TMJ

Question 1

Assessment of Temporomandibular Joint

Answer 1

Question 2

TMJ Symptoms

Answer 2

• Pain - localised to the TMJ region and muscles of mastication
• Cephalgia or cervical pain
• clicking or popping in the TMJ
• dizziness
• dysphasia
• chronic sinusitis
• periauricular pain - ear pain
• tinnitus
• fullness sensation in the ear

Question 3

TMJ Signs

Answer 3

• Alteration in TNJ gait - deflection and deviation
• Displacment of the TMJ articular disc
• Arthritic degenration of the TMJ
• Alterations in the condylar fossa morphology
• trigger points in the muscles of mastication
• conpensatory posture change
• asymmetric dental wearing
• malocclusion

Question 4

TMJ Observation

Answer 4

• Head and Neck Posture
• Facial Symmetryu
• Signs of cranial nerve palsy
• state of dentition
• Normal uvula and tongue movement
• Occluded teeth position - over bite, under bite
• madibular position
• TMJ musculature
• Swelling, ecchymosis and abnormal contours
• TMJ Gait

Question 5

Tempromandibular Movements and Resisted

Answer 5

Depression:

• Gravity
• Inframandibular

Elevation:

• Masseter
• Temporalis
• Medial Pterygoid

Protrusion:

• Medial Pterygoid
• Lateral Pterygoid

Retrusion:

• Temporalis
• Masseter
• Digastrics
• Suprahyoids

Laterotrusion:

• Lateral Pterygoid (contalateral)
• Temporalis (homolateral)

Question 6

TMJ Palpation

Answer 6

Static Palpation:

• Muscles of mastication
• Mandible
• Teeth
• Cricoid Cartilage
• Hyoid Bone
• Thyroid Cartilage
• Mastoid
• Cervical Spine
• Cervical and Shoulder Musculature

Question 7

Active Range of Motion - TMJ

Answer 7

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

Question 8

Knuckle Test

Answer 8

Purpose:

• Assess the opening ROM of TMJ
• Pt’s require a certain amount of ROM to perform normal activities

Procedure:

• Pt is sitting and examiner is to the side
• instruct pt to try place two IP joints in their mouth and observe ability

Positive:

• inability to open mouth to range
• at least 25-35mm needed for activities

Indication:

• joint degeneration
• hypertonic muscles of mastication
• displaced TMJ disc

Question 9

TMJ Joint Sounds

Answer 9

• Presense of sound can indicate abnormal disc motion, abnormal motion of mandible or adhesions in joint
• Early click is developing problem and late click is chronic

Types of sounds

• Click - distinct sound
• Course Crepitus - continuous grinding
• Fine Crepitus - fine grating

Note sounds and see what stage they occur and if you can replicate

Question 10

Auscultation of the TMJ

Answer 10

Purpose:

• Identify joint sounds that can indicate a pathology
• Done in addition to palpation

Procedure:

• Pt is sitting and examiner is next to jaw
• Use the bell of the scope against the side of the jaw and get the pt to move through ranges.
• Listen for noises

Positive:

• Clicking, course crepitus or fine crepitus
• Normal sound during occlusion is is not positive

Indication of a postive

• click is disc derangement
• grating or crepitus is joint degeneration