TMJ Common Clinical Presentations Flashcards
DIFFERENTIAL
DIFFERENTIAL
What MSK conditions should we consider with the TMJ?
- myofacial, internal derangement, degenerative arthropathy
- intra-oral (dental)
- c-spinie referral
What neurological condition should we consider with the TMJ?
Peripheral neuralgia
What vascular conditions should we consider with the TMJ?
- cardiac referral (angina, MI)
- HA
What other conditions should we consider with the TMJ?
- psychiatric
- neoplasm
- RA, inflammatory arthritis
- developmental defect
- infection
- synovial disease
- ankylosis
What are the 3 groups of TMJ disorders?
Group I (Masticatory Muscle Disorders)
- Ia- with normal opening
- Ib- with limited opening
Group II (Disc Displacements)
- IIa- disc displacement with reduction
- IIb- disc displacement without reduction and limited opening
- IIc- disc displacement without reduction without limited opening
Group III (Joint Dysfunction)
- IIIa- arthralgia
- IIIb- osteoarthritis
- IIIc- osteoarthrosis
In short, what are the 3 categories of TMD?
- myofacial
- disc displacement
- degenerative/ inflammatory
GROUP 1 (MASTICATORY MUSCLE DISORDERS0
GROUP 1 (MASTICATORY MUSCLE DISORDERS)
What are the mechanisms of masticatory muscle disorders?
- strain
- overuse injury
- centrally mediated pain
Strain is ______ and can be caused by ____________.
- acute
- direct trauma
Overuse injury is ________ and can happen via __________ and ___________.
- chronic
- parafunctions (unconscious habitual)
- guarding
- Masticatory Muscle Disorders can result in reduced _______ and alter _________.
- They can also result in _______ ________ with pain referral to the face, teeth, auricular area, temporal area, periocular area, and upper cervical area.
- motion, occlusion
- trigger points
How will someone with Masticatory Muscle Disorder present during a physical examination?
- Tenderness and increased turgor of muscles of mastication.
- Aberrant motion pattern with AROM testing.
- Limited ROM when stretching involved structure (painful at end-range).
- Pain with resistance testing.
- Pain with tongue depressor biting on ipsilateral side.
JOINT DYSFUNCTIONS (DISC AND ARTHROPATHY)
JOINT DYSFUNCTIONS (DISC AND ARTHROPATHY)
Category II = ___________
- DDWR = ______________
- DDWOR = ______________
Disc Displacements
- Disc Displacement With Reduction
- Disc Displacement Without Reduction
Category III = ________________
- ___________
- ___________
- ___________
Joint Dysfunctions
- arthralgia
- osteoarthritis
- osteoarthrosis
What structures can be affected with Joint Dysfunction?
Disc, joint surfaces, capsule, ligaments, retrodiscal tissue, synovium.
Joint Dysfunction mechanisms can be either _____ or ______trauma.
- macrotrauma (acute)
- microtrauma (chronic)
Joint Dysfunction can lead to muscle __________.
guarding
What are the general findings with Group II (Disc Displacements) and Group III (Joint Dysfunctions)?
- Preauricular pain commonly primary complaint.
- Painful palpation of joint line.
- Pain with tests that place compressive load on joint structures.
DDWR
- Audible and/or palpable ____________ (1/3 trials)
- Is joint motion typically intact?
DDWOR
- Report of ________ sensation with opening/closing?
- Are there ROM limitations?
- clicking
- Yes, motion is typically intact.
- catching
- Yes, limitations in opening ROM.
What are 2 pathomechanic deviations seen?
- C-type curve
- S-type curve
C-type Curve:
- __________ displacement of a disc (ipsilaterally) without reduction or unilateral muscle hypomobility
- Hypomobility of __________ joint.
- Anterior
- Ipsilateral
S-type Curve:
- ________ imbalance or ________ displacement.
- Condyle “______ ________ the disc”
- muscular, medial
- walks around the disc
- Early deviation = _________
- Late deviation = ________/ tight __________
- spasm
- capsulitis/tight capsule
DDWR AND DDWOR
DDWR AND DDWOR
Describe DDWR clicking and reciprocal clicking.
Clicking
- Partial anterior displacement or dislocation of the disc in resting position.
- Opening click indicates reduction of the disc as the mandibular condyle passes over the posterior border.
Reciprocal Clicking
- Clicking occurs with closing
- Condyle slips posteriorly over the anteriorly displaced disc.
Describe DDWOR.
- Disc is still anteriorly displaced like in DDWR, but the disc no longer reduces.
- This can limit opening motion of the mouth.
- Causes compression loading on retrodiscal lamina.
OPEN LOCK, CLOSED LOCK, ARTHROPATHY
OPEN LOCK, CLOSED LOCK, ARTHROPATHY
Describe an Open Lock at the TMJ.
- The condyle moves over the anterior rim of the disc at max opening.
- The condyle cannot move back past the disc and gets “stuck” in the open position.
What muscles guard during an Open Lock?
- Masseter
- Temporalis
Describe a Closed Lock at the TMJ.
- Involves a DDWOR.
- Partial anterior displacement or dislocation of the disc.
- Condyle unable to pass over the posterior border of the disc.
- Cannot open mouth fully.
- Category III (Joint Dysfunctions) involve ____________ of the capsule, ligaments, retrodiscal tissue, and synovium.
- What are the structural changes that can occur with Group III (Joint Dysfunction)?
- inflammation
- degeneration, osteoarthritis, osteoarthrosis
Does osteoarthrosis or osteoarthritis have an active inflammatory process?
Osteoarthritis
