TMJ Exam/Intervention Flashcards
Common functional limitations of TMJ disorders:
Chewing Eating Talking Sleeping Work Tasks (clenching with prolonged sitting for example - anxiety)
What HPI (history of present illness) needed to know for TMJ disorders:
- Anatomic Location(s): (auricular, mandibular, temporal)
- Onset (acute/ insidious/ congenital)
- Timing (how long has symptoms been going)
- Status (better/ worse/ same)
- Irritability (level of stress causing pain)
Associated symptoms (4) with TMD:
- HEADACHE
- Location
- Frequency
- Visual Aura - Dizziness/ Nausea
- Vertigo
- Light-Headedness - Paresthesia/ Anesthesia of face/scalp or body
- Tinnitus (ringing in ear)
Special questions for patient with possible TMD: (5)
- Joint Noises: Clicking/ popping, Crepitus
- Parafunction (grinding)
- Locking
- Catching
- Hx of Open Lock
Outcome measures for patient reporting with TMD:
- Patient-Specific Functional Scale
- Tampa Scale of Kinesiphobia for TMD (Fear of movement)
- Temporomandibular Pain Disorder Screening Instrument
Intra-oral visual inspection -
Scalloping of tongue – tmj disorder (parafunction causes tongue changes over time)
What planes would you visually inspect the face in?
- Midsagittal (up/down)
- Bipupital (horizontal through eyes)
- Otic (horizontal through nose)
- Occlusal (horizontal through bottom of top teeth)
The face is divided into what vertical divisions:
- Hair line - bipupital line (1/3)
- bipupital line - base of nose (1/3)
- Base of nose - chin line (1/3)
2 Contributing factors to TMD:
- Forward Head Posture
2. Malocclusion - imperfect positioning of the teeth when the jaws are closed
Malocclusion open bite -
space between front teeth when mouth is closed
Malocclusion Retrognathism (Overjet) -
Retracted position
Malocclusion Prognathism -
protracted position
Proposed mechanism of forward head posture on TMD:
- tension of supra/infrahyoid muscles pulling mandible inferiorly and posteriorly
Neuro screening includes what tests for UMN?
pathologic reflexes, coordination, hyper-reflexia
Neuro screening includes what tests for LMN?
Diminished sensation, weakness, hypo-reflexia
What elimination test used for cervicogenic HA?
Cervical flexion rotation test
Clinical implications for Cervical flexion rotation test:
- Low –LR, though use with caution
- Value as a test for confirmation
- Also joint mobility test for C1/C2
- Must assess full motion to determine negative test
- Avoid losing chin tuck
- Stop test when any criteria for positive test are met
If we see C-type curve, we are thinking issue with what?
Hypomobility of ipsilateral joint
If we see S-type curve, we are thinking issue with what?
Muscular imbalance or medial displacement
Condyle “walks around the disc”
Interventions for TMD:
- Reassurance to patient
- Occlusal appliances (to dentist if haven’t done so yet)
- Education
- Exercise
- Referral if appropriate
- Manual therapy interventions
What education can you offer patient with TMD?
- Activity Modification: Avoid loading of the joint & control parafunction
- Sleep position, maintain resting position of TMJ, eating soft foods, avoid gum chewing - Diagnosis, Prognosis, Goals, POC
- Relaxation Techniques
Exercises for patient with TMD:
- Mid & Lower trap/ deep cervical flexor/ thoracic extensor coordination training (“postural” exercises)
- Upper quarter stretching (corner stretching, etc.)
- TMJ muscle coordination training (isometrics, biofeedback)
- TMJ AROM: maintain motion, reduce contracture, improve muscle function
- Neuromuscular control exercises for TMJ muscles
20% of TMD patients will require what 2 possible surgical interventions?
- Arthroplasty (disc)
2. Orthognathic surgery (jaw)
General concepts for manual therapy interventions for TMD:
- Wear gloves for intra-oral techniques
- Before and after measurements
- Interventions based on impairments (muscle guarding, pain, hypomobility)
T/F Level B evidence for manual therapy combined with exercises for treatment of TMD, based on weak RCTs and case-series designs.
True
