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MSK > TMJ Exam/Intervention > Flashcards

TMJ Exam/Intervention Flashcards

1
Q

Common functional limitations of TMJ disorders:

A 
Chewing
Eating
Talking
Sleeping
Work Tasks (clenching with prolonged sitting for example - anxiety)
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2
Q

What HPI (history of present illness) needed to know for TMJ disorders:

A
  1. Anatomic Location(s): (auricular, mandibular, temporal)
  2. Onset (acute/ insidious/ congenital)
  3. Timing (how long has symptoms been going)
  4. Status (better/ worse/ same)
  5. Irritability (level of stress causing pain)
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3
Q

Associated symptoms (4) with TMD:

A
  1. HEADACHE
    - Location
    - Frequency
    - Visual Aura
  2. Dizziness/ Nausea
    - Vertigo
    - Light-Headedness
  3. Paresthesia/ Anesthesia of face/scalp or body
  4. Tinnitus (ringing in ear)
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4
Q

Special questions for patient with possible TMD: (5)

A
  1. Joint Noises: Clicking/ popping, Crepitus
  2. Parafunction (grinding)
  3. Locking
  4. Catching
  5. Hx of Open Lock
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5
Q

Outcome measures for patient reporting with TMD:

A
  1. Patient-Specific Functional Scale
  2. Tampa Scale of Kinesiphobia for TMD (Fear of movement)
  3. Temporomandibular Pain Disorder Screening Instrument
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6
Q

Intra-oral visual inspection -

A

Scalloping of tongue – tmj disorder (parafunction causes tongue changes over time)

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7
Q

What planes would you visually inspect the face in?

A
  1. Midsagittal (up/down)
  2. Bipupital (horizontal through eyes)
  3. Otic (horizontal through nose)
  4. Occlusal (horizontal through bottom of top teeth)
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8
Q

The face is divided into what vertical divisions:

A
  1. Hair line - bipupital line (1/3)
  2. bipupital line - base of nose (1/3)
  3. Base of nose - chin line (1/3)
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9
Q

2 Contributing factors to TMD:

A
  1. Forward Head Posture

2. Malocclusion - imperfect positioning of the teeth when the jaws are closed

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10
Q

Malocclusion open bite -

A

space between front teeth when mouth is closed

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11
Q

Malocclusion Retrognathism (Overjet) -

A

Retracted position

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12
Q

Malocclusion Prognathism -

A

protracted position

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13
Q

Proposed mechanism of forward head posture on TMD:

A
  • tension of supra/infrahyoid muscles pulling mandible inferiorly and posteriorly
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14
Q

Neuro screening includes what tests for UMN?

A

pathologic reflexes, coordination, hyper-reflexia

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15
Q

Neuro screening includes what tests for LMN?

A

Diminished sensation, weakness, hypo-reflexia

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16
Q

What elimination test used for cervicogenic HA?

A

Cervical flexion rotation test

17
Q

Clinical implications for Cervical flexion rotation test:

A
  • Low –LR, though use with caution
  • Value as a test for confirmation
  • Also joint mobility test for C1/C2
  • Must assess full motion to determine negative test
  • Avoid losing chin tuck
  • Stop test when any criteria for positive test are met
18
Q

If we see C-type curve, we are thinking issue with what?

A

Hypomobility of ipsilateral joint

19
Q

If we see S-type curve, we are thinking issue with what?

A

Muscular imbalance or medial displacement

Condyle “walks around the disc”

20
Q

Interventions for TMD:

A
  1. Reassurance to patient
  2. Occlusal appliances (to dentist if haven’t done so yet)
  3. Education
  4. Exercise
  5. Referral if appropriate
  6. Manual therapy interventions
21
Q

What education can you offer patient with TMD?

A
  1. Activity Modification: Avoid loading of the joint & control parafunction
    - Sleep position, maintain resting position of TMJ, eating soft foods, avoid gum chewing
  2. Diagnosis, Prognosis, Goals, POC
  3. Relaxation Techniques
22
Q

Exercises for patient with TMD:

A
  • Mid & Lower trap/ deep cervical flexor/ thoracic extensor coordination training (“postural” exercises)
  • Upper quarter stretching (corner stretching, etc.)
  • TMJ muscle coordination training (isometrics, biofeedback)
  • TMJ AROM: maintain motion, reduce contracture, improve muscle function
  • Neuromuscular control exercises for TMJ muscles
23
Q

20% of TMD patients will require what 2 possible surgical interventions?

A
  1. Arthroplasty (disc)

2. Orthognathic surgery (jaw)

24
Q

General concepts for manual therapy interventions for TMD:

A
  • Wear gloves for intra-oral techniques
  • Before and after measurements
  • Interventions based on impairments (muscle guarding, pain, hypomobility)
25
Q

T/F Level B evidence for manual therapy combined with exercises for treatment of TMD, based on weak RCTs and case-series designs.

A

True

MSK (18 decks)

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