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MS II > TMJ Lecture 2 (Evaluation and Treatment) > Flashcards

TMJ Lecture 2 (Evaluation and Treatment) Flashcards

1
Q

What are the 3 subcategories of the musculoskeletal treatment of TMD?

A
  • Regional (C-spine/ T-spine)
  • Neuromotor control
  • TMJ
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2
Q

How strong is the evidence supporting PT of TMD?

A

Limited

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3
Q

What is the design flaw in many studies of PT in relation to TMD?

A
  • “PT” performed by dental assistants
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4
Q

Is PT more or less effective than arthroscopic surgery or arthroplasty?

A

About the same

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5
Q

What is the advantage of manual therapy of TMD in comparison to dental work?

A
  • Less expensive, and less side effects than dental work
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6
Q

In Nicolakis’ study, how many patients had excellent pain improvement immediately post treatment? How many had excellent function improvement immediately post treatment?

A
  • 80 % pain

- 85 % function

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7
Q

At the 6 month follow up, how many patients had excellent improvement in pain, function, and mouth opening?

A

> 80 %

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8
Q

What are the 6 elements of the historical exam of TMD?

A
  • Body chart (focus on cranial region)
  • Red Flag Screening
  • Yellow Flag Screening
  • Dental Behavior
  • Symptom History and Behavior
  • Outcome Measure
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9
Q

What is the 5 item red flag screen?

A
  • Night pain?
  • Chills?
  • Sweats?
  • Unexplained weight loss/ gain?
  • Medical screen form
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10
Q

What may be used in place of a set yellow flag screening questionairre?

A
  • Depression questions

- Fear Avoidance Belief Questionairre

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11
Q

What are important Dental Behavior questions?

A
  • Do you have any current treatments (appliances)
  • Have you had any work done (mouth open for an extended period of time)
  • Dental history
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12
Q

What 3 components should be considered when assessing symptom history or behavior?

A
  • Symptom Onset, frequency, intensity (relation to one another)
  • Joint locking - open or closed
  • Joint clicking
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13
Q

What is a useful outcome measure for TMD?

A

Temporomandibular Disorder Disability Index (Not validated)

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14
Q

What non-musculoskeletal pathology can mimic patterns of internal derangement of the TMJ?

A
  • Tumors or ganglion cysts
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15
Q

What is the most common malignancy of the TMJ?

A
  • Metastasized osteosarcoma
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16
Q

What benign tumors may affect the TMJ?

A
  • Osteomas

- Giant cell tumors

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17
Q

What 2 cranial nerves should be tested during the physical exam?

A

CN V: Trigeminal

CN VII: Facial nerve

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18
Q

What spinal segments should be considered during the physical exam of the TMJ?

A

C2 - C4

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19
Q

What 3 things should be palpated during the physical exam?

A
  • TMJ, mandible, hyoid
  • Upper quarter landmarks (C-spine/ T-spine)
  • Muscles of mastication for trigger or tender points
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20
Q

What is the 4 step approach to mobility testing?

A
  • Observed
  • Measured
  • Overpressured
  • Acessory
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21
Q

What is the 2 knuckle quick test?

A
  • Can you fit 2 - 3 knuckles in your mouth?

- Associate with symptoms and change in pain (VAS)

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22
Q

Describe the TMJ ROM graph.

A
  • Cross with protrusion and opening at north and south poles, and right and lateral translation at west and east poles.
  • Will deviate from cross pattern with movement incoordination
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23
Q

What are the landmarks for mouth opening measurement?

A
  • Incising edges between maxillary and mandibular central incisors
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24
Q

What are the landmarks for lateral translation of the mandible?

A
  • Point on the mandibular teeth that coincides with the medial edge of the maxillary central incisors
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25
Q

When may overpressure of the TMJ be required?

A

If symptoms cannot be reproduced with active movements

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26
Q

Describe opening overpressure.

A
  • Grip the side of the mandible and pull down with head stabilization
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27
Q

Describe lateral glide overpressure.

A
  • Grip the side of the mandible, and translate
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28
Q

Describe protrusion overpressure.

A
  • Don glove
  • Anterior force at central mandibular incisors
  • Stabilize head
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29
Q

What is the most predictive movement of CMD?

A
  • Static and dynamic tests either with isotonic muscle contraction
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30
Q

Describe distraction of TMJ.

A
  • Raise finger/hand or grunt if it becomes painful
  • Stabilize PT’s head and torso against Pt’s forehead and cranium
  • Hand along back of head is palpating TMJ line and stabilizing head against rib cage
  • Mobilizing thumb along 3rd and 4th mandibular molars
  • 2nd IP along bottom of mandible
  • Don’t use too much pressure on mandibular fossa
  • Light bite; relax
  • Pressure in inferior direction through thumb
  • Can move into mobilization with arm
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31
Q

Describe an anterior/ anteromedial glide of the TMJ.

A
  • Raise finger/hand or grunt if it becomes painful
  • Stabilize PT’s head and torso against Pt’s forehead and cranium
  • Hand along back of head is palpating TMJ line and stabilizing head against rib cage
  • Mobilizing thumb along 3rd and 4th mandibular molars
  • 2nd IP along bottom of mandible
  • Don’t use too much pressure on mandibular fossa
  • Light bite; relax
  • Slight distraction on the TMJ
  • Pull anteriorly/ anteromedially with shoulder
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32
Q

How much mouth opening must a patient have in order to perform an anterior glide of the TMJ?

A

> 15 mm

33
Q

Describe an anterior glide in a patient with less than 10 mm of opening.

A
  • Pt supine
  • Head rotated towards contralateral side
  • Cranial hand stabilizes from a superior direction
  • Thumb is against back side of manible
  • Finger holds front of mandible
  • Push forward with thumb
34
Q

What 3 components does cervical clearing consist of when evaluating the TMJ?

A
  • Active ROM with and without OP
  • Upper cervical protraction and retraction
  • Quadrant positions
35
Q

What other assessment may be performe don the cervical spine aside from clearing?

A
  • Accessory mobility assessment
36
Q

What 2 c-spine joints should be payed special attention in assessment of the TMJ?

A
  • OA

- AA

37
Q

Describe a OA distraction HVT.

A
  • Pt supine over end of plinth
  • Rotate patients head to contralateral side of PT
  • Grasp occiput
  • Remove pressure through TMJ and provide traction through PT’s chest and hand
38
Q

Describe an OA gapping HVT.

A
  • Pt in supine with slight amount of cervical flexion
  • Rotate head left or right short of end range
  • Introduce right side bending force into pillow through zygomatic arch and temporal bone
  • Gentle sidebend thrust
39
Q

Describe 2 methods of self-mobilization into mouth opening.

A 
1:
- Palm of hands against mandible
- Move into opening
2:
- Pressure inferiorly on chin with mouth opening with pads of fingers (a paper towel can be used to lessen the pressure)
40
Q

What are 4 variables for tube exercises for TMJ?

A
  • Start slow and predictable
  • Increase speed
  • Increase complexity
  • Increase total time
41
Q

Describe Tube Exercise 1 (lateral glide).

A
  • Patient places plastic tube between anterior teeth
  • Patient rolls tube by laterally translating the mandible away from the symptomatic TMJ
  • Pt instructed that it should be pain free with no abnormal sounds
  • Start slow and predictable
  • Increase speed and total time
  • Use a mirror for feedback
42
Q

Describe Tube Exercise 2 (lateral glide II)

A
  • With mirror for feedback
  • Laterally glide away from symptomatic side, bite, release, return
  • Pain-free and no abnormal sounds
  • Start slow predictable
  • Increase speed and total time
43
Q

Describe Tube Exercise 3 (lateral glide III)

A
  • Mirror for feedback
  • Laterally glide away from symptomatic side
  • Bite
  • Hold bite while returning to neutral
  • Pain-free and no abnormal sounds
  • Start slow predictable
  • Increase speed and total time
44
Q

Describe Tube Exercise 4 (Protrusion)

A
  • Mirror for feedback
  • Protrusion (Tip the tube upwards)
  • Pain-free and no abnormal sounds
  • Start slow predictable
  • Increase speed and total time
45
Q

Describe Tube Exercise 5 (Protrusion II)

A
  • Mirror for feedback
  • Protrusion
  • Bite, Release, Return to neutral
  • Pain-free and no abnormal sounds
  • Start slow predictable
  • Increase speed and total time
46
Q

Describe Tube Exercise 6 (Protrusion III)

A
  • Mirror for feedback
  • Protrusion
  • Bite
  • Hold while returning to neutral
  • Pain-free and no abnormal sounds
  • Start slow predictable
  • Increase speed and total time
47
Q

Describe Tube Exercise 7 (Resistance)

A
  • Mirror for feedback
  • Bite tube
  • Hold and resist gentle protrusion, retraction, and lateral glides
    (Isometrics)
  • Pain-free and no abnormal sounds
  • Start slow predictable
  • Increase speed and total time
48
Q

What are Rocabado’s 6X6?

A
  • 6 exercises
  • 6 repetitions each
  • 6 times a day
  • Tongue rest and nasal breathing
  • Controlled opening
  • Rhythmic stabilization
  • Craniocervical flexion
  • Cervical retraction
  • Shoulder retraction
49
Q

Describe Rocabado’s Tongue Rest Position with Nasal Breathing.

A
  • Make a cluck sound with the tongue
  • Rest forward 1/3 of tongue on roof of mouth
  • Diaphragmatically breathe through the nose
50
Q

Describe Rocabado’s Controlled Opening.

A
  • Hold anterior 1/3 of tongue on the roof of the mouth
  • Pt opens mouth as far as they can without the tongue leaving the roof of the mouth
  • Prevent anterior gliding (monitor with hands)
51
Q

Describe Rocabado’s Rhythmic Stabilization.

A
  • Anterior 1/3rd of tongue on roof of mouth
  • Maintain jaw is slightly open position (teeth just apart)
  • Hold isometric rhythmic contractions of lateral translation to the right and left, and mouth opening and closing
  • Don’t use excessive force
52
Q

Describe Rocabado’s Craniocervical flexion

A
  • Anterior 1/3rd of tongue on roof of mouth
  • Hand stabilizes C-spine
  • Gentle OA nod
53
Q

Describe Rocabado’s cervical retraction.

A
  • Anterior 1/3rd of tongue on roof of mouth
  • Finger tips on maxilla, mandible, or zygomatic arch for proprioceptive cue
  • Retract the head
54
Q

Describe Rocabado’s shoulder retraction.

A
  • Anterior 1/3rd of tongue on roof of mouth
  • Retract and depress shoulder girdle gently
  • Instruct patient to avoid forward head posture
55
Q

What are the 7 classifications of TMD?

A
  • Capulitis/ Synovitis
  • Capsular FIbrosis
  • Disorders of the Muscles of Mastication
  • Hypermobility
  • Anterior Disc displacement With Reduction
  • Anterior Disc Displacement Without Reduction
  • Osteoarthrosis
56
Q

Which classification group is related to micro/ macro trauma?

A
  • Capsulitis/ Synovitis
57
Q

What are 4 signs and symptoms of a patient classified into the Capsulitis/ Synovitis group?

A
  • Tender to palpation of lateral condyle or posterior compartment
  • Pain with contralateral biting
  • Pain with retraction overpressure
  • Pain with end-range accessory motion testing
58
Q

What are 4 treatments for patients categorized into the capsulitis/ synovitis group?

A
  • Iontophoresis (dex or xylocane)
  • Manual therapy
    • Soft tissue mobilization of muscles of mastication
    • Thrust and non-thrust mobs of TMJ, T and C-spine
  • Postural and TMJ proprioception exercise
59
Q

Which category of patients are categorized by chronic inflammation, trauma, immobilization, and entrapped discs?

A
  • Capsular fibrosis
60
Q

What are 4 signs and symptoms of a patient categorized into the capsular fibrosis group?

A
  • Less than 25 mm mouth opening
  • Limited joint accessory motion
  • No joint sounds
  • Ipsilateral deviation of mandible when opening
61
Q

What are 5 treatments for patients categorized into the capsular fibrosis group?

A
  • Heat prior to manual therapy
  • TMJ mobilization, manipulations
  • Prolonged stretching
  • AROM
  • Proprioceptive exercise
62
Q

What category are patients with overuse tendonitis of the temporalis muscle typically classified into?

A

Disorders of the muscles of masticaiton

63
Q

What are 4 signs and symptoms of a patient categorized into the disorders of the muscles of mastication group?

A
  • Painful to palpation of muscles (potential TrPs)
  • Possible alteration in mandibular active control
  • Parafunctional oral behaviors
  • Pain with ipsilateral biting
64
Q

What are 5 treatments of patients classified into the disorders of the muscles of mastication group?

A
  • Heat at begining of treatment
  • Controlled opening/ closing muscle reeducation
  • Stretching
  • Intraoral and extraoral soft-tissue mobilization
  • Patient education, and activity modificaiton
65
Q

Patients categorized into which category can be asymptomatic?

A

Hypermobility

66
Q

How much mouth opening do patients with hypermobility typically have? What else is present?

A

> 40 mm with a click

67
Q

What loosens in patients categorized into hypermobility? What is the hypermobility a precursor to?

A
  • Loosened collaterals

- Precursor to disc displacement

68
Q

What are 2 signs and symptoms of a patient categorized into the hypermobility group?

A
  • Excessive mouth opening ROM

- Hypermobility of accessory motions

69
Q

What are 4 treatments for patients with hypermobility?

A 
Avoid end range positions
- Tongue on roof of mouth when yawning
- Avoid taking large bites
Exercise
- Proprioception exercises
- Stabilization exercises
70
Q

Patients with laxity in the collaterals and retrodiscal laminae are categorized into which group?

A

Articular disc displacement with reduction

71
Q

What are 4 signs and symptoms of articular disc displacement with reduction?

A
  • Pain from recent dysfunction
  • Abnormal mandibular motion
  • Click on closing due to disc staying anteriorly and condyles slipping over articular eminence
  • Click on opening due to condyles recapturing disc
72
Q

What are 5 treatments for patients categorized into the articular dis displacement with reduction group?

A
  • TMJ mobilization
  • Soft tissue mobilization
  • Posture ROM
  • Isometric stabilization exercises
  • Splints (outside realm of treatment)
73
Q

Patients are categorized into what category with an anterior displacement of the disc that remains anterior to condyle?

A

Articular disc displacement without reduction

74
Q

Patients with articular disc displacement without reduction are limited in opening by how much, and deviate in which direction?

A

> 25 mm opening

Ipsilateral deviation

75
Q

What are 5 treatments for patients with articular disc displacement without reduction?

A
  • TMJ mobilizations
  • C-spine mobilizations/ manipulations
  • Posture exercises
  • C-spine exercises
  • Patient education
76
Q

Patients with joint pain with crepitis on ausciltation are classified into which treatment group?

A

TMJ OA

77
Q

What structural impairment is often present in TMJ OA?

A
  • Disc perforation
78
Q

What are 4 treatments for TMJ OA?

A
  • TMJ, C-spine, T-spine mobs
  • AROM/ PROM
  • Soft tissue mobilization
  • Postural exercises (C and T spine also
79
Q

What are 3 ways the cervical spine may be integrated into TMJ treatment?

A
  • C-spine ROM with/without TMJ
  • DNF with/without TMJ movement
  • Scapular stabilization with/without TMJ movement

MS II (20 decks)

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