Lab 4: TMJ Dysfunction Lab

Question 1

What is the correct setup and technique of MFR/ST for Hypertonic Temporalis M.?

Answer 1

• Pt head rotated contralateral to side being tx
• Caudadthumb padsuperiortoipsilateral angle of pt’s jaw of the temporalis being stretched to anchor insertion of muscle
• Cephalad thumb provides stretching force away from origin of muscle by tractioning along superior temporal line
• Apply force gentle/rhythimically (ST) ever 1-2 sec. or hold tissue into RB (direct MFR). Continue 1-2 mins until tissues soften
• Reasses for TART

Question 2

What is the correct setup and technique of MFR/ST for Mandible restricted to Lateral Translation (“C-shaped” deviation)?

Answer 2

• Doc seated on side of restriction w/ cephalad hand under pt’s head, elevating it slightly
• Doc’s caudad hand positioned w/ 3rd-5th fingers along posterior border of the ramus of mandible and hypothenar eminence along body of jaw
• Instruct pt to open mouth slightly, while doc exerts force w/ hand on jaw so as to draw the jaw forward at the TMJ and deviate jaw laterally to restricted side
• Traction on jaw applied and released in slow rhytmic pattern for 30 sec to 2 min (ST) –> success is determined by reassessing mandible ROM in lateral translation

Question 3

What is the correct setup and technique of bilateral direct MFR/ST for Muscle of Mastification?

Answer 3

• Doc is seated at table head, pt is supine with mouth closed comfortably
• Doc stabilized pt’s jaw w/ thenar eminences on bilateral mandibular angles
• Apply traction to the feather’s edge of barrier, inferiorly and slightly anteriorly corresponding along the long-axis of mandibular ramus
• Maintain traction and monitor w/ thenar eminences for reduced muscle tension and a sense of relaxation

Question 4

What is the correct setup and technique for Medial Pterygoid Counterstrain?

Where is the TP?

Answer 4

• Point found at medial aspect of ascending ramus just anterior to the angle of jaw
• Doc at table head; pt supine; monitor TP w/ ipsilateral index finger and instruct pt to allow their mouth to hang open comfortably
• Contralateral hand translates mandible away from TP, fine-tuning amount of translation and opening until pain is reduced by at least 70% (head rotation towards TP may also be helpful
• Hold for 90 secs, slowly return to neutral and reassess

Question 5

What is the correct setup and technique for Masseter TMJ counterstrain?

Where is the TP?

Answer 5

• Inferior to zygoma, in the belly of the masseter m.
• Doc at table head w/ pt supine, while monitoring the TP have the pt depress mandible slightly to disengage TMJs
• Place one hand on body of mandible opposite of TP and translate mandible toward side of TP until pain decreased by 70%
• Hold 90 sec, slowly return to neutral and then reasses

Question 6

What is the correct setup and technique for TMJ counterstrain?

Where is the TP?

Answer 6

• Posterior aspect of angle of mandible, generally side opposite of mandibular deviation
• Pt supine, Doc at table head monitoring TP
• Doc rotates head and neck to opposite side of TP until pain decreased 70%
• Hold for 90 sec, slowly return to neutral and reassess

Question 7

What is the correct setup and technique of ME for an Adducted Mentum Dysf.?

Answer 7

• Doc at table head; Pt supine w/ mouth open as far as they comfortably can
• Doc stabilized pt’s jaw in open position and pt tries to close jaw for 5 secs/
• Upon relaxation the jaw is opened to its next wider comfortable positon and the same technique is repeated x5 or until muscle doesn’t lengthen anymore

Question 8

What is the correct setup and technique of ME for an “C”hin Deviation?

Answer 8

• Pt supine w/ mouth open comfortable; Doc stands facing patient
• One hand on body of mandible ipsilateral to side of deviation
• Stabilize head w/ other hand on contralateral side of deviation w/ a wide application w/ MTP joints near the ear
• Engage the RB thru your mandibular placed hand, while pt presses their chin lightly against your counterforce for 5 secs.
• Have pt relax, wait 1-2 secs, and then move to next RB
• Repeat 3-5x or until no RB perceived and the reassess for TART

Question 9

What is the correct setup and technique of TMJ BLT?

Answer 9

• Thumbs on anterior ramus, while 1st and 2nd fingers contact posterior ramus
• Medial 3rd and 4th fingers grasp inferior under mandible parallel
• Apply traction inferiorly and anteriorly; follow rotary and lateraly translatory glides towards ease
• Use breath holding to facilitate release

Question 10

What is the correct setup and technique of the Anterior Disc Reduction Technique?

Answer 10

• Doc seated at table head; Pt is supine
• Grasp mandible on involved side w/ 4th and 5th fingers on posterior aspect of ramus + 2nd and 3rd fingers on body of mandible
• Other hand contacts body of mandible on opposite side
• 4th and 5th fingers lift mandible anteriorly, while 2nd and 3rd fingers lift cephalad
• Opposite hand applies force to mandible, pushing medially, gliding the mentum around towards dysf. side.
• This attempts to pin the condyle on the disc and reduce it with the motion of mandible and is a temporary fix until tissue have healed or pt has surgery

Question 11

What is the correct setup and technique of Supraclavicular Fascia Release?

Answer 11

• Pt seated w/ Doc standing facing the pt; Doc applies downward pressure w/ fingers superior to clavicle
• Abduct pt’s UE to 90° and alternate between IR and ER slowly
• Follow fascial release as fingers sink into post-clavicular area

Question 12

What is the correct setup and technique for Doming the Diaphragm?

Answer 12

• Pt is supine w/ hip and knees flexed; Doc on either side of pt
• Doc places thumbs inferior to xiphoid process and pointing cephalad
• Pt takes deep breath and exhales; on exhalation doc presses thumbs posteriorly and superiorly
• Resist on inhalation and push further on exhalation; repeat 3-5x

Question 13

What technique is this?

Answer 13

• Submandibular drainage

Question 14

What technique is this?

Answer 14

Cervical chain drainage

Question 15

Which lymphatics technique is contraindicated in COPD?

Answer 15

Thoracic Pump

Question 16

In general, where is the TMJ TP typically found in relation to the deviated jaw?

Answer 16

Generally on the side opposite of mandibular deviation