L20 TMJ

Question 1

anterior disc of TMJ

Answer 1

dense fibrous tissue attaching posteriotly to the tempral bone
posterior is retrodiscal tissue and anterior is the lateral pterygoid

Question 2

how does the disc contribute to closing?

Answer 2

structure has passive elastic recoil into closing

Question 3

what contributes to TMJ opening

Answer 3

gravity
inferior lateral pterygoid
digastric
hyoid

Question 4

what contributes to TMJ closing

Answer 4

temporalis
masseter
medial pterygoid

Question 5

TMJ muscles contributing to lateral deviation

Answer 5

IL temporalis
CL medial pterygoid
CL lateral pterygoid
masseter

Question 6

TMJ muscles contributing to protrusion

Answer 6

masseter
medial pterygoid
lateral pterygoid

Question 7

TMJ muscles contributing to retrusion

Answer 7

temporalis
digastric
hyoid

Question 8

how much is functional opening of the TMJ

Answer 8

36-44 mm

Question 9

how much should mandible depress in functional opening?

Answer 9

about 3 fingers

Question 10

mechanics of jaw opening

Answer 10

rotation of condyle on disc: 20-25 mm initial opening
translation of condyle and disc: remaining anterior/inferior movement

Question 11

mechanics of jaw closing

Answer 11

disc and condyle move posteriorly together and condyle rotates posteriorly to sit posterior to disc

Question 12

mechanics of jaw lateral movement

Answer 12

5-10 mm normal range
IL condylar rotation and CL translation
temporalis rotates and pterygoid deviates

Question 13

mechanics of jaw protrusion

Answer 13

5-10 mm normal rnage
inferior pterygoid moves disc and condyle anteriorly

Question 14

presentation of TMD

Answer 14

TMJ/ear/temperal/neck pain
decreased jaw ROM
tightness/spasm
joint sounds
headache
tiniitus
female>male
20-40 common age range

Question 15

% of TMD w cervical dysfunction

Answer 15

70%

Question 16

aggravating factors of TMD

Answer 16

chewing, talking, yawning, opening mouth
grinding at night causing morning pain

Question 17

types of CMD

Answer 17

myofasical
disc displacement
arthralgia (itis/osis)

Question 18

types of disc displacements

Answer 18

1a: with reduction and no pain
1b: reduction and painful
2: without reduction
3: without reduction and chronic

Question 19

opening click

Answer 19

condyle reduces anteriorly over the edge of the disc

Question 20

closing click

Answer 20

condyle displaces postiorly over edge of disc

Question 21

disc dysfunction w reduction type 1

Answer 21

at rest disc sits posterior to disc

Question 22

disc dysfunction without reduction

Answer 22

no clicking due to lack of reduction over disc
condyle remains posterior to disc which blocks its glide and translation
lateral deviation to affected side without return to midline

Question 23

disc interventions

Answer 23

TMJ, neck mobs
stretch to temporalis
stretch w mouth opening
STM to trigger points

Question 24

condylar subluxation

Answer 24

4 finger opening is hypermobile
clunking over articular eminence
deviation to CL side bc it stops at normal range

Question 25

intervention for TMJ hypermobility

Answer 25

stabilize don't open mouth so wide tongue up position law isometrics address muscle weakness mandibular muscle relaxation

Question 26

special questions for TMJ

Answer 26

limited mouth opening? clicking during opening/closing? crepitus during opening/closing? symptoms changing with neck movements? jaw ever slipping out or feeling unstable?

Question 27

ROM

Answer 27

opening: 40-60 protrusion/retrusion: 5-10 mm lat deviation: 5-10 mm

Question 28

resisted muscle tests for TMJ

Answer 28

mandibular depression mandibular elevation lateral deviation

Question 29

rocabado 6x6

Answer 29

tongue clucking: tongue on hard palate tongue on roof of mouth while opening upper cervical distraction axial extension shoulder girdle retraction