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OCS prep > TMJ (OCS-A summary) > Flashcards

TMJ (OCS-A summary) Flashcards

1
Q

The TMJ is divided into what two compartments, by which structure?

A
  • superior and inferior compartments

- fibrocartilaginous disk

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2
Q

During opening, the condyle ______ in the _______ cavity, and _______ in the _________ cavity.

A
  • rotates in the inferior compartment

- translates in the superior compartment

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3
Q

What are the 3 divisions of the disk?

A
  • anterior
  • intermediate (avascular/aneural)
  • posterior
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4
Q

What muscles are considered depressors?

A
  • suprahyoids
  • infrahyoids
  • lateral pterygoid (inferior fibers)
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5
Q

What muscles are considered elevators?

A
  • masseters
  • temporalis
  • medial pterygoid
  • lateral pterygoid (superior fibers)
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6
Q

What muscles are considered protrusors?

A
  • medial pterygoid
  • lateral pterygoid
  • masseter (superficial fibers)
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7
Q

What muscles are considered retractors?

A
  • masseter (deep fibers)
  • temporalis
  • suprahyoid
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8
Q

What muscles are considered lateral deviators?

A
  • medial pterygoid (contralateral)
  • lateral pterygoid (contralateral)
  • temporalis (ipsilateral)
  • masseter (to a lesser degree…)
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9
Q

What is considered a normal opening width for the TMJ?

A
  • 3-4 finger widths
  • 35 mm is functional
  • 40-50 mm is normal
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10
Q

What is considered normal lateral deviation?

A
  • 1/4th the amount of opening

- e.g., 10 mm for a 40 mm opening

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11
Q

What is considered normal protrusion?

A
  • 6-9mm
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12
Q

What is considered normal retrusion?

A
  • 3 mm
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13
Q

What are the considerations for classifying internal derangement of the TMJ?

A
  • whether or not the anterior disk reduces or not
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14
Q

If a pt experiences a click when the open their jaw, and when they close it, what is this indicative of?

A
  • anterior disk displacement WITH reduction
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15
Q

What are often contributing factors to an anterior disk displacement with reduction?

A
  • strong pull of superior lateral pterygoid

- very tight posterior capsule fibers

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16
Q

What are the characteristics of an anterior disk displacement without reduction?

A
  • no clicking
  • may have limited, painful opening
  • if fully displaced, may have normal, but painful opening
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17
Q

What is the presentation of a fully displaced anterior disk?

A
  • may have normal opening, but it will be painful
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18
Q

What is the presentation of a posterior disk displacement?

A
  • uncommon
  • usually occurs after prolonged mouth opening (e.g., dental procedure)
  • results in an inability to close the mouth; i.e., open lock
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19
Q

What is the open pack position of the TMJ?

A
  • tongue to roof of mouth
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20
Q

Is TMJ clicking pathological?

A
  • no, it can be a normal variant
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21
Q

Subluxation of the TMJ occurs with over ____mm of opening. Can be associated with connective tissue disorders such as ___________.

A
  • 40 mm

- Ehler’s-Danlos

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22
Q

What are the common causes of an ankylosing TMJ?

A
  • trauma
  • RA
  • polyarthritic disease
  • e.g., some type of inflammatory process
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23
Q

With an ankylosed side of the TMJ, what will opening look like?

A
  • restricted on the ankylosed side with ipsilateral lateral deviation
24
Q

TMD is associated with what 3 factors/habits/symptoms?

A
  • stress
  • headaches
  • bruxism
  • strong connection between all 4 things
25
Q

T or F;

Migraine can be triggered by TMJ tension.

A
  • T
26
Q

What is a pathoanatomical rationale for tension headaches?

A
  • can be caused by postural imbalance w/ forward head posture
  • posture creates bias for trigeminal and greater occipital n. irritation
  • results in head/face pain
27
Q

Are cervicogenic headaches usually unilateral or B?

A
  • unilateral
28
Q

Are cervicogenic headaches and TMD commonly associated?

A
  • yes
29
Q

What is a proposed cause of cervicogenic headaches?

A
  • cervical alignment issues; e.g., decreased lordosis
30
Q

What is in the differential with TMD that’s not a headache?

A
  • Temporal arteritis
31
Q

What may be a clue for temporal arteritis vs TMD?

A
  • can cause claudication; worsening pain during chewing that follows an ischemic pattern
  • potential for severe temporal headache
  • can create visual changes
32
Q

How can one differentiate between a capsular vs disk issue with mouth opening?

A
  • Capsular: deviates from midline, but then returns to midline with full opening.
  • Disk: deviates from midline and does not return (Deflection)
33
Q

What is the Cotton Roll Test used for? How does it work?

A
  • differentiating muscle vs joint origin of pain
  • biting down with back molars on cotton roll creates gapping/unloading at ipsilateral TMJ, with contralateral compression
  • if pt w/ pain on R, bites down with roll on R and pain is alleviated, then likely joint. If aggravated, then likely muscular
34
Q

What is trismus?

A
  • masseter spasm causing acute lock jaw
  • <25mm opening
  • occurs with prolonged mouth opening
  • TTP at masseter
35
Q

What intervention should be considered with myofascial TMD?

A
  • cervical mobs
  • deep flexor therex
  • found to improve pain at rest and with chewing, as well as mouth opening tolerance
36
Q

What is considered a core component of initial TMD intervention?

A
  • education to prevent fear/anxiety and reduce risk of progression to chronic condition
37
Q

When is TMJ manipulation indicated?

A
  • acute closed lock
  • dislocation
  • done by doctor or dentist under anesthesia
38
Q

What are some primary intervention types for TMJ?

A
  • education
  • postural modifications
  • behavioral therapy
  • cervical mobs
  • therex
39
Q

What are specific exercises that are appropriate for TMJ?

A
  • depends on presentation but…
  • deep neck flexor therex
  • tongue controlled mouth opening
  • TMJ isometrics
40
Q

What is a key component of TMJ exercises?

A
  • tongue to the roof of the mouth
  • opening/closing with tongue at roof
  • gentle isometrics with tongue at roof
41
Q

How is a longitudinal distraction of the TMJ executed?

A
  • pull down in a vertical axis with force directed via the thumbs on the bottom molars
42
Q

Condylar remodeling exercises are typically used with what type of TMD?

A
  • anterior disk displacement with reduction
43
Q

What do condylar remodeling exercises look like?

A
  • rubber tubing between incisors
  • lateral deviation AWAY (contralateral) to the painful side
  • can be w/ or w/o bite force during the deviation
44
Q

What are the key components to management of myofascial pain disorder?

A
  • multidisciplinary
  • behavioral intervention
  • education
45
Q

What is an appropriate outcome measure for TMD treatment efficacy?

A
  • Health related quality of life
46
Q

What are common comorbidities related to TMD?

A
  • depression
  • fibromyalgia
  • chronic fatigue syndrome
  • IBS
  • RA
  • chronic headache
47
Q

What is the Rocabado 6x6 protocol for TMD?

A
  • 6 reps, 6x/day
  1. Cluck
  2. Tongue to palate with opening
  3. Jaw isometrics
  4. Upper cervical flexion
  5. Cervical extension with retraction
  6. Scapular retraction and depression
48
Q

What are 7 conditions in the differential for TMD that are not tension/cervicogenic headache or temporal arteritis?

A
  • dental caries
  • post herpetic neuralgia
  • glossopheryngeal neuralgia
  • trigeminal neuralgia
  • giant cell arteritis (…kind of temporal arteritis)
  • maxillary sinusitis
  • migraine headache
49
Q

The following is characteristic of which differential dx for TMD?

  • mandibular pain that is worsened by hot/cold food
  • dull ache
  • visible tooth decay
A
  • Dental caries

- tooth pain can refer to the mandible

50
Q

The following is characteristic of which differential dx for TMD?

  • continuous intraoral or extraoral facial pain
  • continuous pain
  • can be sharp, burning
  • aggravated by light touch or eating
  • recent shingles virus
A
  • post herpetic neuralgia
51
Q

The following is characteristic of which differential dx for TMD?

  • unilateral
  • deep pain in ear, tongue, tonsils, or cervical region
  • episodic, brief intense attacks of shooting electric shock pain
  • aggravated with swallowing, coughing, palpation of ear
A
  • glossopheryngeal neuralgia
52
Q

The following is characteristic of which differential dx for TMD?

  • unilateral
  • deep pain in head/neck region
  • episodic, brief intense attacks of shooting electric shock pain
  • can be spontaneous w/o stimulus
A
  • Trigeminal neuralgia
53
Q

The following is characteristic of which differential dx for TMD?

  • Temporal region jaw pain
  • sudden onset with continuous pain
  • usually dull pain, but can be severe
  • may have diploplia, weight loss, polymyalgia rheumatica, fever, malaise
  • can result in blindness
A
  • giant cell arteritis
54
Q

The following is characteristic of which differential dx for TMD?

  • dull unilateral or B upper quadrant facial pain
  • usually accompanied by nasal discharge or other signs of respiratory infection
  • TTP at maxillary and frontal sinus
A
  • maxillary sinusitis
55
Q

The following is characteristic of which differential dx for TMD?

  • temporal or “behind the eye” pain
  • photophobia, phonophobia, visual aura
  • normal cranial nerve screen
  • often throbbing pain
A
  • migraine

- can often be triggered by TMD

OCS prep (25 decks)

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