TMJ + Migraine OSCE

Question 1

Myofascial Release to Scalp + Cervical Region

Answer 1

Question 2

Cervical Traction

Answer 2

Question 3

PC1 Inion

Answer 3

Inferior nuchal line, lateral to inion

FStAr

Question 4

PC1/2 Occiput

Answer 4

Inferior nuchal line, between mastoid and inion

ESaRa

Question 5

PC2

Answer 5

Superior aspect of C2

ESaRa

Question 6

Ischemic Compression

Answer 6

Question 7

Atypical Cervical OA MET

Answer 7

Question 8

Atypical Cervical AA MET

Answer 8

Question 9

C2-7 MET

Answer 9

Question 10

FPR: All Cervical Facets + Hypertonic Cervical Musculature

Answer 10

1. neutralize sagittal curve – flex neck
2. abb 1lb compression
3. put in position of ease
4. hold 3-5s

Question 11

Atypical Cervical OA Still’s

Answer 11

Pt supine w doc @ head

One hand under head w mid finger in basiocciput on SB side

SB into ease, then F/E into ease

Compress thru top of head

Then go thru restrictive barrier

Release compression and return to neutral

Question 12

OA HVLA

Answer 12

Question 13

AA HVLA

Answer 13

Question 14

C2-C7 HVLA: SB

Answer 14

SB into ease, F/E into RB til vertebrae moves

Rot into RB

Thrust along midline of oblique axis of vertbrae

RAYS of SUN

Question 15

C2-C7 HVLA: Rotation emphasis

Answer 15

F/E (rb) til vertbrae moves

SB into ease til vert moves

Rot to RB

Arc-like thrust

Question 16

Hypertonic Temporalis Muscle: Soft Tissue

Answer 16

Hypertonic ms up

Thumb superior to angle of jaw – anchor

Other thumb pulls ms along the superior temporal line

gentle and rhythmic (1-2s) or hold in RB

Question 17

Mandible Restricted to Lateral Translation: Soft Tissue

Answer 17

open mouth slightly

draw jaw forward at TMJ, deviate laterally

traction in slow rhythmic pattern (30s-2m)

reasses mandibular ROM in LATERAL translation

Question 18

Medial Pterygoid: Soft Tissue

Answer 18

feel for tight band of tissue anterior to the oral pillar

Question 19

Restriction to Mandibular Depression: MET

Answer 19

have pt open jaw

stabilize jaw in open position while they try to close

relax, then open to next position

repeat 5 times, or until there is no more lengthening

Question 20

Medial Pterygoid: CS

Answer 20

anterior to angle of jaw

mandible AWAY

Question 21

Masseter: CS

Answer 21

belly of masseter, inf to zygoma

mandible TOWARDS

Question 22

Temporomandibular Joint: CS

Answer 22

on TMJ OPPOSITE of mandibular deviation

rotate away

Question 23

How do you asses for a trigger point?

Answer 23

• Listen to pt’s pain pattern
• Palpate suspected ms for knot – might feel a twitch response or reproduce pain

Question 24

What are some common head/neck trigger points? (6)

Answer 24

Question 25

How do we perform BLT on spine in general?

Answer 25

AA: fully flex

Grab segment in pincher grasp to stabilize

Establish BLT thru head

Test resp phases and hold breath in best BLT

Repeat 1-3x til best motion

Question 26

What is the distribution of the greater occipital nerve?

How might we treat this?

Answer 26

Back & top of the head

Scalp and cervical MFR

Question 27

How do we diagnose the TMJ?

Answer 27

1. Clench jaw closed to asses muscles
2. Open mouth slowly to see deviation
3. Retract/protrude mandible
4. Move laterally and forward on both sides (asses contra pterygoid)
5. Depress jaw w mild resistance

Question 28

How do we disgnose a trigger point?

Answer 28

1. Listen to pain pattern and palpate suspected muscle
2. Palpate for knot in the muscle
3. Treat with ischmic compression

Question 29

With jaw deviation to the right, we can expect a __ medial pterygoid TP: on the __ aspect of the ___ mandibular ramus.

Answer 29

With jaw deviation to the right, we can expect a left medial pterygoid TP: on the medial aspect of the ascending mandibular ramus.