TMJ P! with Movement Coordination Impairments

Question 1

With TMJ P! with Movement Coordination Impairment, what are the proposed underlying cause of this condition?

Answer 1

• Hypermobility
  –Increased extensibility and laxity of the passive stabilizing elements of the joint
  –May be congenital or acquired through repetitive strain to the capsule and posterior and collateral ligaments
• Disk Displacement with Reduction
  –Displacement of the articular disk anteriorly that reduces
  –Progression from hypermobility
• Mylagia
  –Painful guarded muscles of mastication with taut bands and myofascial trigger points
  –Parafunctional habits, joints conditions, stress and anxiety, nociplastic pain

Question 2

With TMJ P! with Movement Coordination Impairment, what are common subjective findings for Mylagia?

Answer 2

• May have a hx of parafunctional oral habits, stress and anxiety, or nociplastic pain conditions
• May have hx or other TMJ conditions with associated symptoms
• No joint sounds if occurring in isolation
• Pain with palpation of the involved muscles or eating and chewing
• May have painful, limited opening if masseter and temporalis are involved

Question 2

What other conditions should be considered with patients with TMJ P! with Movement Coordination Impairment?

Answer 2

Neuromusculoskeletal
- Neck Pain with HA
- Trigeminal neuralgia

Primary HA
- Migraine
- Tension Type

Question 2

What system, structure, pain mechanism, and phases of healing are unique to patients with TMJ P! with Movement Coordination Impairment?

Answer 2

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 3

With TMJ P! with Movement Coordination Impairment, what are common subjective findings for Hypermobility?

Answer 3

• May have hx of parafunctional oral habits
• During end-range opening may report a click
• Generally asymptomatic unless combined with a myalgia or arthralgia
• Can report pain with end-range opening activities like eating or yawning

Question 3

With TMJ P! with Movement Coordination Impairment, what are common subjective findings for Disk Displacement with Reduction?

Answer 3

• Hx of joint hypermobility
• Presence of reciprocal mid range click
• Previous hx or reciprocal end range joint sounds
• No report of ROM loss unless combined with myalgia or arthralgia

Question 4

With TMJ P! with Movement Coordination Impairment, what will you do when conducting the Structural Examination?

Answer 4

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

Question 5

With TMJ P! with Movement Coordination Impairment, what may you find during the Palpation Examination?

Answer 5

• 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 6

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

Answer 6

• End range or reciprocal click possible
• Aberrant motions common
• May see limited ROM due to pain or could be full to hypermobile

Question 7

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

Answer 7

Possible reproduction of symptoms and joint hypomobility

Question 8

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

Answer 8

• Forced retrusion (compression) TMJ provocation Test
  –Reproduction of symptoms (Joint)
• Forced biting provocation Test (Dental Stick Test)
  –Pain on opposite side (Joint)
  –Pain on same side or bilateral (Muscle)
• Auscultation of the TMJ
  – Joint sounds during midrange or end-range active ROM
• Muscles of Mastication Isometric resistive Provocation Test
  –Limited, painful opening and pain with power stroke
  –Pain free resisted lateral excursion and protrusion
• Lateral Pterygoid
  –Full, pain free opening
  –Pain with resisted protrusion and power stroke

Question 9

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

Answer 9

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

MLT
- Cervicoscapulothoracic

Question 10

With Interventions, what will you educate the patient on?

Answer 10

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

Question 11

With Interventions, what exercises will you give the patient?

Answer 11

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

Question 12

With Interventions, what will you do for Manual Therapy?

Answer 12

• Soft tissue manipulation and dry needling
• Joint mobilization and manipulation of the cervicothoracic spine

Question 13

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

Answer 13

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