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MSK Final - ELBOW/ WRIST & HAND/ TMD > TMD > Flashcards

TMD Flashcards

1
Q

Where is the temporomandibular joint?

A

Anterior to ear tragus

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2
Q

What two bones make up the TMJ?

A

Temporal and mandible (condyle) bones

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3
Q

What is the disc vascularity?

A

Avascular except at periphery

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4
Q

What is the function of fibrocartilage?

A

Shock absorption
stability
Guides motion

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5
Q

What is the disc attached to?

A

Muscles
capsule
condyle
ligament

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6
Q

What are the joint structures, disc and direct contacting muscles of the TMJ mostly innervated by?

A

The branches of the trigeminal nerve

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7
Q

What are the 8 areas of trigeminal nerve symptoms?

A

Ears
Tongue
Eyes
Teeth
Neck
Head
Face
Jaw

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8
Q

What is the capsule attached to?

A

Muscle
Disc

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9
Q

What does the sphenomandiular ligament prevent? What does it help with?

A

Excessive opening, recoils for closing

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10
Q

What does the temporomandibular or lateral ligament prevent?

A

Posterior condyle displacement

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11
Q

What does the temporomandibular or lateral ligament initiate?

A

Opening

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12
Q

What does the stylomandibular ligament restrain?

A

NO MOTION RESTRAINT

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13
Q

What is the resting or closed packed position?

A

Lips closed, teeth not touching and tongue resting on roof of mouth

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14
Q

What amount of overbite is a resting position?

A

2mm

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15
Q

What is the amount of overjet or overjut beyond overbite in a resting position?

A

≥ 2mm

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16
Q

What is the closed packed position of the TMJ?

A

Unknown

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17
Q

What is the function of fibrocartilage?

A

Shock absorption, stability, guides motion

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18
Q

What is the disc attached to in the TM joint?

A

Muscles
capsule
condyle
ligament

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19
Q

What is the capsule attached to in the TMJ?

A

Muscle
Disc

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20
Q

What directions do the mandibular condyles move together in?

A

The same or different directions

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21
Q

What are the arthrokinematics of the TMJ?

A

Mandibular Condyle is convex on the concave temporal fossa

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22
Q

What rule do the TMJ arthrokinematics follow?

A

Kaltenborn’s rule

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23
Q

What do the arthrokinematics of the TMJ allow?

A

Multiple functions

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24
Q

What is opening the mouth also known as?

A

Mandibular depression

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25
Q

What is closing the mouth also known as?

A

Mandibular elevation

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26
Q

What are the Norms with opening of the mouth?

A

~3 knuckles width

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27
Q

What is an urgent referral with opening of the mouth?

A

If only ≤ 1 knuckle, refer to a dentist/oral surgeon

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28
Q

What happens with the mandibular condyles when the mouth is opened?

A

Mandibular condyles glide anterior

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29
Q

What kind of clicking is considered normal upon opening the mouth?

A

Bilateral clicking

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30
Q

What muscles are used to open the mouth?

A

Digastric
lateral pterygoid
hyoids

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31
Q

What is the MAIN opener of the mouth?

A

Digastric

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32
Q

What do the mandibular condyles do upon closing of the mouth?

A

Glide posterior

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33
Q

What muscles are involved in the closing of the mouth?

A

Temporalis
Masseter
Medial Pterygoid
Lateral Pterygoid

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34
Q

What muscles are involved with lateral deviation of the TMJ?

A

Masseter
Pterygoids
Temporalis

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35
Q

What is unique about the pterygoids with lateral deviation of the TMJ?

A

Same side medial and lateral pterygoids primarily act to move the mandible medial for grinding food

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36
Q

What are the S&S of Temporomandibular disorder regarding oral habit history?

A
  • thumb sucker
  • nail / ice biter
  • excessive teeth grinder
  • gum/ smokeless tobacco chewer
37
Q

How do we know if someone is an excessive teeth grinder?

A

Indicated by AM HA that goes away with ADLs

38
Q

What is the difference between a HA from grinding teeth and a HA from cervical dysfunction?

A

from grinding teeth goes away with ADLs, with cervical dysfunction likely worse with ADLs

39
Q

What is normal with sleep?

A

Some grinding, some sleep stages have it happen

40
Q

What are S&S we’d find in observation?

A

FHP

41
Q

Where would we find pain and crepitis with TMJ?

A

Localized

42
Q

What can we look for with observation of opening and closing?

A

Presence and timing of deviation(s)

43
Q

What can become sensitive with TMJ?

A

Trigeminal nerve - possibly

44
Q

Can hypermobility limit motion?

A

Yes, if off axis

45
Q

What is earlier deviation WITHOUT loss of functional opening due to?

A

Greater laxity with hx of trauma

46
Q

Will we have pain with earlier deviation without loss of functional opening?

A

Minimal to no pain unless irritated

47
Q

What can indicate a hypermobile TMJ with an earlier deviation without loss of functional opening?

A

Deviation away from unilateral hypermobile TMJ

48
Q

What does a click at the end range indicate? (me)

A

Larger displacement

49
Q

What is end range deviation without loss of functional motion due to?

A

due to gradual onset from FHP and less laxity/trauma

50
Q

Will we have pain with end range deviation without loss of functional motion?

A

Minimal to no pain unless irritated

51
Q

What will we see with end range deviation without loss of functional motion?

A

Deviation with bilateral hypermobile TMJ, possibly inconsistent

52
Q

What does a click at end range indicate with end range deviation without loss of functional motion?

A

Larger displacement

53
Q

What is earlier deviation WITH a loss of functional opening due to?

A

Acute with recent trauma or chronic with fibrotic TMJ

54
Q

What are the S&S of acute earlier deviation WITH a loss of functional opening?

A
  • Deviation toward painful TMJ
  • Limitation due to inflammation/unwillingness to move
55
Q

What are S&S of chronic TMJ due to earlier deviation WITH a loss of functional opening?

A
  • Deviation toward hypomobile TMJ
  • Limitation due to joint hypo-mobility
56
Q

What does early unilateral clicking upon opening indicate?

A

Smaller displacement

57
Q

What does inconsistent clicking indicate?

A

Hypermobility

58
Q

What does reciprocal clicking indicate?

A

Condyle moves ahead of disc on opening and behind disc on closing

59
Q

What does crepitus indicate in the TMJ?

A

TMJ and/or disc damage

60
Q

Why is FHP an issue with surrounding musculature?

A

Increase tension on digastric/hyoid muscles, hyoid bone becomes further away from mandible and clavicles

61
Q

Why can FHP lead to mouth opening?

A

Tongue drops off roof of mouth, may cause someone to become a mouth breather, makes it hard to keep the neutral position

62
Q

What ligament can FHP increase tension on?

A

Sphenomandibular ligament

63
Q

What can displace due to FHP? Where?

A

Mandibular condyle may displace anterior to disc

64
Q

What can we do to assess FHP?

A
  • Have patient swallow in neutral and in FHP
  • If WNL, no excessive neck motion
  • Excessive neck motion indicates cervical hypermobility/instability
65
Q

What does excessive neck motion in with swallowing indicate?

A

Hypermobility/instability

66
Q

IF WNL opening in neutral in and FHP should be….

A

the same

67
Q

If opening is less in FHP compared to neutral, what does it indicate?

A

possible posterior displacement

68
Q

What happens with a posterior displacement of the TMJ?

A

Condyle posteiror to the disc

69
Q

What will we find in the hx for a posterior displacement?

A

Trauma with sudden closing

70
Q

What are the S&S of a posterior displacement?

A

Likely pain and limitation on opening
Full closing

71
Q

What is the rx for a posterior displacement?

A
  • distraction with anterior glide to reposition mandibular condyle anteriorly to disc
  • sleep with small neck roll for slight neck ext
  • avoid excessive or hard chewing / grinding
72
Q

What orthotics could be considered for a posterior TMJ displacement?

A

night splint to maintain slight opening

73
Q

What is the purpose of MET for posterior displacement of the TMJ?

A

stabilization of TMJ and neck

74
Q

What is an anterior displacement of the TMJ?

A

Condyle anterior to the disc

75
Q

What is the hx for an anterior displacement?

A
  • Prolonged opening such as from FHP or mouth breathing
  • trauma with sudden opening
  • excessive opening such as yawning or from dentistry
76
Q

What are S&S of an anterior displacment?

A
  • Full opening / no deviation
  • likely pain and limitation upon closing
77
Q

What is the rx for an anterior displacement?

A
  • distraction with a posterior glide to reposition the mandibular condyle posteriorly to disc
  • Avoid wide opening with diet/yawning
  • sleep with neck flexed and chin tucked
  • correct posture
78
Q

What is the purpose of MET for anterior displacements?

A

Stabilization of TMJ and neck

79
Q

Is an upper or lower TMJ disorder more common?

A

upper > lower

80
Q

What is the PT rx for TMJ disorders?

A

POLICED
Postural education

81
Q

What specific aspects of POLICED should we use with TMJ patients?

A

STM - intra and extraorally
Modalities for pain/guarding

82
Q

What are some aspects of postural education we need to keep in mind with TMJ?

A

Sit tall
Maintain open packed position

83
Q

What kind of breathing can help with TMJ?

A

Diaphragmatic breathing training

84
Q

What are some activity modifications that can help with TMJ?

A
  • Oral habit alterations
  • Dietary changes
  • motion extremes
  • sleep modifications
85
Q

What kind of MT can we do for TMJ?

A

JMs / oscillations of TMJ and neck for hypomobility and displacement reductions

86
Q

What other MET can we do for PT rx for TMJ disorders?

A
  • Isometrics, plus neck exercises
  • practice resting and talking with cork in between teeth
  • Cervical stabilization
87
Q

What will the dentist/MD do for TMJ disorder?

A

Splints
Orthodontics
Sx

88
Q

What is the prognosis for TMJ disorders?

A

Very good if proper mechanics, posture, stabilization and breathing patterns restored

MSK Final - ELBOW/ WRIST & HAND/ TMD (6 decks)

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