TMJ Classification/Diagnoses Flashcards
ADD Definition
- Articular Disc Displacement
- alteration in normal mechanics due to hypermobility can lead to internal derangement of the disc (4 phases)
ADD: Phase 1
- Lateral and medial ligs slightly elongated from repeated microtrauma
- Disc slides medially during opening and reduces laterally when condyle moves back during closing
- No joint sounds; pain free
ADD: Phase 2
- Lateral and medial lig elongation progressis and bilaminar tissues lengthen
- disc migrates medially and anteriorly (stays there at rest when mouth is closed or when the freeway space is maintained)
- During opening: condyle rides over post disc producing EARLY OPENING CLICK and reducing the condyle onto the disc
- During Closing: condyle will luxate off the disc and LATE CLOSING CLICK will occur
ADD: Phase 3
- Significant overstretching of post and lat lig
- disc deformed (more convex) and no longer sits on top of condyle
- condyle rests on post, sup, lat position which retracts the lat and med capsules (causes shortening of capsule)
- Lateral pterygoid shortens and becomes inactive
- LATE OPENING CLICK
- EARLY CLOSING CLICK
ADD: Phase 4
- No joint sounds
- post lig completely stretched
- condyle no longer on disc
- mandibular head deformed from bone on bone
- condyle rests in most sup, post position of mandibular fossa
- Entrapment neuropathy (post lig can perforate)
Systemic Inflammatory conditions
- RA, gout, psoriatic arthritis, SLE, ankylosing spondylitis
- chronic inflam of capsule can–>adhesions & fibrosis–>limited/painful opening and lat deviation and facial deformity
Capsular Fibrosis
- unresolved local inflamm due to micro/macro trauma
- chronic inflam–>shortening and fibrosis of capsule
- limited opening and reduced lateral deviation to opposite side
Potential Sources of TMJ Pain
UCS, C3, neuralgia, Arteritis, Dental problems, Sinusitis, Tumor
Referred, Non-radicular Pain
UCS, Teeth, Muscles (temporalis, masseter, pterygoids
Neurogenic Pain (referred radicular)
- Trigeminal N
- Geniculate N
- Glossopharyngeal N
- Tumor compressing cord, meninges, spinal nerve, nerve root, peripheral entrapment, neuritis
Viscerogenic Referral
-Heart
Vasculogenic
- venous congestion or arterial deprivation to MS areas
- Arteritis (carotidynia, temporal arteritis)
S/Sx Associated with TMJ
- Chronic HA
- Teeth clenching/grinding
- Ringing/throbing/swishing ears/earaches
- clicking/popping jaw while eating/talk/sing/yawn
- pain/difficulty opening mouth very wide
- shoulder pn/stiffness
- face/neck pain
- tooth pain with no apparent cause
- Jaws lock in open or closed
- sensitive hearing/hearing loss
Body Chart:
ADD
- Joint noises in early phases progressing to difficulty opening and pain by phase 3 (crepitus at phase 4)
- Phase 1: no sounds
- Phase 2: early opening/late closing click
- Phase 3: late opening/early closing click
- Phase 4: no joint sounds (or crepitus)
Body Chart:
Systemic Inflammatory Conditions
- Pn in periauricular area
- increased or decreased with functional or parafunctional activities
- better with rest
Parafunctional Activities
thumb sucking, lip chewing, nail biting, chewing ice/hard candy, gum chewing, bruxing, abnormal tongue pressure, clenching, resting jaw in hand
Body Chart:
Capsular Fibrosis
Stiffness (may have pain)
Body Chart:
Joint Hypermobility
Feeling of jaw going out of place
Body Chart:
Dislocations
- Inability to close mouth
- may or may not have pain
Body Chart:
Degenerative conditions
- primary complaint is joint noises
- Joint noise/crepitus at same points in ROM
History:
ADD
- initial trauma
- gradual onset that progresses to noises or intermittent locking
History:
Systemic Inflammatory Conditions
Gradual/acute exacerbation of chronic condition
History:
Capsular Fibrosis
follows history of prolonged capsulitis, prolonged immobilization or mandibular restriction, trauma, repetitive microtrauma or arthritis
History:
Joint Hypermobility
may report catching when mouth opened making closing difficult
History:
dislocation
may report catching or feeling jaw is going out of place due to trauma or over opening
History:
Degenerative Conditions
End result of OA
9 Points of Hypermobility
1/2: pinky extension >90* 3/4: Thumb to forearm 5/6: elbow hyperextension >10* 7/8: Knee hyperextension 9: palms flat on floor with knees extended
Objective Tests:
ADD
- Clicking over lateral poles with opening/closing
- Limited depression with deviation to ipsilateral side
- protrusion limited with deviation to ipsilateral side
- Lateral deviation limited to contralateral side
- Palpable crepitus
Stage 1: non/min pn with #1, 2, &3 synovials
Stage 2: pn with #1, 2, 3 synovials
Stage 3: pn with #3, 5, 6 synovials (#4 variable), stiff inferior glide
Stage 4: pn with #3, 5, 6 synovials; pn with #7, 8 provocation tests (#4 variable); stiff inferior glide
Objective Tests:
Systemic Inflammatory Conditions
- Unable to fully open or fully close (due to pn)
- pn with TMJ palpation with mouth closed and opened
- (+) forced biting
- (+) retrusive overpressure
Objective Tests:
Capsular Fibrosis
- decreased mandibular mobility and deflection from midline
- decreased translation
- restricted inferior and lateral glides
Objective Tests:
Joint Hypermobility
- large indentation palpable post to condyle when mouth opened
- deviation of mandible to contralateral side at end opening
- Depression >40mm
- Provocation test #4 increase movement
Objective Test:
Dislocations
- mouth locked in opening and deviated to contralat side with unilat dislocations
- no deviations with bilateral deviations
Objective Test:
Degenerative Conditions
- global limitations in movement but not function
- close to functional depression and protrusion with slight deviation toward involved side at end range
- close to functional lateral deviation to opposite side
- X-ray (+) for structural changes
