TMJ Flashcards
1
Q
Capsulitis/synovitis
A
- TTP at TMJ lateral condyle or posterior compartment
- Pain with biting on opposite side
- Pain with retrusion overpressure
- Pain with accessory motion testing
2
Q
Capsular Fibrosis
A
- limited AROM with mandibular dynamics
- Limited mobility with TMJ accessory motion tests
- No joint sounds
- Deviation of mandible with opening toward limited side
- History of trauma or surgery
- Dr B: chronic inflammation, trauma, immobilization, entrapped disc
3
Q
Masticatory Muscle Disorders
A
- No joint sounds
- Pain with palpation of muscles of mastication
- Inconsistent alterations in mandibular control
- Parafunctional oral behavior
- Pain with biting on same side of facial pain
- Commonly tendonitis of temporalis, overuse
4
Q
Hypermobility
A
- Excessive AROM with opening >40mm
- Joint sound at end range of opening
- Hypermobility with accessory motion testing
- Dr B: can be asymptomatic, collateralls loosen, hypothesized pre-cursor to disc displacement
5
Q
Anterior Disc Displacement with Reduction
A
- Reciprocal joint sound with opening/closing
- S curve with opening
- Full AROM (unless combined with capsulitis)
- Dr. B: laxity in collaterals and retrodiscal lamina
6
Q
Anterior Disc Displacement without Reduction
A
- History of joint sounds
- Limited opening <25mm if acute
- Deviation of mandible with opening toward limited side
7
Q
Osteoarthritis
A
- TMJ crepitus as noted with stethoscope
- Pain with TMJ palpation
- Radiographic evidence of osteoarthritis
8
Q
Movements of Mandible
A
- Elevation/Depression
- Protraction/Retraction
- Lateral gliding
- Combinations of above
9
Q
TMJ Ligaments
A
- Medial Collateral
- Lateral Collateral
- Fibrocartlaginous Disc
10
Q
Muscles in lateral excursion
A
- ipsalateral temporalis, massester
- contralateral medial/lateral pterygoid
11
Q
FHP =
A
posterior occlusion
12
Q
Retracted C-spine =
A
anterior occlusion
13
Q
FHP Links (2)
A
- Increased passive tension of suprahyoids, infrahyoids
- Pulls mandible inferiorly, posteriorly
14
Q
Early phase opening
A
- First 35-50% of ROM (first 20-25 mm)
- Rotation in inferior joint space
- Increased tension in oblique portion of lateral lig
15
Q
Late phase opening
A
- Last 50-65% of ROM (last 20-25mm)
- Anterior translation in superior joint space
- Increased tension in sup. retrodiscal lamina
16
Q
Early phase closing
A
- Posterior translation in superior joint space
- Disc pulled back by tension in superior retrodiscal lamina, posterior fibers of temporalis
- Controlled by eccentric superior lateral pterygoid
17
Q
Late Phase closing
A
- Rotation in inferior joint space
- muscles of mastication (temporalis, masseter, medial pterygoid)
18
Q
Subjective
A
- onset of symptoms
- Incidence of jt locking– open or close
- Presence of jt sounds (jt click hallmark of disc derangement, click on opening/closing)
- History of surgery/trauma
- Pain (intensity, frequency, location)
- Outcome measure (TM disorder disability index)
19
Q
Capsulitis/Synovitis – Rx
A
- Ionto (dex or xylocane)
- Manual therapy – intraoral STM, non-thrust mobs
- Postural and TMJ proprioception ex
20
Q
Capsular Fibrosis – Rx
A
- Heat
- TMJ mob/manip, prolonged stretching
- AROM, proprioception exercises
21
Q
Disorders of Muscles of Mastication – Rx
A
- Heat
- Controlled opening/closing muscle re-ed
- intraoral and extraoral STM
- Pt ed, activity mod (gum chewing, grinding)
22
Q
Hypermobility – Rx
A
- avoid end-range positions (tongue on roof of mouth when yawning, avoid taking large bites)
- Exercise: proprioception, stabilization
23
Q
Articular Disc Displacement with Reduction – Rx
A
- TMJ mob
- STM
- Posture ROM, isometric stabilization exercises
- Splints
24
Q
Disc Displacement without Reduction – Rx
A
- TMJ mobs
- Cspine mob/manip
- Posture, Cspine exercises
- Pt ed (soft foods, parafunctional habits, tongue resting position, relaxation, activity modification)
25
Q
TMJ OA – Rx
A
- TMJ joint mobs
- AROM/PROM
- STM
- Postural exercises
26
Q
Rocabado’s 6x6
A
- 6 exercises, 6 reps each, 6x/day
1. Tongue rest & nasal breathing
2. Controlled opening
3. Rhythmic stabilization
4. Craniocervical flexion
5. Cervical retraction
6. Shoulder retraction
27
Q
Proprioception training
A
- Phase 1 (ROM phase): Perform active lateral deviation away from painful TMJ within pain free ROM and without jt sounds
- Phase 2 (Bite phase): At end of lateral deviation ROM, pt applies submaximal bite onto tube, holds 5 sec. Mandible then back to midline. 5-6 reps
- Phase 3: maintain bite as mandible is returned to midline
- Phases 4-6: Protrusion ROM, bite at end range, and bite as return to starting postion – progress like phase 2/3
- Final progression: gently pull tube and resist in either protrusion or laterally deviated position
28
Q
ROM exercises
A
- To increase lateral excursion/protrusion – place tongue blades between teeth for ~10-11mm opening. Pt then protrudes mandible at this opening or protrudes and glides
- pt actively opens mouth, finger pressure is applied to the maxillary and mandibular directions with one or both hands
29
Q
Isometric Stabilization
A
- first one, then two knuckles placed between teeth, then removed, keeping teeth apart, Apply gentle pressure to lower jaw
- builds on exercises in Patient-Related instruction
30
Q
Hypermobility and Muscle Performance
A
- TMJ rotation/translation control
- proprioception, strengthening, and stabilization ex
- isometric or static exercises initially
- progress to dynamic/functional
