TMJ And neck Flashcards
TMJ static visualization
Observe facial symmetry: nose, lips, corners of the mouth.
- Existence of clear prognathism and retrognathism
- Asymmetry in the condylar relief
- Observe the symmetry of the smile. Does the patient show his teeth?
- Observe the occlusion with his mouth closed, showing his teeth
TMJ dynamic visualization
- oppening - overpressure, 45-55 mm
- protrusion - 1 hand on back of head, 1 hand on chin - 7 mm
- retrusion 1 hand on back of head, 1 hand on chin - 2mm
- lateral movement - R and L, hand on top of head other on chin - 7mm
Neural origin TMJ
- patiet does painful movement and flexes their head (double chin, with both hands on the back of their head
Functional demonstration TMJ
patient does painful movement and test flexion, extension, laterality and neck rotation
joint assesment TMJ
caudal sliding of mandibular condyle
- Cranial hand fixes the Occipital and with the thumb, feels the movement of the condyle
- Caudal hand grabs the lower teeth with the thumb and with the index finger hooks the lower angle of the mandible externally.
- A caudal slide (not opening) of the condyle downwards is performed. Assess bilateral range of motion and pain
joint assesment TMJ
lateral sliding of mandibular condyle
- The cranial hand fixes the Occipital and with the thumb, feels the movement of the condyle.
- The caudal hand grasps the gum internally with the thumb, and with the index finger guides the lower angle of the mandible externally.
- A transverse sliding of the condyle is performed towards the opposite side. Assess bilateral range of motion and pain
joint assesment TMJ
AP sliding
The upper hand is sensitive behind the mandibular condyle.
The lower hand takes the mandibular ramus in a duck beak and prints anteroposterior sliding.
Assess bilaterally for differences: amplitude and pain
Joint assesment TMJ
PA sliding
2 ways:
Way 1: one thumb
Make patient lay on their side
Make patient open and close mouth so that you can locate where the TMJ is and put thumb on top of tmj
Put other thumb on ramus and apply pressure
Tip: start with elbow bent and straighten elbow so that you don’t push too hard
Way 2: both thumbs
muscle assesment masseter
2 masseters: superficial and deep
origin: zygomatic arch
inserts: angle and lateral surface of the mandibular ramus
muscle assesment temporalis
origin:temporal fossa, and temporal fascia
insertion: Tip and medial surface of coronoid process of mandible
muscle assesment digastric
origin: posterior digastric belly: mastoid process of the temporal bone, anterior digastric belly:digastric fossa of the mandible
insertion: hyoid bone
muscle assesment pterigoide
2 types: medial and lateral
- pinching pain
- follow teeth, find tmj and turn finger upwards
origin: lateral pterygoid plate of sphenoid bone
insertion: articular disc and fibrous capsule of the temporomandibular joint
billateral condyle compression
is a orthopedic test
purpose: to confirm there is inflammation in the pterygoid and massater muscles
test positive = if there is pain
static assesment cervical column
anterior view:
* Chin position
* Ears position
* Clevicules
* Shoulder heights
* Muscle reliefs:
* Trapezious
* SCOM
* Pectoral
* Deltoids
sagital plane (Side):
*Cervical Lordosis
* Cervical straightening
* Protraction
* Retraction
* Rounded/forward shoulders
posterior view:
* Shoulder Height
* Cervical Lat flex
* Cervical rotation
* Ear height
* Scapulae
* Distance to spinous processes
* Winged scapula
* Muscular reliefs:
* Trapezious
* Elevator Scapulae
* Posterior Deltoid
functional testing
radicular syndrome 1st hypothesis
- Patient in sitting position reproduces the painful movement
- PT axial compression
- Symptoms are reproduced or increased = Radicular Syndrome
2nd hypothesis neural origin
3 nerves: ulnar, median, radial
3rd hypothesis shoulder origin
1st: active movement
2nd: physio does movement
4th hypothesis Cx 1
perform PA in cervical
5th hypothesis Cx 2
for cervicodorsal junction - C7/T1
6th hypothesis thoracic spine
rotate thoracic spine without moving cervical
Compression for lateral Flexion Cx
there are 3:
1. Compression in general Cx
2. Compression in general Cx to increase lat
flex
3. Compression in analytical Cx to a specific
level
compression for Cx rot
pinch upper cervicals
accesory passive movements
- central P-A from C3-T4, for C=thumbs next to eachother, for T= hand on top of eachother
- transversal movements - find transverse process
- unilateral P-A –>from C3 to T4, fingers touching not overlapping,
Head extension
ROM: 0-25degrees
grade 2: lay on back and look backwards (towards examiner) without raising head
