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
2
Q
During opening, the condyle ______ in the _______ cavity, and _______ in the _________ cavity.
A
- rotates in the inferior compartment
- translates in the superior compartment
3
Q
What are the 3 divisions of the disk?
A
- anterior
- intermediate (avascular/aneural)
- posterior
4
Q
What muscles are considered depressors?
A
- suprahyoids
- infrahyoids
- lateral pterygoid (inferior fibers)
5
Q
What muscles are considered elevators?
A
- masseters
- temporalis
- medial pterygoid
- lateral pterygoid (superior fibers)
6
Q
What muscles are considered protrusors?
A
- medial pterygoid
- lateral pterygoid
- masseter (superficial fibers)
7
Q
What muscles are considered retractors?
A
- masseter (deep fibers)
- temporalis
- suprahyoid
8
Q
What muscles are considered lateral deviators?
A
- medial pterygoid (contralateral)
- lateral pterygoid (contralateral)
- temporalis (ipsilateral)
- masseter (to a lesser degree…)
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
10
Q
What is considered normal lateral deviation?
A
- 1/4th the amount of opening
- e.g., 10 mm for a 40 mm opening
11
Q
What is considered normal protrusion?
A
- 6-9mm
12
Q
What is considered normal retrusion?
A
- 3 mm
13
Q
What are the considerations for classifying internal derangement of the TMJ?
A
- whether or not the anterior disk reduces or not
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
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
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
17
Q
What is the presentation of a fully displaced anterior disk?
A
- may have normal opening, but it will be painful
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
19
Q
What is the open pack position of the TMJ?
A
- tongue to roof of mouth
20
Q
Is TMJ clicking pathological?
A
- no, it can be a normal variant
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
22
Q
What are the common causes of an ankylosing TMJ?
A
- trauma
- RA
- polyarthritic disease
- e.g., some type of inflammatory process
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
T or F;
Migraine can be triggered by TMJ tension.
- T
26
What is a pathoanatomical rationale for tension headaches?
- 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
Are cervicogenic headaches usually unilateral or B?
- unilateral
28
Are cervicogenic headaches and TMD commonly associated?
- yes
29
What is a proposed cause of cervicogenic headaches?
- cervical alignment issues; e.g., decreased lordosis
30
What is in the differential with TMD that's not a headache?
- Temporal arteritis
31
What may be a clue for temporal arteritis vs TMD?
- can cause claudication; worsening pain during chewing that follows an ischemic pattern
- potential for severe temporal headache
- can create visual changes
32
How can one differentiate between a capsular vs disk issue with mouth opening?
- Capsular: deviates from midline, but then returns to midline with full opening.
- Disk: deviates from midline and does not return (Deflection)
33
What is the Cotton Roll Test used for? How does it work?
- 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
What is trismus?
- masseter spasm causing acute lock jaw
- <25mm opening
- occurs with prolonged mouth opening
- TTP at masseter
35
What intervention should be considered with myofascial TMD?
- cervical mobs
- deep flexor therex
- found to improve pain at rest and with chewing, as well as mouth opening tolerance
36
What is considered a core component of initial TMD intervention?
- education to prevent fear/anxiety and reduce risk of progression to chronic condition
37
When is TMJ manipulation indicated?
- acute closed lock
- dislocation
- done by doctor or dentist under anesthesia
38
What are some primary intervention types for TMJ?
- education
- postural modifications
- behavioral therapy
- cervical mobs
- therex
39
What are specific exercises that are appropriate for TMJ?
- depends on presentation but...
- deep neck flexor therex
- tongue controlled mouth opening
- TMJ isometrics
40
What is a key component of TMJ exercises?
- tongue to the roof of the mouth
- opening/closing with tongue at roof
- gentle isometrics with tongue at roof
41
How is a longitudinal distraction of the TMJ executed?
- pull down in a vertical axis with force directed via the thumbs on the bottom molars
42
Condylar remodeling exercises are typically used with what type of TMD?
- anterior disk displacement with reduction
43
What do condylar remodeling exercises look like?
- rubber tubing between incisors
- lateral deviation AWAY (contralateral) to the painful side
- can be w/ or w/o bite force during the deviation
44
What are the key components to management of myofascial pain disorder?
- multidisciplinary
- behavioral intervention
- education
45
What is an appropriate outcome measure for TMD treatment efficacy?
- Health related quality of life
46
What are common comorbidities related to TMD?
- depression
- fibromyalgia
- chronic fatigue syndrome
- IBS
- RA
- chronic headache
47
What is the Rocabado 6x6 protocol for TMD?
- 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
What are 7 conditions in the differential for TMD that are not tension/cervicogenic headache or temporal arteritis?
- dental caries
- post herpetic neuralgia
- glossopheryngeal neuralgia
- trigeminal neuralgia
- giant cell arteritis (...kind of temporal arteritis)
- maxillary sinusitis
- migraine headache
49
The following is characteristic of which differential dx for TMD?
- mandibular pain that is worsened by hot/cold food
- dull ache
- visible tooth decay
- Dental caries
| - tooth pain can refer to the mandible
50
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
- post herpetic neuralgia
51
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
- glossopheryngeal neuralgia
52
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
- Trigeminal neuralgia
53
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
- giant cell arteritis
54
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
- maxillary sinusitis
55
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
- migraine
| - can often be triggered by TMD
