WEEK 11

Question 1

TMJ P/E

Answer 1

START OBS IN STANDING - LOOK AT SURROUNDING JOUNTS TO ASSESS FOR NORMAL FUNCTION AND NMC OF SHLDR GIRLDE

Question 2

IN SITTING

obser 1

Answer 2

• Upright postural position of the mandible (UPPM) -TUTALC

1) At “rest” there is a 2-5mm gap between the upper and lower teeth – “freeway space”
2) Occlusal position – teeth are maximally intercuspated – centric occlusion

Question 3

sitting obs 2

Answer 3

1/3 of face - chin to nose, nose to outer eye
Length of the mandibles
Symmetry of condyles – size, position Symmetry of muscles

Question 4

palp

Answer 4

Temperature
Sweating
Swelling

muscles: 
Temporalis
Masseter
Medial pterygoid – inside angle of the
mandible 
Anterior belly of digastric
Suprahyoid muscles
Infrahyoid muscles
Intra‐orally – lateral pterygoid SCM, scalenes, UT, Lev scap etc

Question 5

TMJ AMs

Answer 5

repeat 3-4 times
overbit and overjet
– Opening/closing
– Protrusion/retrusion
– Lateral deviation L and R
* (remember you would also do upper and lower Csp active movt assessment)

+ then do loading tests

Question 6

opening

Answer 6

about 45mm (up to 60mm)
Initial rotation – inferior joint
‐ condylar ridge moves forward on
the intermediate zone of the disc Disc rotates backward on condyle
Translational phase – superior joint
‐ disc and condyle move together down the articular eminence

Question 7

Protrusion – 5mm

Answer 7

Almost purely translation ‐ superior joint

Question 8

Retrusion – 3mm

Answer 8

‐ discs and condyles glide forward together.
Translation – superior joint Position of centric relation
Close packed position of the joint

Question 9

Lateral Deviation

Answer 9

(L) and (R) – 7‐9mm (could be up to 12‐15mm)
Going to the (L)
‐ the right disc & condyle
move/ translate forward, inferior and medial
‐ the left disc & condyle pivot/ moving posteriorly

Question 10

treatment

Answer 10

techniques:
• ↔caud Neutral II, III, IV*
• Can also be done in different positions
• ↔caud in an open position IV‐, IV
• ↔caud with opening – therapist performs opening
• MWM ↔caud with opening (therapist glides PA and patient performs opening)
• ↔caud N II in sitting
• ↔caud with opening in sitting
• ↔caud with protrusion

Question 11

eg for R) tmj

Answer 11

do R) medial glide w/ r) lat devand l) lateral glide w/ L) lat. deviation

Question 12

exercise approaches

Answer 12

• Increasingrange,stretches
• Controllingabnormalmovementpatterns(mirror)
• Teachingrestingposition
• Strengthtraining(isometric)
• Addressing contributing factors – eg: poor posture,
– habitual movement patterns – Stress behaviours
– Parafunctional activities