TMJ

Question 1

biomechanics of TMJ

Answer 1

mandibular condyle (convex)

on

TM disc and glenoid fossa of temporal bone
(concave)

Question 2

ROM of TMJ depression
- mm associated

Answer 2

35-55mm

lateral pterygoid

Question 3

mm associated with mandible closing/occlusion

Answer 3

temporalis
masseter
medial pterygoid

Question 4

normal protrusion ROM of TMJ
– mm associated

Answer 4

7 mm

medial/lateral pterygoid

Question 5

normal retraction ROM of TMJ
– mm associated

Answer 5

3-4 mm

temporalis (post fibers)

Question 6

normal lateral deviation ROM of TMJ
– mm associated

Answer 6

10-15 mm

contralateral medial/lateral pterygoid
(R excursion = L mm)

Question 7

explain disc displacement with reduction

Answer 7

movement coordination of articular disc slipping off and back on through movement

Question 8

“reciprocal click”

Answer 8

upon opening and closing

palpation of lateral pole = opening click (reduction)

closing click as disc displaces anterior to condyle

Question 9

explain disc displacement without reduction

Answer 9

intermittent locking without joint noises

deflection of jaw toward involved side

limited lateral excursion contralateral to involved jt

Question 10

arthrokinematics of TMJ elevation (closing)

Answer 10

anterior roll
posterior slide

Question 11

mob needed to improve ROM closing TMJ

Answer 11

posterior glide of mandible

Question 12

arthrokinematics of TMJ depression (opening)

Answer 12

early - posterior roll/anterior slide

late - condyle/disc move anterior and inferior

Question 13

mob to improve mandible depression

Answer 13

anterior glide of mandible

Question 14

arthrokinematics of TMJ protrusion/retrusion

Answer 14

pro - anterior translation

ret - posterior translation

Question 15

arthrokinematics of TMJ lateral excursion

Answer 15

ipsilateral side creates pivot

contralateral rotates anterior and medially

R excursion = Right pivot, L rotation

Question 16

explain deviation in TMJ

Answer 16

hypomobility evident toward side of deviation

due to displaced disc or unilateral mm hypomobility

Question 17

C-type curve

Answer 17

to the left upon opening

Question 18

reverse C-type curve

Answer 18

right deviation on opening

Question 19

TMJ compression test
- performance
- (+)

Answer 19

evaluation of pain with compression of retrodiscal tissue

sitting or supine
stabilize head, push mandibular condyle into joint space

(+) = repro of pain

Question 20

mobility deficit of TMJ

Answer 20

related to DJD and OA/RA
–> all common aspects of joint degeneration as well as derangement without reduction

Question 21

muscle power deficit of TMJ

Answer 21

those that control jaw movement as well as cervical spine/shoulder mm

Question 22

causes of internal derangement of joint

Answer 22

trauma

congenital changes of joint

abnormal function due to mastication/breathing or head posture

Question 23

PT goals/outcomes/interventions for TMD

Answer 23

postural reeducation

modalities (pain/inflammation)

biofeedback (stress/anx)

joint mobilization
(anterior-inferior for hypomob during opening)

flexibility/mm strengthening ex
(rocobado)

education (foods/posture)

night splints = dentist

Question 24

strong recommended pain relief interventions

Answer 24

patients experiencing >3mo chronic TMD

jaw mobilization
jaw exercise and stretching
trigger point therapy
postural exercise
(multimodal)