TMJ Examination Flashcards
INTRODUCTION (PATIENT INTERVIEW)
INTRODUCTION (PATIENT INTERVIEW)
What common functional limitations may be present with TMJ dysfunction?
- Chewing
- Eating
- Talking
- Sleeping
- Work Tasks
With the History of Present Illness (HPI) what do we want to consider?
- Anatomical Location
- Onset
- Timing
- Status
- Irritability
What are some associated symptoms with TMJ dysfunction?
- Headaches
- Dizziness/Nausea
- Paresthesia/Anesthesia of face/scalp/body
- Tinnitus
What are some special questions to ask patients with TMJ dysfunction?
- Joint noises
- Parafunction
- Locking
- Catching
- Hx of Open Lock
With the patient interview we want to consider any previous interventions and the ________ to it. What are some examples?
-response
- PT
- other disciplines (dentistry, oral surgery, ENT, neurology, etc.)
- Imaging/Testing (US, radiograph, MR/CT)
What are some outcome measures that can be useful in this population?
- PSFS
- Tampa Scale of Kinesiphobia for TMD
- TMD Pain Disorder Screening Instrument
VISUAL INSPECTION
VISUAL INSPECTION
What are some things to consider when performing a visual inspection?
- Posture
- Craniofacial-Specific Observations
- Intro-oral Inspection
What are the 3 planes we look at during visual inspection to check and see if they are parallel to each other?
- bipupital plane
- otic plane
- occlusal plane
We divide the face into __ vertical divisions of the face.
3
What are some contributing factors related to posture abnormalities?
- Forward head posture
- Malocclusions
What are some different types of malocclusions?
Open Bite -space between front teeth when mouth is closed Retrognathism -retracted position Prognathism -protracted position
Retrognathism and Prognathism can relate to both the _______ or the __________.
mandible or maxilla
What is the proposed mechanism for forward head posture present with TMJ dysfunction?
- Passive tension by the supra/infrahyoid muscles alter resting position of the mandible
- Mandible pulled inferiorly and posteriorly, changing the position of the mandibular condyle on the cranium
ELIMINATION TESTING
ELIMINATION TESTING
What thing should be performed during elimination testing?
- UQS (including C-spine and UE)
- Initial TMJ Screening
- Neuro Screening (CN, UMN, LMN)
- Special Tests
When looking at gross TMJ AROM we want to look at:
- Motions including _______, _______, and __________.
- Symptoms that produce _________ pain.
- Signs such as joint _________, ____________ and gross ___________.
- opening, clenching, and protrusion
- concordant
- noises, deviations/correction, and gross quantity
What one elimination test can be helpful to rule out cervicogenic HA?-
-Cervical Flexion Rotation Test
STRUCTURAL STRESS TESTING
STRUCTURAL STRESS TESTING
What motions do we want to look at with the TMJ?
- opening/closing
- protraction/retraction
- lateral deviation
What 4 things are we assessing for with AROM?
- Quantity
- Quality
- Provocation
- Willingness to move
- With quantity we can use a ______/____________.
- With quality we want to note _________, _________ and __________.
- With provocation we want to note the point in movement of provocation.
- ruler/tape measure
- coordination, symmetry, compensations
- How should we position ourselves when assessing AROM?
- We want to observe for deviations such as what?
- eye level at pt’s level of the TMJ
- c-shaped or s-shaped curves and correction back to midline
Why do we want to look at PROM as well?
To compare to AROM/resistive to look for patterns consistent with contractile or joint lesion.
With resistive testing we want to look for _______ and ______.
Symptoms -provocation of concordant pain Signs -quality of contraction -quantity (strong v weak)
PALPATION AND JOINT MOBILITY TESTING
PALPATION AND JOINT MOBILITY TESTING
What extra-oral structures can we palpate at the TMJ?
- Temporalis
- Masseter
- Medial Pterygoid
- TMJ joint line
- Suprahyoids
- SCM
- Cervical paraspinals
- Zygomatic Arch
What intro-oral structures can we palpate at the TMJ?
- Lateral Pterygoid
- Medial Pterygoid
- Temporalis tendon
- Masseter
- Teeth
- Gum line
What joint mobility tests can be performed at the TMJ?
- Caudal Glide
- Ventral Glide
- Medial Glide
- Lateral Glide
- What is the resting position of the TMJ?
- What is the closed position?
- slight opening
- fully closed
CONFIRMATION TESTS
CONFIRMATION TESTS
What are the few confirmation tests that we have for the TMJ?
- Auscultation of TMJ with stethoscope during AROM
- Provocation Test: Retrodiscal Material
- Unilateral tongue depressor biting
