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MS II -- C-Spine > TMJ > Flashcards

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
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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
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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
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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
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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
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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
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7
Q

Osteoarthritis

A
  • TMJ crepitus as noted with stethoscope
  • Pain with TMJ palpation
  • Radiographic evidence of osteoarthritis
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8
Q

Movements of Mandible

A
  • Elevation/Depression
  • Protraction/Retraction
  • Lateral gliding
  • Combinations of above
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9
Q

TMJ Ligaments

A
  • Medial Collateral
  • Lateral Collateral
  • Fibrocartlaginous Disc
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10
Q

Muscles in lateral excursion

A
  • ipsalateral temporalis, massester

- contralateral medial/lateral pterygoid

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11
Q

FHP =

A

posterior occlusion

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12
Q

Retracted C-spine =

A

anterior occlusion

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13
Q

FHP Links (2)

A
  • Increased passive tension of suprahyoids, infrahyoids

- Pulls mandible inferiorly, posteriorly

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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
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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
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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
  1. 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
  2. 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

MS II -- C-Spine (7 decks)

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