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MSK 2 > TMJ Classification/Diagnoses > Flashcards

TMJ Classification/Diagnoses Flashcards

1
Q

ADD Definition

A
  • Articular Disc Displacement

- alteration in normal mechanics due to hypermobility can lead to internal derangement of the disc (4 phases)

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2
Q

ADD: Phase 1

A
  • 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
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3
Q

ADD: Phase 2

A
  • 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
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4
Q

ADD: Phase 3

A
  • 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
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5
Q

ADD: Phase 4

A
  • 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)
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6
Q

Systemic Inflammatory conditions

A
  • RA, gout, psoriatic arthritis, SLE, ankylosing spondylitis

- chronic inflam of capsule can–>adhesions & fibrosis–>limited/painful opening and lat deviation and facial deformity

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7
Q

Capsular Fibrosis

A
  • unresolved local inflamm due to micro/macro trauma
  • chronic inflam–>shortening and fibrosis of capsule
  • limited opening and reduced lateral deviation to opposite side
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8
Q

Potential Sources of TMJ Pain

A

UCS, C3, neuralgia, Arteritis, Dental problems, Sinusitis, Tumor

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9
Q

Referred, Non-radicular Pain

A

UCS, Teeth, Muscles (temporalis, masseter, pterygoids

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10
Q

Neurogenic Pain (referred radicular)

A
  • Trigeminal N
  • Geniculate N
  • Glossopharyngeal N
  • Tumor compressing cord, meninges, spinal nerve, nerve root, peripheral entrapment, neuritis
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11
Q

Viscerogenic Referral

A

-Heart

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12
Q

Vasculogenic

A
  • venous congestion or arterial deprivation to MS areas

- Arteritis (carotidynia, temporal arteritis)

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13
Q

S/Sx Associated with TMJ

A
  • 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
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14
Q

Body Chart:

ADD

A
  • 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)
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15
Q

Body Chart:

Systemic Inflammatory Conditions

A
  • Pn in periauricular area
  • increased or decreased with functional or parafunctional activities
  • better with rest
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16
Q

Parafunctional Activities

A

thumb sucking, lip chewing, nail biting, chewing ice/hard candy, gum chewing, bruxing, abnormal tongue pressure, clenching, resting jaw in hand

17
Q

Body Chart:

Capsular Fibrosis

A

Stiffness (may have pain)

18
Q

Body Chart:

Joint Hypermobility

A

Feeling of jaw going out of place

19
Q

Body Chart:

Dislocations

A
  • Inability to close mouth

- may or may not have pain

20
Q

Body Chart:

Degenerative conditions

A
  • primary complaint is joint noises

- Joint noise/crepitus at same points in ROM

21
Q

History:

ADD

A
  • initial trauma

- gradual onset that progresses to noises or intermittent locking

22
Q

History:

Systemic Inflammatory Conditions

A

Gradual/acute exacerbation of chronic condition

23
Q

History:

Capsular Fibrosis

A

follows history of prolonged capsulitis, prolonged immobilization or mandibular restriction, trauma, repetitive microtrauma or arthritis

24
Q

History:

Joint Hypermobility

A

may report catching when mouth opened making closing difficult

25
Q

History:

dislocation

A

may report catching or feeling jaw is going out of place due to trauma or over opening

26
Q

History:

Degenerative Conditions

A

End result of OA

27
Q

9 Points of Hypermobility

A 
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
28
Q

Objective Tests:

ADD

A
  • 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

29
Q

Objective Tests:

Systemic Inflammatory Conditions

A
  • Unable to fully open or fully close (due to pn)
  • pn with TMJ palpation with mouth closed and opened
  • (+) forced biting
  • (+) retrusive overpressure
30
Q

Objective Tests:

Capsular Fibrosis

A
  • decreased mandibular mobility and deflection from midline
  • decreased translation
  • restricted inferior and lateral glides
31
Q

Objective Tests:

Joint Hypermobility

A
  • 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
32
Q

Objective Test:

Dislocations

A
  • mouth locked in opening and deviated to contralat side with unilat dislocations
  • no deviations with bilateral deviations
33
Q

Objective Test:

Degenerative Conditions

A
  • 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

MSK 2 (16 decks)

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