TMJ / Breathing

Question 1

What is the only joint in the body that has equal movement in rotation and translation?

Answer 1

TMJ

Question 2

What movement occurs in the superior compartment, divided by the disk?

Answer 2

gliding; hinging and rotation occurs in the inferior compartment

Question 3

What bony parts make up the TMJ?

Answer 3

fossa of temporal bone articulates with the condyle of the mandible

Question 4

What muscles do retrusion?

Answer 4

temporalis and suprahyoids (pull mandible up)

Question 5

What are the osteokinematics for protrusion?

Answer 5

anterior translation, some rotation, mandible slightly goes down

Question 6

How can poor posture affect TMJ?

Answer 6

poor posture tugs forward omohyoid (which is attached to scapula), which tugs on hyoid, affecting TMJ

Question 7

What osteokinematics occur with L lateral excursion?

Answer 7

• ipsilateral side (L) acts as a pivot (only rotation occurs)
• contralateral side (R) moves in an anteriomedial direction via BOTH translation and rotation

Question 8

What is the order of translation and rotation for depressing mouth? elevating mouth?

Answer 8

depressing mouth = rotation then translation

elevating mouth = translation then rotation

Question 9

What must happen to the lungs during inspiration, involving Boyle’s law?

Answer 9

THORACIC CAVITY: P decreases, V increases

• for inspiration, they need to go from high to low pressure (for air to come in)
• to do this, we need to manipulate volume (needs to increase)

Question 10

How do we expire naturally? Forcefully?

Answer 10

P must increase, V must decrease

• expiration is a passive event: alveoli recoil without much work on our part
• forced expiration involves abs and intercostals to push air out, like during exercise

Question 11

What happens to the diaphragm during breathing?

Answer 11

• inspiration = diaphragm contracts and lowers, which increases volume
• expiration = diaphragm relaxes and raises, decreasing volume

Question 12

What two bony articulations make the T-spine so stable?

Answer 12

• tubercle of rib to the transverse process of T-vert

- head of the rib to the vertebral body

Question 13

What two pieces make up the sternocostal joint? What kind of movement is allowed here?

Answer 13

1) costochondral = rib to cartilage, little to no movement

2) chondrosternal = some gliding here

Question 14

What is the main issue with COPD?

Answer 14

they can get air in, but they can’t get it back out

• alveoli broken down, won’t passively recoil
• their chest will change shape b/c they’re working so hard to get air out: “barrel-chest”

Question 15

What happens to the diaphragm over time with COPD?

Answer 15

• the residual volume in the lungs continues to increase (b/c you can’t get it out), which flattens the diaphragm and rearranges the fibers
• now it’s not a good inspiratory muscle b/c it won’t pull as efficiently, so these people have issues breathing IN now, as well as out

Question 16

What is the normal tidal volume during normal breathing?

Answer 16

~500mL

Question 17

What is vital capacity?

Answer 17

inspiratory capacity + tidal volume + expiratory capacity

- does NOT include residual capacity

Question 18

How does total lung capacity differ from vital capacity?

Answer 18

total lung capacity includes everything that vital capacity does, but also includes residual lung capacity (that dead air we can’t get out)

Question 19

What should we teach low back pain pts with breathing?

Answer 19

teach them proper breathing techniques:

• you want your stomach to expand more than your chest
• breathe in through nose, out through mouth

Question 20

What pts may demonstrate shallow breathing?

Answer 20

• these pts have no deep breaths

- could be from a pulled intercostal muscle, heart failure, infection

Question 21

What 3 diameter changes increase the volume for the lungs during inspiration?

Answer 21

1) vertical diameter change via diaphragm lowering
2) pump handle via ribs 2-5, increases ant/post diameter
3) bucket handle via ribs 7-10, increases lateral diameter

Question 22

How are the ribs able to expand in the bucket and pump handle?

Answer 22

there’s movement at the sternocostal joint by the work of the external and internal intercostals, which move the ribs

Question 23

What are the muscles of ventilation?

Answer 23

external and internal intercostals, as well as diaphragm

Question 24

Parasternal and interosseus intercostals are what kind of intercostals? What do they do?

Answer 24

internal intercostals

• parasternal = close in alignment w/ ext. intercostals, aka interchondral; do inspiration
• interosseus = run in a different angle and do forced expiration, depress ribs

Question 25

What muscles elevate the ribs?

Answer 25

external intercostals, and parasternal intercostals assist

Question 26

What are the three types of dysfunctional breathing?

Answer 26

1) accessory breathing = using more muscles, especially during expiration
2) chest breathing = using more chest than diaphragm
3) shallow breathing = no deep breaths, can be due to disease or pulled intercostal

Question 27

What muscles can be used in accessory breathing?

Answer 27

abdominals, sternal head of pec major, scalenes

- bring your arms up behind your head or anchor on knees to allow better breathing via pec

Question 28

What occurs in paradoxical breathing?

Answer 28

• chest goes in while abdominals go out; not in sync

- some muscles are intact, some not

Question 29

What is flail chest?

Answer 29

• when the abs and intercostals are moving but the ribs are not; may look like they’re going in
• ribs are likely fractured due to trauma aren’t aren’t working, leaving abs and intercostals to do all the work, which is inefficient

Question 30

What kind of breathing issue would a SCI cause for a pt?

Answer 30

could cause paradoxical breathing if diaphragm is intact but abs/intercostals aren’t
- this would make the chest go in while abdominals go out