TMJ Sx and Post-Sx Rehab

Question 1

TMJ Sx and Post-Sx Rehab

Indications???

*NOTE: MOST cases do NOT require Sx

Answer 1

• Congenital, traumatic, dev. abnorms
• Systemic connect. tissue dis. affecting TMJ
• Internal disc derangements w/ failed conservative Tx
• Failed comprehensive PT Tx
• Contractures, ankylosing (fusing), fibrosis

Question 2

TMJ Sx and Post-Sx Rehab

Procedures: ALL

Answer 2

• Lysis and lavage
  
  • least comp’d
• Debridement of adhesions, spurs, etc
  
  • least comp’d
  • arthro OR open proc.
• Disc Suturing
  
  • MAJOR ROM precautions
  • recapture from deranged pos.
• Disc plication (repair)
  
  • when disc is torn or fragmented
• Condlyectomy
  
  • last resort
  • unlikely to see, removal of condylar side of joint→ similar to girdlestone proc in hip (remove femoral head)
• Total TMJ arthroplasty
  
  • like TKA/THA
  • do NOT typ return to full ROM

Question 3

TMJ Sx and Post-Sx Rehab

Procedures:

Which are the most invasive or will have most precautions and require you to communicate w/ surgeon???

Answer 3

• Disc suturing
• Disc plication (repair)
• Total TMJ Arthroplasty

**Post-op restrictions→ Communicate w/ surgeon! Protocol??

Question 4

TMJ Sx and Post-Sx Rehab

Key Point for Rehab

Answer 4

*Communication w/ surgeon

**Be aware of post-op ROM restricts and precautions!

Question 5

Goals/Tx Principles for the EARLY POST-OP PHASE

0-72 hrs Post-Op

Answer 5

• Control inflammation/pain w/ ice and/or other modalities
• Stabilization splint
• Maintain jt. mobility and prevent scar tissue adhesions by utilizing controlled opening mvmts
  
  • follow ROM precautions***
• Gentle superf STM MAY be approp.
• Adjunctive Upper Quarter postural edu. and ex.
• AVOID yawning, sneezing, coughing
• Liquid or very soft-food diet

Question 6

Goals/Tx Principles for the Post-Op REPAIR PHASE

72hrs-6wks post-op

Answer 6

• Improve ROM
  
  • cont. conrolled-ROM opening for improving jt. health
  • Initiate controlled lateral dev. towards uninvolved side
  • Utilize protrusion ROM ex’s if full opening ROM not easily achieved
    
    • DO NOT use protrusion once 35mm of opening has been successfully achieved
  • Monitor lateral excursion-to-opening ratio→ Optimal is 1:4
    
    • Ex. 5mm lat dev:20mm opening
  • Utilize specific joint/STM tech’s as indicated
• Initiate stabilization training as ROM normalizes
• Utilize manual tech’s and/or modalities for pain control as needed
• Cont. adjunctive postural ed. and ex.
• Cont. softer-food diet and suppress yawning, sneezing, coughing
• Continue use of stabilization splint→ Communicate w/ surgeon regarding weaning

Question 7

TMJ Sx and Post-Sx Rehab

Two major takeaways***

Answer 7

1. Be mindful of post-sx restrictions/precautions
   
   1. ESP any repair sx’s or TMJ total arthro
2. Communicate often/freq w/ surgeon

***GOAL→ restore function to TMJ w/ minimal sx’s→ do NOT be over-aggressive