TMJ P! with Mobility Deficits

Question 1

With TMJ P! with Mobility Deficit, what are the proposed underlying cause of this condition?

Answer 1

• Arthralgia (Capulitis/Synovitis)
  –Inflammatory condition of the capsule and extracapsular soft tissue
• Capsular Fibrosis
  –Loss of Capsular mobility
• Osteoarthritis
  –Progressive degeneration of the articular cartilage
• Disk Displacement without reduction
  –Displacement of the articular disk anterior to the condyle blocking further anterior translation
  –Progressed from disk displacement with reduction and hypermobility

Question 2

What other conditions should be considered with patients with TMJ P! with Mobility Deficit?

Answer 2

Neuromusculoskeletal
- Neck P! with HA
- Trigeminal neuralgia

Primary HA
- Migraine
- Tension Type

Dental Conditions

Question 3

What system, structure, pain mechanism, and phases of healing are unique to patients with TMJ P! with Mobility Deficit?

Answer 3

System
- Neuromusculoskeletal

Structure
- Temporomandibular Joint and Periarticular soft tissue

Pain Mechanism
- Nociceptive, Neuropathic

Phase of Healing
- Muscle strain 2-4 weeks, Capsular strain and cartilage injuries 10-12 weeks

Question 4

With TMJ P! with Mobility Deficit, what are common subjective findings for Arthralgia?

Answer 4

• Recent hx of parafunctional oral habits or trauma
• May be gradual or immediate onset
• May report tenderness to palpation
• Symptom reproduction with biting on the contralateral side
• No current joint sounds if in isolation

Question 5

With TMJ P! with Mobility Deficit, what are common subjective findings for Capsular Fibrosis?

Answer 5

• Hx of trauma, disk displacement without reduction or immobilization
• Gradual onset
• Will report limited mouth opening
• No current joint sounds, may have a previous hx of end range or mid range clicks
• May be pain free

Question 6

With TMJ P! with Mobility Deficit, what are common subjective findings for Osteoarthritis?

Answer 6

• Hx of trauma, disk displacement without reduction
• Older age with gradual onset
• Crepitus currently, may have a previous hx of end range or mid range joint sounds
• May report tenderness to palpation and limited mouth opening
• Radiographic evidence of osteoarthritis

Question 7

With TMJ P! with Mobility Deficit, what are common subjective findings for Disk Displacement without Reduction?

Answer 7

• Hx of disc displacement with reduction and hypermobility
• Previous history of reciprocal mid range and end range joint sounds
• No current joint sounds
• Hx of joint locking or catching
• Acutely will have a sudden loss of ROM
• Chronically ROM may be normal

Question 8

With TMJ P! with Mobility Deficit, what will you do when conducting the Structural Examination?

Answer 8

Dental Occlusion
This is checking the alignment of teeth and the way the upper and lower teeth fit together when biting down

Question 9

With TMJ P! with Mobility Deficit, what may you find during the Palpation Examination?

Answer 9

• Tenderness to palpation of the lateral condyle and/or posterior compartment
• Point tenderness may include myofascial trigger points if concurrent myalgia
• Increases in resting tone of superficial cervical muscles and muscles of mastication

Question 10

With TMJ P! with Mobility Deficit, when conducting the Movement and Provocation Examination, what may you find with AROM?

Answer 10

• May see limited ROM due to pain and/or joint hypomobility
• Deviation towards ipsilateral side with opening and protrusion
• Limited contralateral lateral excursion

Question 11

With TMJ P! with Mobility Deficit, when conducting the Movement and Provocation Examination, what may you find with Passive Intervertebral Motion/Accessory Testing?

Answer 11

• Possible reproduction of symptoms and joint hypomobility

Question 12

With TMJ P! with Mobility Deficit, when conducting specific test and measures, what type of test will you do in Orthopaedic Examination Test?

Answer 12

Muscles of Mastication Isometric Resistive Provocation Test

Question 13

With TMJ P! with Mobility Deficit, when conducting the Muscle Performance Examination, which muscles will you test for Muscle Recruitment and Endurance and what muscles would you lengthen (MLT)?

Answer 13

Muscle Recruitment and Endurance
- Deep Flexors and Extensors
- Parascapular muscles

MLT
- Cervicoscapulothoracic

Question 14

With TMJ P! with Mobility Deficit, wha is the Test-Item Cluster for Disk Displacement without Reduction?

Answer 14

• Dental Stick Test
• Isometric Test
• Joint Provocation Test
• Joint Sounds Test (Crepitus)
• Deviation with Mandibular Opening
• Limited Contralateral Lateral Excursion
• Limited Anterior Glide Accessory Test

5/7 (+) has high Sn and Sp; and High LR

Question 15

What is the Prognosis for TMJ P! with Mobility Deficit?

Answer 15

• There is minimal evidence to project clinical course and prognosis for conservative management
• Intraorbital devices demonstrate inferior effectiveness to manual therapy
• Only 50% of patients after TMJ arthroplasty report favorable outcome

Question 16

With Interventions, what will you educate the patient on?

Answer 16

• Cessation of parafunctional oral habits
• Mouth resting position
• Limit positions that load the joint
• Soft diet and small bites

Question 17

With Interventions, what exercises will you give the patient?

Answer 17

• Exercises that promote ROM and mobility of TMJ
• Impairment-based approach to address cervicoscapulothoracic mobility, flexibility, endurance, neuromuscular control, and strength
• Rocabodo 6 x 6

Question 18

With Interventions, what will you do for Manual Therapy?

Answer 18

• Mobilization of the TMJ
• Mobilization and manipulation of the cervicothoracic spine

Question 19

When should we consider interprofessional or Intraprofessional referral and what are other treatment options?

Answer 19

Imaging
- Radiograph necessary to confirm osteoarthritis
- Indicated only when a non-musculoskeletal condition is suspected to failure of conservative management where imaging may change the course of care

Medical Intervention
- Medications/Injections
- NSAIDs
- Intraorbital appliances
- Arthroplasty

Psychological
- Counseling
- Medication
- Biofeedback