TMJ Common Clinical Presentations

Question 1

DIFFERENTIAL

Answer 1

DIFFERENTIAL

Question 2

What MSK conditions should we consider with the TMJ?

Answer 2

• myofacial, internal derangement, degenerative arthropathy
• intra-oral (dental)
• c-spinie referral

Question 3

What neurological condition should we consider with the TMJ?

Answer 3

Peripheral neuralgia

Question 4

What vascular conditions should we consider with the TMJ?

Answer 4

• cardiac referral (angina, MI)

- HA

Question 5

What other conditions should we consider with the TMJ?

Answer 5

• psychiatric
• neoplasm
• RA, inflammatory arthritis
• developmental defect
• infection
• synovial disease
• ankylosis

Question 6

What are the 3 groups of TMJ disorders?

Answer 6

Group I (Masticatory Muscle Disorders)

• Ia- with normal opening
• Ib- with limited opening

Group II (Disc Displacements)

• IIa- disc displacement with reduction
• IIb- disc displacement without reduction and limited opening
• IIc- disc displacement without reduction without limited opening

Group III (Joint Dysfunction)

• IIIa- arthralgia
• IIIb- osteoarthritis
• IIIc- osteoarthrosis

Question 7

In short, what are the 3 categories of TMD?

Answer 7

• myofacial
• disc displacement
• degenerative/ inflammatory

Question 8

GROUP 1 (MASTICATORY MUSCLE DISORDERS0

Answer 8

GROUP 1 (MASTICATORY MUSCLE DISORDERS)

Question 9

What are the mechanisms of masticatory muscle disorders?

Answer 9

• strain
• overuse injury
• centrally mediated pain

Question 10

Strain is ______ and can be caused by ____________.

Answer 10

• acute

- direct trauma

Question 11

Overuse injury is ________ and can happen via __________ and ___________.

Answer 11

• chronic
• parafunctions (unconscious habitual)
• guarding

Question 12

• Masticatory Muscle Disorders can result in reduced _______ and alter _________.
• They can also result in _______ ________ with pain referral to the face, teeth, auricular area, temporal area, periocular area, and upper cervical area.

Answer 12

• motion, occlusion

- trigger points

Question 13

How will someone with Masticatory Muscle Disorder present during a physical examination?

Answer 13

• Tenderness and increased turgor of muscles of mastication.
• Aberrant motion pattern with AROM testing.
• Limited ROM when stretching involved structure (painful at end-range).
• Pain with resistance testing.
• Pain with tongue depressor biting on ipsilateral side.

Question 14

JOINT DYSFUNCTIONS (DISC AND ARTHROPATHY)

Answer 14

JOINT DYSFUNCTIONS (DISC AND ARTHROPATHY)

Question 15

Category II = ___________

• DDWR = ______________
• DDWOR = ______________

Answer 15

Disc Displacements

• Disc Displacement With Reduction
• Disc Displacement Without Reduction

Question 16

Category III = ________________

• ___________
• ___________
• ___________

Answer 16

Joint Dysfunctions

• arthralgia
• osteoarthritis
• osteoarthrosis

Question 17

What structures can be affected with Joint Dysfunction?

Answer 17

Disc, joint surfaces, capsule, ligaments, retrodiscal tissue, synovium.

Question 18

Joint Dysfunction mechanisms can be either _____ or ______trauma.

Answer 18

• macrotrauma (acute)

- microtrauma (chronic)

Question 19

Joint Dysfunction can lead to muscle __________.

Answer 19

guarding

Question 20

What are the general findings with Group II (Disc Displacements) and Group III (Joint Dysfunctions)?

Answer 20

• Preauricular pain commonly primary complaint.
• Painful palpation of joint line.
• Pain with tests that place compressive load on joint structures.

Question 21

DDWR

• Audible and/or palpable ____________ (1/3 trials)
• Is joint motion typically intact?

DDWOR

• Report of ________ sensation with opening/closing?
• Are there ROM limitations?

Answer 21

• clicking
• Yes, motion is typically intact.
• catching
• Yes, limitations in opening ROM.

Question 22

What are 2 pathomechanic deviations seen?

Answer 22

• C-type curve

- S-type curve

Question 23

C-type Curve:

• __________ displacement of a disc (ipsilaterally) without reduction or unilateral muscle hypomobility
• Hypomobility of __________ joint.

Answer 23

• Anterior

- Ipsilateral

Question 24

S-type Curve:

• ________ imbalance or ________ displacement.
• Condyle “______ ________ the disc”

Answer 24

• muscular, medial

- walks around the disc

Question 25

- Early deviation = _________ | - Late deviation = ________/ tight __________

Answer 25

- spasm | - capsulitis/tight capsule

Question 26

DDWR AND DDWOR

Answer 26

DDWR AND DDWOR

Question 27

Describe DDWR clicking and reciprocal clicking.

Answer 27

Clicking - Partial anterior displacement or dislocation of the disc in resting position. - Opening click indicates reduction of the disc as the mandibular condyle passes over the posterior border. Reciprocal Clicking - Clicking occurs with closing - Condyle slips posteriorly over the anteriorly displaced disc.

Question 28

Describe DDWOR.

Answer 28

- Disc is still anteriorly displaced like in DDWR, but the disc no longer reduces. - This can limit opening motion of the mouth. - Causes compression loading on retrodiscal lamina.

Question 29

OPEN LOCK, CLOSED LOCK, ARTHROPATHY

Answer 29

OPEN LOCK, CLOSED LOCK, ARTHROPATHY

Question 30

Describe an Open Lock at the TMJ.

Answer 30

- The condyle moves over the anterior rim of the disc at max opening. - The condyle cannot move back past the disc and gets "stuck" in the open position.

Question 31

What muscles guard during an Open Lock?

Answer 31

- Masseter | - Temporalis

Question 32

Describe a Closed Lock at the TMJ.

Answer 32

- Involves a DDWOR. - Partial anterior displacement or dislocation of the disc. - Condyle unable to pass over the posterior border of the disc. - Cannot open mouth fully.

Question 33

- Category III (Joint Dysfunctions) involve ____________ of the capsule, ligaments, retrodiscal tissue, and synovium. - What are the structural changes that can occur with Group III (Joint Dysfunction)?

Answer 33

- inflammation | - degeneration, osteoarthritis, osteoarthrosis

Question 34

Does osteoarthrosis or osteoarthritis have an active inflammatory process?

Answer 34

Osteoarthritis