TMJ Functional/Special Tests

Question 1

Seated Exam- NO GLOVES

Answer 1

1. Check Jaw Opening/Saggital Plane/Resting Occlusion
2. Auscultation
3. Palpate While Opening
4. C-spine/T-spine/UQ screen
5. Posture

Question 2

Jaw Opening

Answer 2

C-Shaped:
-comes out them back in
-doesn’t pass midline
-Capsular pattern=Hypomobility

S-Shaped:
-deviates in multiple ways
-crosses midline
-Dec NM control

Deflection:
-Anterior disc displacement
-typical toward side of displacement

Question 3

Overbite

Answer 3

-portion of the mandibular incisor that is covered by maxillary tooth
-vertical measurement

Question 4

Overjet

Answer 4

what we think of as overbite

-horizontal distance between maxillary arch and mandibular arch when mouth is closed

Question 5

Underbite

Answer 5

-mandibular teeth sit further anterior than maxillary teeth

Question 6

Cross Bite

Answer 6

-mandibular teeth are not in line with maxillary
-name by mandibular side

Question 7

Open Bite

Answer 7

-in full occlusion, molars are touching but not front teeth

Question 8

Supine Exam- NO GLOVES

Answer 8

1. Muscle palpation
2. Mandibular Neurodynamic Testing (if neuro suspected)
3. Muscle Length Tests
4. Muscle strength testing
5. C-spine joint play

Question 9

Muscle Palpation (NON-ORAL)

Answer 9

-masseter
-temporalis
-Pterygoid (external auditory meatus)

Question 10

Mandibular Neurodynamic Testing

Answer 10

-done if suspected neuro cause of pain

1. Pt in supine w/ head over plinth supported by PT
2. PT performs capital flexion; ask
3. Then full cervical flx; ask
4. Then SB contra; ask
5. Open Pt mouth, Laterally glide to contra side and hold; ask
6. Then do in neutral

Neutral + Deviation pain= Joint
Flx/SB + Deviation pain= Neural

Question 11

Supine Exam- GLOVES

Answer 11

1. ROM
2. Joint play
3. Muscle Palpation
4. Centric Relation Provocation Test

Question 12

ROM of TMJ

Answer 12

Opening:
-functional 35mm
-40-60mm

Lateral Deviation:
-1/4 of opening
~10mm

Protrusion:
-5-10mm

Retrusion:
-3mm

Question 13

TMJ Joint Play

Answer 13

Distraction
Anterior Translation
Lateral Translation
Anteromedial Rotation (rotation on ipsi)

Question 14

Centric Relation Provocation Test

Answer 14

-identify discal issues

1. Grasp mandible
2. Scoop jaw into space

(+): pain recreated anterior to tragus

Question 15

Muscle Palpation (ORAL)

Answer 15

Medial Pterygoid:
-rope like bundle behind molars

Question 16

Prone Exam- NO GLOVES

Answer 16

-Assess CT and thoracic

Question 17

MET for TMJ Opening

Answer 17

-resist closing

1. Pt in supine w/ neutral head
2. Depress mandible
3. Have Pt hold against for 8s
4. Then take a deep breath and open mouth
5. Use new ROM to start over until no new movement

Question 18

MET for TMJ Protrusion

Answer 18

-resist protrusion

1. Pt in supine w/ neutral head
2. PT press on lower teeth into retrusion
3. Have Pt hold against for 8s
4. Then take a deep breath and relax
5. Use new ROM to start over until no new movement

Question 19

MET for TMJ Lateral Excursion

Answer 19

-resist contra lateral excursion

1. Pt in supine w/ neutral head
2. PT press jaw into contra lateral excursion
3. Have Pt hold against for 8s
4. Then take a deep breath and relax
5. Use new ROM to start over until no new movement

Question 20

MET for Suboccipitals

Answer 20

-resist cevical extension

1. Pt in supine w/ head at furthest upper cervical flexion
2. Have Pt look up as far as they can for 10s
3. Then take a deep breath and look down
4. Use new ROM to start over until no new movement

Question 21

TMJ Mobilizations

Answer 21

oscillatory

-distraction
-ant mobilization
-lateral mobilization
-Posterior mobilization

Question 22

TMJ HEP

Answer 22

-Self Resisted METs
-Soft tissue massage

Question 23

Discal Intervention: ADD w/ Reduction

Answer 23

ADD w/ Reduction

1. Open mouth until opening click
2. Close teeth while protruding
3. The retrude before opening click
4. Repeat

Question 24

Tongue Depressor Exercises

Answer 24

1. Bite down on tongue depressors held together
2. Move into closing, lateral excursion, protrusion/retrusion

Question 25

Neuromuscular Re-Ed Exercises

Answer 25

-use a mirror and self correct with hand on side of deviation -switch to other side -then use only mirror