OCS > TMJ > Flashcards

TMJ Flashcards

(55 cards)

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1
Q

Stats

A
  • 35% of population
  • 5-10% seek treatment
  • ages: 20-40
  • women>men
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2
Q

Comorbid conditions

A
  • whiplash or associated trauma
  • severe headache
  • moderate headache
  • neck pain
  • LBP
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3
Q

TMD causes

A
  • dental
  • msk
  • psychosocial
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4
Q

3 axes of research diagnostic criteria

A

Axis 1: clinical/diagnosis
Axis 2: behavior/psychosocial (poorer prognosis)
Axis 3: prognosis

We primarily treat axis 1

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5
Q

Areas to examine

A
  1. cervical screening
  2. look for concordant sign
  3. OA and AA assessment
  4. TMJ mobility assessment
  5. Jaw opening/deviation
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6
Q

Treatment options

A
  1. splinting/orthoses - OTC=custom, minimal effectiveness
  2. Joint mobs - caudal, AP, PA, regional interdependence
  3. Soft tissue intervention - manual, TDN
  4. Exercise - posture, relaxed jaw position, breathing, DNF retraining
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7
Q

Opening- normal value

A

30mm

2 knuckles, 3 fingertips

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8
Q

TMJ bite test

A

1 cm width applied to molars

  • tongue depressors
  • TMJ ipsilateral side UNLOADED
  • contralateral side is LOADED
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9
Q

Protrusion normal value

A

8mm

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10
Q

Lateral deviation normal values

A

8-10 mm

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11
Q

TMJ accessory motions

A
  • inferior distraction
  • inferior/anterior
  • caudal (inferior/posterior)
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12
Q

TMJ Anatomy

A
  • diarthrodial
  • temporal bone and mandibular bone joined through fibrocartilagionous disk, ligaments, and joint capsule
  • TMJ and disk are covered with fibrocartilage that has a reparative property
  • inferior and superior cavities
  • rotation of condyle occurs in the inferior cavity and translation occurs in superior cavity
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13
Q

Superior cavity

A

between the temporal fossa and superior aspect of disc

-translation

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14
Q

Inferior cavity

A

between inferior aspect of disk and mandibular condyle

-rotation

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15
Q

Disc

A
  • biconcave shape
  • allows congruency of TMj during ROM
  • provides lubrication to articular surfaces
  • transmits force
  • stabilizes joint
  • endures long term stress
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16
Q

Disc divisions

A
  1. anterior - attached to superior condylar neck, ant. capsule, sup. lat. pterygoid, temporal bone
  2. intermediate
  3. posterior - bilmainar connective tissue connecting to bone
    A&P have innervation and vascular supply
    -Densest area is bw condylar head and articular eminence
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17
Q

Capsule

A
  • capsule thickens inferiorly due to medial and lateral collateral ligaments
  • more mobility in the AP direction than ML
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18
Q

Temporomandibular ligament

A
  • supports lateral wall of capsule

- limits rotation of condylar head during jaw opening

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19
Q

Collateral ligaments

A
  • attach to medial and lateral borders

- restrict excessive m/l movement of disc

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20
Q

Stylomandibular ligament & Sphenomandibular ligament

A
  • limited function other than assisting in suspending the mandible from the cranium and preventing excessive protrusion
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21
Q

Masseter

A

Origin: anterior 2/3 of zygomatic arch
Insertion: lateral border of mandibular angle
Action:
1. Unilateral contraction - causes lateral deviation to same side
2. Bilateral contraction - elevation of mandible with force added for chewing/grinding hard foot
3. Bilateral superficial fibers = protrusion
4. Bilateral deep fibers = retraction

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22
Q

Temporalis

A

Origin (proximal): entire temporal fossa
Insertion (distal) : coronoid process and medial border of mandibular ramus
Action:
1. Bilateral contraction - elevate and retract mandible
2. Unilateral contraction - lateral excursion/deviation to same side

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23
Q

Medial pterygoid

Study These Flashcards
A

Large head:
Origin (proximal): medial surface of lateral pterygoid plate of sphenoid bone
Small head:
Origin (proximal): tuberosity of maxilla
Insertion (distal): Both insert on medial surface of mandibular angle
Action:
1. Bilateral contraction - elevation and protrusion
2. Unilateral contraction - contralateral deviation

24
Q

Lateral pterygoid

Study These Flashcards
A

Superior head:
Origin (proximal): from greater wing of sphenoid bone
Insertion (distal): anterior aspect of disk
Inferior head:
Origin (proximal): lateral border of lateral pterygoid plate of sphenoid
Insertion (distal): condylar neck
Action:
1. Unilateral - contralateral deviation
2. Bilateral - protrusion
3. Inferior head - depression of mandible
4. Superior head - contracts eccentrically during mouth closing to monitor disc and avoid displacement

25
Suprahyoids
Digastric, mylohyoid, geniohyoid, stylohyoid. | All are responsible for depression and retrusion when the hyoid bone is fixed.
26
Infrahyoids
sternohyoid, sternothyroid, thyrohyoid, omohyoid. Action: stabilize hyoid and form a firm base for suprahyoid muscles.
27
Innervation
- Mandibular division of trigeminal nerve - Deep temporal nerve - masseter nerve - auriculotemporal nerve
28
Normal values for movement
Depression: 40-45mm for males, 45-50mm for females (approximately 4 finger width of nondominant hand) - Functional opening = 3 fingers, 35 mm - Lateral deviation: 1/4 opening range - Protrusion: 6mm to 9mm - Retrusion: 3mm
29
Depression arthrokinematics
- rotation and translation occur simaltaneously - posterior rotation of the condyle (condylar head moves anterior, body posterior) in early depression - anterior translation occurs in late phase of opening - disc rotates posteriorly
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Elevation
- initiated by tension of retrodiscal lamina that retracts disc - condylar head translates posteriorly w/ disc, condyle body rotates anteriorly - at end range - disc rotates slightly anterior
31
Protrusion
-mandibular condyle head and disk translate anterior and inferior
32
Retrusion
-mandibular condyle and disc translate posterior
33
Lateral deviation
-rotation of ipsilateral condyle and horizontal translation of contralateral condyle
34
Causes of pathology
- imbalance of soft tissue - mechanical derangement - both
35
2 major classifications of disc derangement
1. anterior disc displacement with reduction | 2. anterior disc displacement without reduction
36
Anterior disc displacement with reduction
- the disc rests in front of the condylar head while mouth is closed - during opening, it "reduces" back to the top of the condylar head causing a click and then translates anteriorly with the condyle - at end of closing range disc displaces again causing a 2nd click - "reciprocal clicks" - limited opening - mandible deflects to ipsilateral side - "c" or "s" curve
37
Anterior disc displacement without reduction
- disc will stay displaced in front of condyle and not be able to return to normal resting position -no clicking during opening/closing -pateint may have limited opening (when disc is blocking condylar head) OR no limitation in opening (when disc is completely anterior) -hx of reciprocal joint noises -limited opening -deflection and pain
38
Posterior disc displacement
- very rare - usually occurs after wide opening of mouth (aka yawn) - inability to close the mouth (open-lock) - may report closing clicks if reduction occurs
39
Disc-condyle incoordination-internal derangement
- localized mechanical fault in snovial joint that interferes with smooth action 1) anterior disc displacement w/ reduction 2) " " w/o reduction
40
Subluxation/discloation of condyle
1. Dislocation - mouth is kept in open position - may be caused by trauma, muscular hyperactivity, connective tissue disorder, hypermobility 2. Subluxation - temporary dislocation. - systemic laxity - systemic hypermobility
41
Ankylosis
- restricted mandibular mobility and ROM - limited translation of involved side - deviation to ipsilateral side is observed with opening
42
Masticatory muscle disorder
- caused by direct or indirect macrotrauma - forward head posture - psychosocial factors
43
Myofascial pain disorder
-trigger points
44
Myositis
- acute inflammation of muscle | - palpable tenderness, pain during ROM, limited opening of jaw
45
Myospasm
- spasm of masticatory muscles caused by overstretching, trismus (spasm of masster muscle) from a dental proecdure - can also be cause by overuse (excessive gum or hard foods0
46
Dystonia
- neurological condition - CNS - unable to voluntarily control movement of the jaw, lips, tongue - function of chewing/swallowing/speech affected - botox injection may be beneficial
47
Capsulitis
- caused by trauma or poor oral habits - inflammatory process - pain upon palpation and with jaw movement - "C" curve opening with deflection and protrusion towards ipsilateral side (tight/stretched side)
48
Objective assessment
- thorough upper quadrant screen - posture - abdominal and cervical muscles - postural retraining recommended
49
"S" curve
- mandible deviates in "s" shape with opening - without pain may indicate muscle imbalance or improper muscle coordination - if painul or with limited opening, may indicate involvement of disc or capsule
50
"C" curve
- mandible deviates to one side in middle of opening and returns to center at end of opening - indicative of capsular pattern
51
Deflection
- mouth deflects to one side during opening and does not return to center at end range - indicative of ipsilateral disc involvement - limited opening, protrusion to ipsilateral side, and limited lateral excursion to C/L side also common
52
Clinical progression of internal derangement
1. reciprocal clicks 2. absent joint noise with limited opening (locked joint) 3. osteoarthrosis
53
Cotton roll test
- used to differentiate between muscular and joint involvement - bite down on an object with back molars = gap in ipsilateral side and compress contralateral side - have patient bite down on side of complaint - PAIN INCREASE: cause is muscular - PAIN DECREASE: cause is joint related
54
Ultrasonography
-reliable in IDing internal derangement, condylar erosion, articular effusion, degenerative OA
55
Intervention
- relaxation - postural correction - oral habit modifiation (resting position of tongue) - soft diet - modalities for pain control - AVOID IONTOPHORESIS due to skin breakdown in the facial area - STM - joint mobs - dry needling
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