TMJ Functional/Special Tests Flashcards
Seated Exam- NO GLOVES
- Check Jaw Opening/Saggital Plane/Resting Occlusion
- Auscultation
- Palpate While Opening
- C-spine/T-spine/UQ screen
- Posture
Jaw Opening
C-Shaped:
-comes out them back in
-doesn’t pass midline
-Capsular pattern=Hypomobility
S-Shaped:
-deviates in multiple ways
-crosses midline
-Dec NM control
Deflection:
-Anterior disc displacement
-typical toward side of displacement
Overbite
-portion of the mandibular incisor that is covered by maxillary tooth
-vertical measurement
Overjet
what we think of as overbite
-horizontal distance between maxillary arch and mandibular arch when mouth is closed
Underbite
-mandibular teeth sit further anterior than maxillary teeth
Cross Bite
-mandibular teeth are not in line with maxillary
-name by mandibular side
Open Bite
-in full occlusion, molars are touching but not front teeth
Supine Exam- NO GLOVES
- Muscle palpation
- Mandibular Neurodynamic Testing (if neuro suspected)
- Muscle Length Tests
- Muscle strength testing
- C-spine joint play
Muscle Palpation (NON-ORAL)
-masseter
-temporalis
-Pterygoid (external auditory meatus)
Mandibular Neurodynamic Testing
-done if suspected neuro cause of pain
- Pt in supine w/ head over plinth supported by PT
- PT performs capital flexion; ask
- Then full cervical flx; ask
- Then SB contra; ask
- Open Pt mouth, Laterally glide to contra side and hold; ask
- Then do in neutral
Neutral + Deviation pain= Joint
Flx/SB + Deviation pain= Neural
Supine Exam- GLOVES
- ROM
- Joint play
- Muscle Palpation
- Centric Relation Provocation Test
ROM of TMJ
Opening:
-functional 35mm
-40-60mm
Lateral Deviation:
-1/4 of opening
~10mm
Protrusion:
-5-10mm
Retrusion:
-3mm
TMJ Joint Play
Distraction
Anterior Translation
Lateral Translation
Anteromedial Rotation (rotation on ipsi)
Centric Relation Provocation Test
-identify discal issues
- Grasp mandible
- Scoop jaw into space
(+): pain recreated anterior to tragus
Muscle Palpation (ORAL)
Medial Pterygoid:
-rope like bundle behind molars
Prone Exam- NO GLOVES
-Assess CT and thoracic
MET for TMJ Opening
-resist closing
- Pt in supine w/ neutral head
- Depress mandible
- Have Pt hold against for 8s
- Then take a deep breath and open mouth
- Use new ROM to start over until no new movement
MET for TMJ Protrusion
-resist protrusion
- Pt in supine w/ neutral head
- PT press on lower teeth into retrusion
- Have Pt hold against for 8s
- Then take a deep breath and relax
- Use new ROM to start over until no new movement
MET for TMJ Lateral Excursion
-resist contra lateral excursion
- Pt in supine w/ neutral head
- PT press jaw into contra lateral excursion
- Have Pt hold against for 8s
- Then take a deep breath and relax
- Use new ROM to start over until no new movement
MET for Suboccipitals
-resist cevical extension
- Pt in supine w/ head at furthest upper cervical flexion
- Have Pt look up as far as they can for 10s
- Then take a deep breath and look down
- Use new ROM to start over until no new movement
TMJ Mobilizations
oscillatory
-distraction
-ant mobilization
-lateral mobilization
-Posterior mobilization
Self Manual Therapy
-Self Resisted METs
-Soft tissue massage
Discal Intervention: ADD w/ Reduction
ADD w/ Reduction
- Open mouth until opening click
- Close teeth while protruding
- The retrude before opening click
- Repeat
Tongue Depressor Exercises
- Bite down on tongue depressors held together
- Move into closing, lateral excursion, protrusion/retrusion
Neuromuscular Re-Ed Exercises
-use a mirror and self correct with hand on side of deviation
-switch to other side
-then use only mirror
