TMD and miscellaneous

Question 1

The jaw is controlled directly by the muscles of mastication and indirectly by?

Answer 1

The cervical muscles

Question 2

The cartilage of the TMJ is made of?

Answer 2

Fibrocartilage

Question 3

What is significant about knowing what kind of cartilage the TMJ is made of?

Answer 3

Fibrocartilage is easier to repair

Question 4

Whast are the ligaments of the TMJ?

Answer 4

-Medial collateral
-Lateral Collateral
-Stylomandibular
-Sphenomandibular

Question 5

What is the only structure that can pull the jaw posteriorly into the joint space?

Answer 5

Superior band of the retrodiscal tissue

Question 6

What are mandibular opening muscles?

Answer 6

Primary:
-Inferior lateral pterygoid
-Digastric

Secondary:
-Stylohyoid
-Geniohyoid
-Mylohyoid

Question 7

What are the mandibular closing muscles?

Answer 7

-Temporalis
-Masseter
-Medial Pterygoid

Question 8

How does lateral movement of the jaw occur?

Answer 8

Combination of:
Same side temporalis
Opposite Pterygoids

Question 9

What is the average amount of lateral movement of the jaw?

Answer 9

5-10 mm

Question 10

What muscles perform mandibular protrusion?

Answer 10

-Masseter (superficial head)
-Medial Pterygoid
-Lateral Pterygoid (superior head)

Question 11

What muscles perform mandibular retrusion?

Answer 11

-Temporalis
-Digastric
-Suprahyoid muscles including Stylohyoid, geniohyoid, and mylohyoid

Question 12

What innervates the muscles of mastication?

Answer 12

Trigeminal nerve

Question 13

What cervical levels refer to the TMJ?

Answer 13

C2 and C3

Question 14

What are the two components of TMJ opening?

Answer 14

Rotation and translation

Question 15

What is the normal amount of jaw opening?

Answer 15

40-60 mm

Question 16

The rotational part of jaw opening is what amount of the opening?

Answer 16

The first 20-25 mm

Question 17

What is the force couple of jaw closing?

Answer 17

The eccentric contraction of the superior lateral pterygoid and the release of passive tension in the retrodiscal tissue

Question 18

TMD is also called?

Answer 18

Craniomandibular disorder

Question 19

What are symptoms of craniomandibular disorder?

Answer 19

-Face or jaw pain
-Joint Sounds (29-66%)
-Limitation of jaw movement
-Muscle tenderness
-TMJ joint tenderness
-Headache
-Ear Symptoms
-Cervical spine disorders

Question 20

What other systems are included in regional involvement of CMD?

Answer 20

-Stomatognathic
-Cervical Spine
-Shoulder Girdle

Question 21

TMJ related issues can refer pain where?

Answer 21

Structures of:
-Facial
-Auditory
-Dental

Question 22

What are the categories of TMD?

Answer 22

-Myofascial Pain
-Myofascial Pain with limitations in aperture
-Disc Displacement with reduction
-Disc Displacement without reduction and no limitation in aperture
-Disc Displacement without reduction and with limitation in aperture
-Arthralgia
-Osteoarthritis of the TMJ
-Osteoarthrosis of the TMJ

Question 23

What is occuring with disc displacement with reduction TMD?

Answer 23

At rest, the dist lies anterior and when the mouth opens the condyle reduces back over the posterior region of the disc

Question 24

What is characteristic of a unilateral disc displacement with reduction?

Answer 24

-One side of the TMJ will breifly be restricted upon opening
-Makes an “S” shape, -Deviating toward the involved side
-May hear a click upon opening and closing

Question 25

What is going on with disc displacement without reduction in TMD?

Answer 25

The condyle is unable to move forward of the anteriorly placed disc due to the lost elasticity of the collateral ligaments and retrodiscal tissue.

Question 26

What is characteristic of disc displacement without reproduction?

Answer 26

-No click since it's blocked -Jaw deviates toward the involved side -Moves in a "C" shape

Question 27

What is happening with condylar subluxation?

Answer 27

Hypermobility of the joint capsule causes the condyle and disc to translate over the articular eminence

Question 28

What is characteristed of condylar subluxation?

Answer 28

-May have a "clunk" -Deviation will be away from the affected side

Question 29

What are general interventions for hypermobile TMD?

Answer 29

-Teach not to open wide -Use tongue-up position -Palpate at the lateral pole -Isometric exercises -Address muscle weakness -Mandibular muscle relaxation / biofeedback

Question 30

What are general interventions for hypomobile TMD?

Answer 30

-Manual mobilization -Self-Mobilization -Intraoral appliance/mobilizing splints -Stretching

Question 31

What factors are incorporated in the musculoskeletal response?

Answer 31

-Musculoskeltal -Biopsychosocial -Somatovisceral -Neurophysiological

Question 32

What does regional interdependence emphasize?

Answer 32

The need to evaluate joints above and below the area of symptoms - 2 joint rule

Question 33

What is perceived with vertigo?

Answer 33

Either the world is moving and they are standing still or they are still and the world is moving

Question 34

What is "dizziness?"

Answer 34

Feeling of being light-headed, foggy, unsteady, or off-balance sometimes associated with nausea, vomiting, or fainting

Question 35

What are causes of dizziness?

Answer 35

-Blood pressure drop -Cardiac disease: acute or chronic -Hypovolemia -Anemia -Hypoglycemia -Some anxiety disorders -Endurance events in a high heat environment

Question 36

What is the definition of orthostatic hypotension?

Answer 36

20 mmHg drop in systolic or 10 mmHg drop in diastolic withing 3 minutes of standing

Question 37

What are findings along with dizziness that might clue you into a cardiac origin?

Answer 37

-Brady or tachy cardia -Arrythmias -Chest Pain -Sweating -Other symptomatic cardiac findings

Question 38

What are symptoms of hypovolemia?

Answer 38

-Anxiety/agitation -Cool/clammy skin -Confusion -Decreased or no urine output -General weakness -Pale Skin -Rapid Breathing -Low blood pressure regardless of position -Rapid, weak, thready pulse

Question 39

What are symptoms of anemia?

Answer 39

-Fatigue -Weakness -Pale/yellowish skin -Irregular heartbeat -SOB -Chest Pain -Cold hands/feet -Headaches

Question 40

When is a person in hypoglycemia?

Answer 40

Blood sugar below 70 mg/dL

Question 41

What are symptoms of hypoglycemia?

Answer 41

-Sweating, chills, clammy skin -Irritability and confusion -Tachycardia -Hunger -Sleepy/weak/no energy -Tingling of lips, tongue, cheeks -Headaches -Coordination issues

Question 42

What are conditions included in central vertigo?

Answer 42

-Head Injuries -Illness/Infection -MS -Migraines -Brain Tumors -Stroke/TIA

Question 43

What are examples of peripheral vertigo?

Answer 43

-BPPV -Vestibular Neuronitis -Meniere's Disease -Labyrinthitis -Perilymph Fistula -Superior Semicircular canal dehiscence syndrome

Question 44

What causes vestibular neuritis?

Answer 44

Most often a viral infection

Question 45

What are characteristics of vestibular neuritis?

Answer 45

Sudden and severe: -Nausea/vomiting -Ear drum normal -Horizontal nystagmus -Neuro exam/hearing unremarkable -Fully Resolves in 7 days

Question 46

What are characteristics of Meniere's Disease?

Answer 46

-Symptoms are unilateral and last minutes to hours -Vertigo, hearing loss, and tinnitus -Usually resolves within 24 hours

Question 47

What differentiates Meneire's Disease from BPPV?

Answer 47

BPPV does not have ear ringing or unilateral hearing loss

Question 48

What is the most common type of BPPV?

Answer 48

Posterior canal

Question 49

If a person is going to shift from one type of BBPV to another, what would it be?

Answer 49

From lateral to posterior

Question 50

What should be recommeneded post BPPV treatment?

Answer 50

-Should NOT recommend postural restrictions -May offer vestibular rehab -Should NOT treat BPPV with vestibular suppressant medications such as antihistamines or benzos -Educate on BPPV and their safety, potential for recurrence, and importance of follow up -Encourage AWAY from Meclazine (suppresses vestibular system and does not fix crystals)