TMJ PCE Flashcards
What are the 3 lateral ligaments of the TMJ
- they blend in with th capsule of thr TMJ
1.temporomandibular lilgaments
2.stylomandibular
3.sphenomandibular ligaments
What muscles do opening of MAndible
Lateral pterygoid
What muscles do closing of Mandible
Masseter, Medial Pterygoid, Temporalis
What muscles do Protrusion
Lateral Pterygoid (primary), medial pterygoid
What muscles do retrusion
Temporalis
What muscles do Lateral deviation
Ipsilateral (same side) temporalis
Contralateral: Masseter, medial pterygoid, lateral pterygoid
What Nerves supply the muscle sof mandible
and what is the vascular supply
- Trigeminal N (CN5): Mandibular branch (originates in brainstem)
- Secondary arteries form external carotid artery
What is a common misdiagnosis in TMJ
Trigeminal Neuralgia (painful jaw) is ofen misdiagnosed for Temporomandibular dysfunction (TMD)
What are the Cardinal Signs of TMD (3)
- Restricted jaw moveemnt
- Jaw noise
- Orofascial pain
What arte the types of Temporomandibular disorders (5)
- discal
- Ligamentous
- Capsular
- Myofascial
- Joint
Describe Osteoarthritis and TMD
- degenerative
- Diffuse pain - after long periods of rest (sleep) there is Gelilng period –> increased stiffness and pain
- increased pain in biting firm foods
- Decreased ROM
Atrophy and weakness of muscles of mastication
Crepitus
Describe Disc Displacement with Reduction
(Derangement) - Dislocated Disc that is then reduced –> hear two clicks
Click 1: Reduction of disc
Click 2 is dislocation
Anterior displacement is the most common
Describe the Movement of the disc
The articulation between condyle of mandible and mandibular fossa (in temporal bone)
–> cushion between the two t=bones is the ARTICULAR DISC (lacks nerve endings or blood vessels so no pain) - anteriorly it is attaches to the Lateral Pterygoid Muscle
Posteriorly is the RETRODISCAL tissue - has blood vessels and nerves
First 20mm rotational movement of Condyle in socket
For it to open wider condyle and disc to move forward and down the articular eminence = Translation
Disc Displacement - dislocated anteriorly - disc moves forward and retrodiscal (innervated and vascular) goes between the two bones causing pain
When Opening - Condyle moves forward onto to displaced articular disc (Click) –> closing - condyle slides out of disc - Click 2
Describe Disc Displacement without Reduction (LOCKING) 2 types
Closed Lock
- Locking on opoening Jaw (Jaw cannot fully open <30mm) (NORMAL is 50mm)
- Anterior Disc displacement is infront of condyle and stopping its movement - translation
Open lock
* Locking on closing jaw (jaw cannot close)
- Posterior displacement of disc (behind condyle)
NOT COMMON
What is Hypomobility syndrome
- Decreased ROM
- Localized pain at end range - at end range the more stretch of joints and capsules causes pain
- Signs of contracture
- History of trauma
- Deviation of jaw to affected side - right jaw is hypomobile - when opening jaw it will move to right side (like wheel chair)
What is Hypermobility syndrome
Excessive anterior translation –> Lax jaw
- Increased ROM >50mm
- may have generalized laxity (high Beighton score)
- Pain with opening**
Deviation towards unaffected side (contralateral)
May have noise at end range (Hypo has pain at end range as tissues are stretched)
What is Myofascial Syndrome
Increased Pain in open position
- No joint NOISE
- Traumatic (post MVA) or insidious –> constant strain like grinding teeth - forward head psoture
- Trigger points may result in reffered pain
- Decreased ROM due to pain or mm spasm
What should we observe for? (5)
- cervical spine and posture (myofascial
- Assymetry of face
- Occlusion (how does jaw line up): Normal, cross bite (lateral shift), underbite, overbite
- Facial profile
- Teeth
What is your Physical Examination
Cervical spineAROm
TMJ AROM
Mandibular measurement - Jaw to chin (any developmental issues)
Swallowing and tobgue position - “Swallow- keep tongue in position of Swallow - open mouth and check where tongue is”
Cranial N testing
Passive moevemnts
Resisted Iso
Functional Assessments - talk, chew, blow, swallow
Special tests
What is the Knuckle test for opening
Fucnitonal opening (40mm) - 2 knuckles
Maximal opening (30mm) - 3 flexed IP
if clicking is present during opening retest with jaw retrusion and protrusion
- if clicking is more porminent in retrusion and absent with rpotrusion - PROBLEM IS LIKELY ANTERIOR DISC DISPLACEMNT WITH REDUCTION
What special tests can be used
- Auscultation - clicking is more likely in hypermobility TMJ
-*late clicking - anterior displacement with reduction
* Crepitus - degenrative joint –> if painful
indicates - rubbing between madnibular condyle and fossa of temporal bone due to eroded disc - Fucntional opening knuckle test
What are the Interventions (9)
- Education: posture c-spx –> habits like chewing gum or biting pens
- Fascial muscle relaxation
- Tongue proprioception and control - write out alphabet on roof of tongue
- Jaw proprioception and control - ABCs with jaw
- Strnegtheing
- Manual therapy - Passive stretch (myofascial and hypo) –> STR –> Mobs –> Joint manipulation
- MOdalities
8.Postural
