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MSK 1 > TMJ Anatomy and Clinical Presentation > Flashcards

TMJ Anatomy and Clinical Presentation Flashcards

1
Q

the joint capsule of the TMJ is divided into ____ portions. Describe each

A

two portion

upper → attaches disc to temporal bone

lower → attaches mandibular condyle to disc

the joint capsule itself is thin A/P and thickened/supported M/L by collateral ligaments

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2
Q

describe the structure and function of the disc at the TMJ

A

bi-concave and flexible

oval fibrocartilage plate

made up of A/P and intermediate bands

function is to separate joint cavity into 2 functional components and disperse force

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3
Q

where is the disc located in the TMJ?

A

positioned between the mandibular fossa of the temporal bone and condylar process of the mandible

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4
Q

describe the attachments of the disc in the TMJ

A

posterior attachment → retrodiscal lamina

anterior attachment → lateral Pterygoid (pulls disc forward during mouth closure) and anterior articular capsule

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5
Q

describe the structure of the retrodiscal lamina

A

ligament from temporal bone to the posterior border of the disc

made up of 2 layers divided by a loose connective tissue

has elastic fibers that aid in disc recoil during mouth closing

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6
Q

what is the function of the retrodiscal laminae?

A
  1. stabilize the disc
  2. prevent excessive translation of the disc over the condyle
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7
Q

describe the structure and function of the temporamandibular ligament

A
  • Structure → fan shaped, thickening of anterior joint capsule from neck of mandible to zygomatic arc
  • Function
    • helps prevent posterior dislocation of the joint
    • prevents medial slippage of disc
    • counters lateral pterygoidpull
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8
Q

List the muscles of mastication

A
  1. Temporalis
  2. Masseter
  3. M/L Pterygoid
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9
Q

List the origin, insertion and action of the Temporalis

A
  1. Origin → temporal fossa
  2. Insertion → coronoid process on anterior ramus of mandible
  3. Action → elevate mandible
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10
Q

List the origin, insertion and action of the Masseter

A
  1. Origin → inferior and medial zygomatic arch
  2. Insertion → coronoid process of lateral ramus of mandible
  3. Action → elevation and protrusion of mandible
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11
Q

List the origin, insertion and action of the medial pterygoid

A
  1. Origin
    • medial surface of lateral pterygoid plate
    • pyramidal process of palatine bone
    • tuberosity of maxilla
  2. Insertion → medial aspect of mandibular ramus
  3. Action → elevation and protrusion of mandible
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12
Q

List the origin, insertion and action of the lateral pterygoid

A
  1. Origin
    • superior head to lateral surface of greater wing of sphenoid
    • inferior head to lateral surface of lateral plate
  2. Insertion → neck of mandible and articular disc as well as TMJ capsule
  3. Action
    • protrude and depress mandible
    • lateral deviation of mandible (unilaterally)
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13
Q

What innervates the infrahyoids and what is their gross action?

A

branches of C1-C3

depress hyoid

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14
Q

what is the role of the Digastric?

A

depress mandible against resistance and elevates hyoid

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15
Q

what innervates the muscles of mastication?

A

Mandibular nerve (V3 → branch of trigeminal)

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16
Q

The Mandibular nerve provides sensory info for what areas?

A
  1. Teeth
  2. Temporal region
  3. external auditory meatus
  4. tympanic membrane
  5. lower face and lip
  6. mucosa anterior 2/3rds of the tongue
  7. floor of oral cavity
17
Q

Desribe the arthrokinematics of the TMJ joints

A
  1. 50% of motion occurs as rolling in the lower joint
    • condyle on temporal bone
    • disc remains stationary
  2. 50% of motion occurs in upper joint as gliding
    • begins at mid-opening
    • disc pulled anteriomedially by lateral pterygoid
    • condyle along sigmoid-shaped temporal bone
    • disc slides along w/condyle
18
Q

List the osteokinematic motions and their normative values for the TMJ

A
  1. Opening → 35-50 mm
  2. Lateral deviation → 10-15 mm
  3. Protrusion → 3-6 mm
  4. Retrusion → 3-4 mm
19
Q

what is the resting (open pack) position for the TMJ?

A

slight opening (tongue resting on roof of mouth)

20
Q

how common is TMD?

A

65-85% of US population experience some TMD symptoms during their lives

more common in women (8-15%) than men (3-10%)

21
Q

Your differential list for someone who presents with TMJ issues includes what broad categories?

A
  1. Musculoskeletal
    • Myofacial
    • Internal derangement
    • degenerative arthropathy
    • Intra-oral → refer to dentist
    • C-Spine referral
  2. Neurogenic
    • Peripheral neuralgia (trigeminal normally)
  3. Vascular
    • cardiac referral (angina, MI)
    • HA
  4. Other
22
Q

TMD can be broken down into what 3 broad categories and subcategories?

A
  1. Masticatory Muscle disorders
    • with normal opening
    • with limited opening
  2. Disc displacements
    • with reduction
    • without reduction and with limited opening
    • without reduction and without limited opening
  3. Joint Dysfunction
    • arthralgia
    • osteoarthritis
    • osteoarthrosis
23
Q

Masticatory Muscle Disorders can be caused by what?

A
  1. Acute → strain
    • direct trauma (blow to the face, excessive widening with dental procedure, etc.)
  2. Chronic → overuse injury
    • parafunctions
    • guarding
  3. Centrally mediated pain
24
Q

define parafunctions

A

clenching, grinding teeth, nail biting, etc

behaviors relating the jaw movements that are not normal

25
Q

what can result from masticatory muscle disorders?

A
  1. reduced motion and altering of occulsion
  2. trigger points with pain referral to:
    • face
    • teeth
    • auricular area
    • temporal area
    • perioccular area
    • upper cervical area
26
Q

List some physical exam findings for an individual with masticatory muscle disorders

A
  1. tenderness and increased turgor of muscles of mastication
  2. aberrant motion pattern with AROM testing
  3. Limited ROM when stretching involved structure
    • painful at end-range motion
  4. pain w/resistance testing to invovled structure
  5. pain w/tongue depressor biting on ipsilateral side
27
Q

describe the TMD category of joint dysfunction

A

invovles the disc, joint surfaces, capsule, ligaments retrodiscal tissue, and/or synovium

Mechanisms involve micro/macrotrauma

can lead to guarding

28
Q

List the general findings for Disc displacements and Joint Dysfunction

A
  1. Perauricular pain commonly primary complaint
  2. painful palpation of joint line
  3. pain with tests that place compressive load on joint structures
29
Q

list clinical findings for DDWR

A
  1. audible clicking and/or palpable clicking (1/3 trials)
  2. joint motion typically intact
30
Q

list clinical findings for DDWOR

A
  1. report of catching sensation with opening/closing
  2. limitations in opening ROM
31
Q

describe the pathomechanics of an C-type curve

A

anterior displacement of disc (ipsilaterally) without reduction or unilateral muscle hypomobility

hypomobility of ipsilateral joint

32
Q

describe the pathomechanics of an S-type curve

A

muscular imbalance or medial displacement

condyle “walks around the disc”

33
Q

describe what is going on during DDWR

A
  1. Clicking:
    • partial anterior displacement or dislocation of the disc in resting position
    • opening click indicating reduction of the disc as the mandibular condyle passes over the posterior border
  2. Reciprocal clicking (clicking occurs with closing)
    • condyle slips posteriorly over (anteriorly) displaced disc
34
Q

describe what is occuring during DDWOR

A

the disc no longer reduces, but remains anteriorly reduced

this can limit mouth opening

result in compression loading on retrodiscal lamina

35
Q

Describe what occurs with Open Lock

A

the condyle moves over the anterior rim of the disc at max opening

the disc lies posterior to the condyle outside of the fossa which prevents the condyle from sliding back

masseter and temporalis guard

36
Q

Describe what occurs with closed lock

A

disc displacement w/o reduction

partial anterior displacement or dislocation of the disc in resting position

mandibular condyle unable to pass over the posterior border of the disc with opening (disc remains bunched anterior to the mandibular condyle)

37
Q

what is Joint dysfunction? What are the types that can occur at the TMJ?

A

inflammation of capsule, ligaments, retrodiscal tissue, synovium of the TMJ

structural changes of joint surfaces, 3 types:

Degenerative, Osteoarthritis, Osteoarthrosis

38
Q

Describe the clinical presentation for joint dysfunction of the TMJ

A
  1. May report crepitus
  2. unilateral vs bilateral
  3. deviation with opening, protrusion, contralateral deviation (unilateral)

MSK 1 (17 decks)

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