TMJ

Question 1

AROM of TMJ

Answer 1

• Mandibular Depression (35-55mm)
• Mandibular Elevation
• Mandibular Protrusion (>7mm)
• Mandibular Retrusion (3-4mm)
• Lateral deviation (10-15mm)

Question 2

The Knuckle Test

Answer 2

Purpose:

• To assess the opening ROM of the TMJ
• Patients require a certain amount of opening range to perform the normal activities of daily living such as chewing and talking

Procedure:

• Patient is sitting or standing
• The practitioner stands adjacent to the patient’s affected jaw
• The practitioner instructs the patient to try to place two flexed IP joints into their open mouth between their teeth
• The practitioner observes the patient’s ability to perform the procedure

Positive:

• An inability/difficulty to open the mouth to the desired range
• At least 25-35 mm of opening is required for normal daily activities

Indication of a positive:

• May indicate joint degeneration
• Hypertonic muscle of mastication
• Displaced TMJ disc

Question 3

Motion Palpation of TMJ

Answer 3

Posterior to joint space:

• Examiners index finger pads inside the patients external auditory meatus

Lateral to joint space:

• Examiners index finger pads overlying the mandibular condyles

Question 4

Auscaltation of TMJ

Answer 4

Purpose:

• To identify joint sounds that may indicate pathology of the TMJ
• This is test is usually performed in addition to palpation of the TMJ •

Procedure:

• Patient is sitting
• The practitioner stands adjacent to the patient’s affected jaw
• The practitioner places the bell of the stethoscope against the side of the patients jaw overlying the TMJ
• The practitioner instructs the patient to slowly move their jaw through the normal ranges of motion
• The practitioner listens for abnormal sounds and takes note of when they occur

Positive:

• Clicking, coarse crepitus, or fine crepitus during AROM
• The normal sound produced during occlusion is not a positive test •

Indication of a positive:

• Clicking noises are usually the result of disc derangement
• Grating or crepitus may indicate joint degeneration