor to disc displacements
hypermobility S/S
- excessive opening ROM
- hypermobility noted on accessory motion exam
hypermobility rx
avoid end range positions
- tongue on roof of mouth-yawning
- avoid taking large bites
exercise
- proprioception
- stabilization
articular disc displacement w/ reduction S/S
=laxity in collaterals and retrodiscal lamina
- pain if recent dysfunction
- abnormal mandibular motion maybe
- on closing, disc does not come back and condyle slides posteriorly-click
- on opening, the condyle re-captures the disk-click
articular disc displacement w/ reduction rx:
- TMJ mob
- STM
- posture ROM, isometric stabilization exercises
- splints
articular disc displacement w/out reduction
=history of disc displacement w/ reduction (joint clicks)
- disc remains displaced anterior to condyle
- opening <25mm, ipsilateral deviation
articular disc displacement w/out reduction rx
- TMJ mobs
- c-spine mob/manip
- posture, c-spine exercises
- pt ed (soft foods, parafunctional habits, tongue resting position, relaxation, activity mod)
TMJ OA
often accompanied by disc perforation
=joint pain and crepitus
TMJ OA rx
- TMJ mobs
- A/PROM
- STM
- postural exercises
proprioceptive exercises
rubber rube
phase 1: active lateral deviation away from painful side
phase 2: lateral deviation, bite for 5 sec, release, return
phase 3: lat dev, bite and maintain to return
phase 4: protrusion
phase 5: protrusion, bite, relax, return
phase 6: protrusion, bite and maintain to return
final: gently pull tube (resist protrusion and lat dev)
rocabodo’s 6x6
6 exercises
6 reps
6x/day
1: tongue rest and nasal breathing
2: controlled opening
3: rhythmic stabilization (isometric)
4: craniocervical flexion (nod)
5: cervical retraction
6: shoulder retraction (retract and depress)
hypermobility
head and/or ice if condition is painful
muscle performance:
- TMJ rotation and translation control
- proprioception, strengthening and stabilization exercises
- isometric or static exercises initially
- progress to dynamic and functional exercises
