TMJ

Question 1

What kind of joint is the TMJ

Answer 1

Sliding Hinge Joint (ginglymoarthrodial joint)

Question 2

What are the Articular surfaces associated with the TMJ?

Answer 2

Mandibular condyles and the mandibular fossa

Question 3

Muscles of Mastication

Answer 3

Masseter, Temporalis, Lateral Pterygoid, and Medial Pterygoid

Question 4

Masseter Movement

Answer 4

Elevate and protrusion

Question 5

Temporalis Movement

Answer 5

Elevate and Retraction

Question 6

Medial Pterygoid Movement

Answer 6

Elevate and retraction

Question 7

Lateral Pterygoid Movement

Answer 7

Depress and protrusion

Question 8

Muscles of mastication Innervation

Answer 8

Trigeminal Nerve (CNV), mandibular branch

Question 9

TMJ Osteokinematics

Answer 9

Elevate (Close)
Depress (Open)
Protrusion
Lateral deviation

Question 10

Depression Normal Values (How many mm is normal to open mouth?)

Answer 10

40-50 mm

Question 11

Lateral Deviation Normal Values (How many mm is normal to open mouth?)

Answer 11

10 mm

Question 12

Medial Deviation Normal Values (How many mm is normal to open mouth?)

Answer 12

10 mm

Question 13

TMJ Arthrokinematics (Depression and Elevation)

Answer 13

• Roll in mandibular fossa first 20 mm
  - Rotation (spin)
• Slide onto articular eminence
  - Translation

Question 14

TMJ Arthrokinematics (Lateral Deviation)

Answer 14

• Ipsilateral rotation w/i fossa
• Contralateral transition
  - anteromedial

Question 15

TMJ Arthrokinematics (Protrusion)

Answer 15

• Forward slide w/o roll
• Translation only

Question 16

Habits Effecting TMJ

Answer 16

• WB on mandibles
• Smoking
• Biting nails
• Chewing gum
• mouth breathing
• Snoring
• Mask Wearing

Question 17

Objective TMJ Measures (Symmetry and Posture)

Answer 17

• Fascial Symmetry
• Posture

Question 18

Breathing Pattern (Things to look for)

Answer 18

• Accessory muscles
• Mouth breathing
• Short upper lip (tendency to snore)
• Stridor
• Frenulum restriction (tongue tie)

Question 19

Exterior Palpation

Answer 19

• Cervical Musculature
  - Symmetries
  - Hypertrophies
  - Tenderness
• Joint opening and Closing
  - Symmetries
  - Feel for any popping /clicking
• Masseter Palpation
  - Patient will clench and relax

Question 20

Intra-Oral Palpation (Medial Pterygoid)

Answer 20

• Use index finger
• Slide along inside of bottom teeth all the way back to base of the tongue
• Have pt bite down gently

Question 21

Intra-Oral Palpation (Lateral Pterygoid)

Answer 21

• Patient will open big
• slide back of pinky along outside of top teeth
• Have patient deviate ipsilateral and close slightly

Question 22

Hypermobility Screen (Beighton)

Answer 22

• Do this BEFORE taking ROM measurements!
• Ask quick screening questions. ex)
  - Can you bend over and place palms of hands on the floor? Can you bend your thumb back to touch forearm
• Yes to 2 or more questions is 84% sensitivity and 87% specificity

Question 23

TMJ Deviations

Answer 23

S- Curve
- lateral movements that return to midline
- Cause: neuromuscular dysfunction

Question 24

TMJ Deflections

Answer 24

C- Curve
- Lateral movement that stays lateral when open
- Cause: muscle imbalance or capsular tightness

Question 25

Intra-Oral Mobility Tests (Inferior Glide)

Answer 25

* Patient supine * Therapist on Contralateral side * Thumb on bottom molars and hand cradles mandible * Distract caudally

Question 26

Intra-Oral Mobility Tests (Anterior Glide)

Answer 26

* Patient supine * Therapist on Contralateral side * Thumb on bottom molars and hand cradles mandible (can try to hook back molar) * Distract caudally first and then anteriorly

Question 27

Intra-Oral Mobility Tests (Medial Glide)

Answer 27

* Patient supine * Therapist on Contralateral side * Thumb on bottom molars and hand cradles mandible * Distract caudally then deviate towards therapist

Question 28

Intra-Oral Mobility Tests (Lateral Glide)

Answer 28

* Patient supine * Therapist on Contralateral side * Thumb on bottom molars and hand cradles mandible * Distract caudally then deviate away from therapist

Question 29

TMJ Strength Testing

Answer 29

Grading: * Functional – all available ROM and holds against resistance * Weak functional – decreased motion and only able to hold minimal resistance * Nonfunctional – no resistance tolerated * 0 – no voluntary motion occurs

Question 30

TMJ Other Testing

Answer 30

* Deep Cervical flexors * Scapular Stabilizers * Jaw Jerk reflex CNV

Question 31

Common TMJ Pathologies

Answer 31

* Muscle Imbalance * Disc Derangement * Capsular fibrosis * Inflammatory conditions * Degenerative condition

Question 32

Muscle Imbalance

Answer 32

A deflection (C- Curve) will occur towards tight side or away from lax side.

Question 33

Disc Derangement w/ reduction

Answer 33

- 2 clicks (reciprocal) - Mandible jumps on/off disc w/ depression/elevation

Question 34

Disc Derangement w/o reduction

Answer 34

- Unable to open (limited by disc) - patient will not be able to get past 40 mm of opening because disc does not go back in place

Question 35

Capsular Fibrosis

Answer 35

- Usually w/ hx of long term disc dysfunction and or muscle imbalance - usually no pains or joint sounds - limited opening - Deviation (S-curve) to ipsilateral side w/ depression and protrusion - Lateral deviation limited to contralateral side

Question 36

Inflammatory Conditions (Capsulitis)

Answer 36

- Pain w/ protrusion & deviation. - Pain to bite on contralateral side - pain to open wide

Question 37

Inflammatory Conditions (Synovitis)

Question 38

Degenerative Conditions