Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Principles VI > TMJ and Cranium > Flashcards

TMJ and Cranium Flashcards

1
Q

How many times a day does the TMJ move?

A

1,500 -2,000 times a day

–Chewing, talking and swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How much bite force does the TMJ have?

A

Over 900 lbs per square inch of Bite Force

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is Costen’s syndrome?

A
  • Trigeminal neuralgia, tinnitus & altered sensations of tongue and throat
  • Condyle compressing the Eustachian tube & nerves (chorda tympani, auriculotemporal nerve)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the last joint to develop?

A

TMJ is the last joint to develop

–Meckel’s cartilage; 1stbranchial arch (malleus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where does the trigeminocervical nucleus combine infor from?

A

C1-C3 and V1-V3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which cranial nerve refers pain to the ear?

A

Cervical portion of cranial nerve 9 & 10 refer to the ear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where can the trap refer pain to on the head?

A

The trapezius refers pain to the temporal area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What cervical nerve has a dermatomal pattern under the mandible?

A

C2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some common symptoms of masticatory system overload?

A

Some of the more common symptoms are

(a) tooth wear,
(b) pulpitis,
(c) tooth mobility,
(d) muscle pain,
(e) TMJ pain,
(f) earpain, tinnitus
(g) headache.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the origin and insertion of the lateral pterygoid muscle?

A

Lateral portion of lateral pterygoid plate to condyle of mandible and disk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the origin and insertion of the medial pterygoid muscle?

A

Medial portion of lateral pterygoid plate to the medial angle of the mandible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the main muscle actions of the temporalis muscle?

A

Closing (adduction)
Retrusion (posterior glide)
Excursion (lateral glide) ipsilaterally (primary)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the main muscle actions of the masseter muscle?

A

Closing

Anterior Glide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the main muscle actions of the lateral pterygoid muscle?

A

–Opening (depressionAKA: abduction)-inferiorhead, bilat
–Protrusion(anterior glide) i, bilat
–Excursion(lateral glide) i, unilat, contralaterally
–Closing/Stabilization –superiorhead

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the main muscle actions of the medial pterygoid muscle?

A

–Closing(elevation AKA: adduction)
–Excursion(lateral glide) contralaterally
–Protrusion(anterior glide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the main muscle actions of the digastric muscle?

A

–Opening(depressionAKA: abduction) p

–Protrusion(bilateral anterior bellies)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

To get left lateral glide of the TMJ what has to happen to the Right side?

A

– Relax Right side Temporalis, Masseter, and Medial Pterygoid
- Contract Right Lateral and Medial Pterygoid muscles (contralateral motion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

To get left lateral glide of the TMJ what has to happen to the left side?

A

Contract Left Temporalis posterior belly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What happens to the condylar head with left lateral glide of the TMJ?

A

Condylar head protrudes to the right.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How many distinct joint compartments make up the TMJ?

A

Two distinct Non-communicating joint compartments: Upper joint and lower joint separated by a disc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What action occurs first in the TMJ, rotation or translation?

A

Rotation is where the ginglymoarthodial joint hinges in place which happens first.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What happens with translation of the TMJ?

A

The ginglymoarthrodial joint glides forward

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Is the upper joint of the TMJ responsible for rotation or translation of the TMJ?

A

Translation of the condyle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How much of the TMJ movement should the upper joint should be responsible for?

A

Upper joint is responsible for 20 mms - max (55mm) upon opening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Is the lower joint of the TMJ responsible for rotation or translation of the TMJ?

A

Rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How much of the TMJ movement should the lower joint should be responsible for?

A

20-25mms max

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is deflection?

A

The swinging of the jaw to a certain side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is deviation?

A

The swinging of the jaw in an “S” or “C” pattern.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the pressure test?

A

Compare the tenderness of the anterior belly of the temporalis to the condyle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

When is the TMJ disk most vulnerable and why?

A

Most vulnerable with mouth open because disk is thinnest and most easily damaged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What side does the chin point to with mech obstruction?

A

Chin points to the side with mechanical obstruction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How long of dental work does it take before a sprain/strain occurs in the TMJ?

A

Occurs 20 mins after dental work.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

With chronic sprain/strains what is the most important approach?

A

Rehab/proprioceptive exercises

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are some possible causes that can cause jaw pain? (3)

A

1) Habits/Stress
2) Occlusion
3) Dentist/Trauma/Braces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What does early opening and late closing click mean and what is it called?

A

Anterior displacement of disc and it is known as a reciprocal click

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the compression test?

A 
Compare the timing and
intensity of the joint
noise while opening
under compression and
relaxation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the 5 C’s of the physical exam of the TMJ?

A

1) Clicking
- Reciprocal
2) Cracking
3) Cavitation
4) Clunking
5) Crepitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What does reciprocal clicking usually represent?

A

Usually an anteriorly displaced disc with reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What % of the population has popping or clicking of the TMJ that is “normal”?

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What does Nimmo suggest is often the cause of a stretched ligament?

A

Nimmo suggests that clicking is often
due to a stretched ligament and should
resolve with treatment and healing time.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Imbalance in what muscle of mastication can cause clicking?

A

• Imbalance in the Lateral Pterygoid

muscles also can cause clicking

42
Q

What are the most common symptoms of TMJ? (9)

A

1) Hearing, Tinnitus or Ear symptoms
2) Headache
3) Neck and upper shoulder muscle pain
4) Jaw pain
5) Temporomandibular joint noise (clicking, grating)
with mandibular movement
– Only when painful or associated with dysfunction
6) Limited mouth opening and/or disturbances in
capacity for mandibular movement
7) Dizziness or Vertigo
8) Pain and paresthesia in the upper extremities
9) Difficulty swallowing

43
Q

What is the IHS diagnosis of TMD-related headache definition?

A

The patient must report recurrent pain in one
or more regions of the head and/or face
associated with at least one of the following:
1) Pain is precipitated by jaw movements
and/or chewing of hard or tough food,
2) Reduced range of or irregular jaw opening,
3) Noise from one or both TMJs during jaw
movements, or
4) Tenderness of the joint capsule(s) of one
or both TMJs.

44
Q

What imaging evidence and what resolution time is required to diagnose a TMD-related headache according to the IHS?

A 
1) There should be
x-ray, MRI or bone scintigraphy
evidence of TMD and
2) The headache should resolve within
3 months, without recurrence, after
treatment of the TMJ and/or related
muscles. (IHS 2004)
45
Q

What are some physical exam procedures that should be done with TMJ? (6)

A

1) Auscultate
2) Palpate
– Lymph nodes
– Mastoid
3) Observe
– Ear/Insufflation
– Throat
4) Test
– Temp
– CN V3 (motor/sensory)
5) Kinetic chain/posture
6) Imaging (new/old)

46
Q

What are some specific mechanical examination that should be done with TMJ? (7)

A

1) Range Of Motion
2) Observation (joint noise)
3) Gait Biomechanics
4) Palpation (lateral pole and EAM)
5) Forced Bite (occlusion)
6) Orthopedics
7) Request old films

47
Q

What is the average opening of the TMJ?

A

55mm

48
Q

The chin points to which side? The side of mechanical obstruction or the side that is not affected?

A

The chin points to
the side of the
mechanical
obstruction

49
Q

What does premature translation on the left TMJ suggest? (4)

A

1) left capsular sprain,
2) underactive suprahyoid muscles (rotators)
3) overactive left lateral and medial pterygoids (protruder)
4) inhibited right pterygoids

50
Q

How to separate capsular sprain, underactive suprahyoid muscles, overactice left (> lateral) pterygoids and inhibited right (>lateral) pterygoids?

A

Orthopedic tests and palpation

51
Q

What does the resisted protrusion test assess for?

A

Pain is produced the inferior head of the lateral pterygoid muscle is indicated. (depends on which side experiences pain)

52
Q

What does the left separation clench test assess for?

A

If the pain occurs opposite of the object then the pain is due to compression or pinching of some (tissue) or joint. If the pain occurs on the same side as the object then it is d/t distraction of the muscle on that side or a sprained capsule

53
Q

Which is better to image the TMJ, Ultrasound or MRI?

A

MRI as the gold standard

54
Q

What is the limitation of the diagnostic ultrasound on the TMJ even though it is moderately acceptable for sensitivity and specificity?

A
  • only the lateral aspect of the disc is seen
    because the medial part is anatomically blocked
    from view
  • Medial displacements of the disc could be
    overlooked
55
Q

When are blood tests indicated?

A

Blood tests are rarely indicated except in cases
where an inflammatory TMJ arthritic condition
or temporal arteritis as a cause of the jaw pain
is suspected

56
Q

What tests are used for inflammatory arthritis?

A

ESR or

CRP, RA factor and anti-CCP

57
Q

What tests are used for temporal arteritis?

A

ESR and/or
CRP, a CBC with platelets and perhaps a liver
panel (AST or ALP are elevated in 15-30% of
temporal arteritis patients)

58
Q

What are the 5 diagnostic categories of TMD?

A

1) Articular Joint Disorders
2) Disc Disorders
3) Bilaminar & Joint Capsule Disorders
4) Ligament Disorders
5) Muscular Disorders

59
Q

What injuries to the TMJ can trauma cause? (5)

A

1) Fractures
2) Jaw
dislocations
3) Sprain
4) Strain
5) Hypermobility

60
Q

Which side of the TMJ is more damaged, the compressed side or the distracted side?

A

Compressed side

61
Q

What is retrodiscitis?

A

Trauma to the retrodiscal tissues can lead
to swelling. With swelling of these tissues,
the condyle can be displaced anteriorly and
inferiorly. This results in an acute
malocclusion that clinically appears as a
lack of posterior tooth contacts on the
ipsilateral side.

62
Q

What is jawlash?

A 
CAD injuring the jaw has
not shown compelling
evidence
- TMD symptoms are
commonly associated with
whiplash
63
Q

What are the different chiropractic DDX’s for TMJ?

A 
1) Sprain/Strain
–Capsulitis
–Synovitis
–Plica
–Retrodiscitis
2) Intersegmental Dysfunction “joint dysfunction”
–Hyper/hypomobility
3) MFPS
64
Q

How does a capsular sprain present? (5)

A

1) Pain with stretching of the capsule
– Chewing on the ipsilateral side
2) Pain with joint loading in protrusion, and with
joint distraction maneuvers
3) Palpatory pain at the capsule
4) Excessive ROM ipsilaterally when chronic
5) Possible contralateral deflection if chronic, or
ipsilateral if acute and painful

65
Q

Is there any noise with a capsular sprain?

A

No

66
Q

How does a hypermobile TMJ present? (5)

A

1) Opening contralateral deflection when
condyle passes the slope of the eminence
2) Capsular tenderness toward anterior joint line
3) Palpatory pain in the masticatory muscles
4) Joint clicking/clunk/thud as condyle
partially dislocates anteriorly
5) Possible joint locking in an open position

67
Q

How does a TMJ with MFPS present? (3)

A

Myofascial pain dysfunction is often a
secondary component to other types of TMJ
disorders
1) Pain provocation with eating or clenching
2) Often bilateral, palpatory pain in the
masticatory muscles with palpable
myofascial trigger points
3) Palpatory pain in the cervical musculature

68
Q

What are the 6 stages of TMD dysfunction?

A
  1. Meniscal Hesitation (Adhesions)
  2. Meniscal Attachment Damage (Internal
    Derangement)
  3. Stage 3 Reducible Meniscal Displacement
    (Functional Disc displacement with reduction)
  4. Irreducible Meniscal Displacement (Disc
    displacement without reduction)
  5. Resolution (Pseudodisc)
  6. Degeneration (Arthritis)
69
Q

How long does the initial stage last?

A

progress over approximately 4 years

70
Q

How long does the interim stage last?

A

progress over about 1 year

71
Q

How long does the terminal stage last?

A

progress ½-1 year

72
Q

Which of the 6 stages make up the initial stage?

A
  1. Meniscal Hesitation (Adhesions)
  2. Meniscal Attachment Damage (Internal
    Derangement)
  3. Stage 3 Reducible Meniscal Displacement
    (Functional Disc displacement with reduction)
73
Q

Which of the 6 stages makes up the interim stage?

A
  1. Irreducible Meniscal Displacement (Disc

displacement without reduction)

74
Q

Which of the 6 stages makes up the terminal stage?

A
  1. Resolution (Pseudodisc)

6. Degeneration (Arthritis)

75
Q

What are the 7 different disc diagnoses for the TMJ?

A

1) Mechanical disc derangement
2) Anterior disc displacement with reduction
3) Anterior disc dislocation without reduction
4) Medial, lateral or posterior disc
displacement
5) Perforated, torn, fragmented or worn disc
6) Unstable disc
7) Deformed disc (congenital or dysplastic)

76
Q

What are some treatment goals of TMD?

A

1) Reduce pain and swelling
2) Promote soft tissue healing
3) Eliminate muscle spasm
4) Increase free range of motion
5) Restore normal motion and stability
6) Establish functional muscle balance
7) Prevent reoccurrences

77
Q

What is the recommendation for moist heat for TMJ?

A

Moist heat when subacute
– 3-5 min. every hour
– Studies have shown that moist and dry heat
might be equally effective on orofacial pain

78
Q

What is the recommendation for ice for TMJ?

A 
Ice when acute
An ice pack is applied to the painful
area for 2 to 5 min or until the
tissue feels numb. Than the tissue
is allowed to slowly warm again.
This can be repeated as needed.
Ice should not be left on the
face for longer than 5 min or
tissue injury may result.
79
Q

What are some TMJ physiotherapy modalities?

A 
1) Electrical stimulation
– Mini pads
2) TENS
– Studies have show that pad
placement/channel balance are not
crucial
3) Ultrasound (pulsed)
– Studies have shown that tooth and
filling materials only rise a few
degrees
4) Laser
5) Iontophoresis
- Local
anesthetics and
anti-inflammatories are
commonly used with
iontophoresis.
80
Q

What settings should ultrasound be put on for the TMJ?

A

8 mins, pulsed

81
Q

Where can trigger points from the trapezius muscle refer to?

A 
Trigger points located in the
trapezius muscle refer
pain to behind the ear, the
temple, and the angle of
the jaw.
82
Q

Where can trigger points from the SCM muscle refer to?

A

refer pain to the temple
area (typical temporal
headache)

83
Q

What myosfascial trigger-points refer pain to the teeth? (3)

A 
1) The temporalis refers only
to the maxillary teeth.
2) The masseter refers only to
the posterior teeth.
3) The digastric anterior refers only
to the mandibular incisors.
84
Q

Where does a trigger point in the semispinalis capitis refer pain to?

A

A trigger point in the semispinalis capitis
muscle will refer pain to the preauricular
(TMJ) area and anterior temporal region.

85
Q

Is there a specific order to manipulation of the TMJ or Cx spine?

A 
There seems to be
an importance to the
order of treatment.
–A primary neck issue
should be corrected
first
–A primary TMJ issue
should be addressed
first
86
Q

What is the direction of thrust when adjusting the jaw AP/PA?

A

Slope of the

Eminence

87
Q

What is the direction of thrust when adjusting the jaw Lateral?

A

Anterior aspect of

Foramen Magnum

88
Q

What are some contraindications to TMJ manipulation? (6)

A 
1) Acute stage of
Inflammatory
Diseases
2) Infection
3) Crepitus- end
stage DJD
4) Variable click -
unstable disc
5) Bone Softening
Diseases
6) Hemearthrosis - Bleeding
in joint
89
Q

What 5 conditions does TMJ manipulation help?

A
  1. Stretch the joints (muscular mobility)
  2. Adhesion release (disc)
  3. Capsular stretch/adhesion release
  4. Disc “recapture“ (allowing an anteriorly
    displaced disc to re-seat itself on top
    of the mandibular condyle)
  5. Plical entrapment
90
Q

How can joint distraction of the TMJ be accomplished?

A 
This can be accomplished by placing
the thumb in the patient’s mouth over
the mandibular second molar area on
the side to be distracted. While the
cranium is stabilized with the other
hand, the thumb
exerts downward
force on the molar.
91
Q

What are some basic TMD exercises? (6)

A

1) Relaxation (tongue on roof of mouth)
2) Clench and relax
3) Linear opening (mirror/tongue on roof of mouth)
4) Stretching exercises (using fingers to separate jaw)
5) ABC’s (mobilization)
6) isometric jaw exercses

92
Q

What are some activity modifications to give a TMD patient?

A 
1) Eat soft foods
– pasta, cooked
veggies,
blenderized foods
2) Avoid hard,
crunchy or
chewy foods
– raw veggies, apples,
pretzels, bagels, gum
3)  Watch posture and ergonomics
4) Self-Massage
5) Avoid pounding
– running, tennis, boxing
6) Reduce Stress and Jaw
clenching or grinding
7) Avoid wide opening
– yawning, yelling, dental
appointments
8) Watch sleep posture
– Pillow (Side sleeper contour)
93
Q

What are some anti-inflammatory supplements for TMD? (4)

A
  • Bromelain 1200mg on empty stomach
  • Chymotrypsin/Trypsin 800mg
  • Citrus Bioflavonoids 2000mg
  • Curcumin 2000mg
94
Q

What are some sedation supplements for TMD? (5)

A
  • Valerian 300-800mg
  • Kava 100mg
  • Passion flower 100mg q4h
  • Melatonin .5-3mg
  • PSI (NF) with Willow Bark (day & night)
95
Q

What are some chronic tissue healing supplements for TMD?

A
  • Multivitamin / Mineral
  • Omega, Flax or GLA Oils
  • Vit C 2000mg
  • Zinc 50mg
  • Glucosamine sulfate / GAG’s 2000mg
  • Calcium lactate 50mg q4h
  • Magnesium citrate 100mg q4h
  • Valerian root may prevent muscle flare-ups
96
Q

When should orthodontics or surgery be used for TMD?

A 
- Noninvasive, conservative
treatments are usually best
for temporomandibular
disorders.
- Orthodontics or
surgery should be a
last resort.
97
Q

What 4 medical/surgical interventions can be done for TMD?

A

• Meniscectomy
– Partial often better outcome than total
• Arthroscopic lysis of adhesions and joint
lavage/irrigation (arthrocentesis)
• Injections (trigger point, joint block)
• Joint replacement
– Vitek II, Christensen system

98
Q

What is the aim of cranial therapy and which techniques are most well known?

A

The aim of therapeutic intent of CT physically alter the cranial
environment, including the alignment of the cranial
bones. CS an SOT are most well known

99
Q

What iatrogenic side effects can occur with cranial therapy?

A

worsening of vertiginous symptoms,

and increase in psychiatric symptoms.

100
Q

What is the goal of cranial sacral therapy?

A
  • The goal is to “maximize the function of the Primary
    Cranial Sacral Respiratory Mechanism, to restore
    weight bearing postural dynamics , and
    specifically to treat lumbar vertebral disc,
    and sciatic nerve problems.”
  • CSF and vascular flow issues
    are also addressed

Principles VI (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions