Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Ortho > TMJ > Flashcards

TMJ Flashcards

(45 cards)

Start Studying
1
Q

What is the difference between CR and CO?

A 
CR = condyle in the fossa with a normal loss-disc-condyle relationship
CO = condyle placement while teeth are together
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What percentage of people have CR=CO? is this a problem?

A

about 33% have CR = CO

- it can become a problem, but only 5% of people have TMD related pain (case in which it would be treated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is TMD?

A

A collective term embracing disorders of the masticatory and cervical musculature, the TMJ’s and associated structures, OR BOTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does myofacial TMD usually involve?

A

Masseter and pterygoids

  • there are 12 m’s that influence mandibular motion, but those are the most problematic
  • all attach primarily to condyle/ ramus and elevate the mandible (incl. temporalis)
  • known as the supramandibular group
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What m’s are included in the inframandibular group?

A 
4 suprahyoids:
-digastric
-geniohyoid
-mylohyoid
-stylohyoid
4 infrahyoids:
-sternohyoid
-omohyoid
-sternothyroid
-thyrohyoid

All depress the mandible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the most unstable part of the TMJ?

A

restrodiscal tissue

  • Attaches the articular disc to poserterior part of the joint
  • Not a lot of tough collagen, highly vasuclarized, highly innervated
  • With time, disc slips forward
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How much mandibular depression is due to rotation and translation?

A
  • Rotation = first 20-25mm

- Translation = last 15-20,,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the significance of location of pain in TMD?

A
  • Muscle problem = pain in m location

- joint problem = pain right IN the joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you distinguish a true closed lock from m tension/spasm?

A

Closed lock = hard end feel

M guarding = you can push beyond the “end” range and open the jaw more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are causes of non-articular TMD (due to muscle)?

A
  1. Muscle spasm
  2. Myofascial pain and dysfunction (MPD)
  3. Fibromyalgia
  4. Myotonic dystrophies
  5. Myositis Ossificans progressiva
  6. Growth disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the causes of articular TMDs?

A
  1. Noninflammatory arthropathies: Primary OA, Secondary OA, Internal derangement (loose disc), Bone/Cart disorders with articular manifestations, and JOINT ANKYLOSIS
  2. Inflammatory arthropathies: Synovitis, Capsulitis, RA, JRA, Seronegative polyarthritis, Ankylosing spondylitis, Psoriatic arthritis, and Infectious arthritis
  3. Neoplasm: Pseudotumors (synovial chondromatosis), Benign (chondroma, osteotoma), Malignant (primary, metastatic)
  4. Diffuse connective tissue disorders
  5. Growth disorders: Developmental (hyperplasia, hypoplasia, dysplasia), and Acquired (condylolysis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the nonsurgical management methods of TMD?

A
  1. Diet modification: Full liquids, Pureed (Mashed potato consistency)
  2. Moist heat (as much as possible)
  3. Splint therapy - brings mandible forward, resulting less m engagement
  4. Dental equilibration: attempt to make CR = CO
  5. Orthodontics
  6. Medication: NSAIDS, Steroids, M relaxants, Analgesics (generally not prescribed), anxiolytics, antihistamines, antidepressants, local anesthetics (inj into TrP)
  7. PT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why will splint therapy work for only 50% of people and it will worsen problems in 50% of people?

A
  • 50% of people’s TMD will subside with a muscle guard

- 50% will get worse because they use it as a chew toy; splint built by dentists causes glide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the acute flare-up protocol for non-surgical management of TMD?

A
  1. Mashed potato consistency diet for 2 weeks
  2. NSAIDS around the clock for 7-10 days
  3. Muscle relaxants for 10-14 days
  4. Splint wear full time
  5. Warm compresses as much as possible
  6. Physical Therapy
  7. Behaviour / Stress Modification
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is brisemont procedure?

A

forced manipulation under general anaesthesia, fully paralyzed, for diagnostic and therapeutic reasons—eg. Ankylosis
- Allows for physical exam without m guarding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why does Botox only work temporarily?

A

habits haven’t changed

  • TrP develops in another place of m
  • generally not used, saline injections yield similar results for less money
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Acute closed lock treatment: Injects fluid into joint space and flushes it out; Basically a lavage in the joint space; Reduces inflammatory mediators; Sometimes diagnostic; gives idea about how joint is functioning

A

Arthrocentiesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is surgical management of TMD?

A
  1. Arthrocentesis - For acute closed lock (less than 3 months) or inflammatory purposes
  2. Arthroscopy - diagnostic, can do arthrocentesis at same time, disc repair and lysis of adhesions
  3. Discectomy without replacement
  4. Discectomy with replacement
  5. Disc repositioning
  6. Disc repair
  7. Condylotomy (re-shaping the condyle)
  8. Condylectomy (removing condyle)
  9. Eminectomy (Shaving the articular eminence to make it more flat)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which way will the jaw deviate if there is a broken condyle or condylectomy?

Study These Flashcards
A

jaw will deviate to ipsilateral side

20
Q

Composed of the mandibular condyle and synovium attached to the distal aspect of the disc; Joint capsule is taut in the inferior compartment to allow for pure rotation of the condyle in the fossa; Initial motion of jaw opening occurs in the inferior compartment as pure rotation

Study These Flashcards
A

Inferior compartment of the TMJ

21
Q

Composed of the temporal fossa/eminence and the superior synovium attached to the disc; Joint capsule is loose in the superior compartment to allow for translation; Translation of the condyle on the eminence occurs after rotation; Late joint motion usually occurs here

Study These Flashcards
A

Superior compartment of the TMJ

22
Q

This limit limits extreme opening and provides prodection for blood and nerve supply

Study These Flashcards
A

posterior ligament

23
Q

_______ provides stability by attaching to anterior
aspect of disc. _____ and _____ ligaments including the collaterals attach the
disc to the condyle.

Study These Flashcards
A

Anterior capsule; Medial; lateral

24
Q

protects the superior joint structures and assists in

condylar translation while protecting at maximum opening

Study These Flashcards
A

temporomandibular ligament

25
What are the TMJ's check reign ligaments in extreme opening?
Stylomandibular and sphenomandibular
26
Lateral excursion results in [ipsi/contralateral] spinning and [ipsi/contralateral] translation
ipsilateral spining; | contralateral translation
27
Mover actions of: - Temporalis - Lateral pterygoid - medial pterygoid - masseter - digastric - hyoids
1. Temporalis – guides biting motion to close the jaw and laterally deviates jaw – cn 5 2. Lateral pterygoid – depresses and protrudes the mandible and guides disc movement by pulling the condyle and disc forward – CN 5 3. Medial pterygoid – elevates or closes jaw – CN 5 4. Masseter – initiates elevation of mandible and is considered the strongest elevator of the jaw (Muscle of mastication) – CN 5 5. Digastric muscles pull or depress the mandible inferiorly – Anteroir belly (CN5) – Posterior belly (CN7) 6. Hyoids initiate jaw opening.
28
What is the "position of rest"
1. Slightly open (teeth NOT touching) 2. Lips together 3. Tongue lightly on the roof of the mouth
29
Created by posterior rotation of cranium and loss of cervical lordosis.; Creates muscle tension and tissue entrapment; Less than 20 mm of space noted between occiput and C2 (2 fingers in width); Changes jaw positioning by causing mandibular retraction and distal occlusion; This creates muscle overuse and tension, thereby changing jaw mechanics.
Mechanical entrapment neuropathy
30
what are the components of the craniomandibular system?
cranio-cervical joints and craniomandibular joints - Neck and jaw position need to be evaluated together when considering facial pain. - Cervical spine positioning and muscle tightness effect jaw mechanics and vice versa. - Most important area of examination in the cervical spine is the suboccipital region including C2 - Neck pain experienced in up to 70% of TMD cases reported
31
What stage of joint derangement are: - Disc displacement/ dislocation with reduction (reciprocal click) - Disc location without reduction (closed lock)
- Disc displacement/ dislocation with reduction (reciprocal click) = Stage I-II - Disc location without reduction = Stage III
32
What are the inflammatory processes that can occur in TMD?
1. Retrodiscitis – irritation of the posterior aspect of the joint 2. Capsulitis and synovitis – will cause pain due to swelling irritating nerve tissue 3. Arthritis (stage IV-V)
33
Thought to result from excessive or premature translation of condyle; Parafunction causes microtrauma to the disc and ligamentous tissue; Mouth breathing leads to an increase in muscle activity and changes jaw positioning
Hypermobility - Hypermobility creates anterior disc migration and possible synovium trauma. - Ultimately a vicious cycle is created - Almost 80% of those with TMJ hypermobility and parafunction will develop problems versus only 16% for those that have hypermobility alone
34
When assessing pain in the synovial folds, what does anterior vs posterior pain represent?
- Anterior pain is an acute response to inflammation | - Posterior pain is a longer standing problem
35
When pain mapping what does Pain # 1, 4, 5, 7, 8 represent?
Pain #1 usually occurs early in dysfunction. Pain #4 usually due to malocclusion. Pain #5 indicates start of disc displacement. Pain #7 start of degenerative process. Pain #8 posterior joint compression. - #1 = anterior = acute and more concerning
36
What ratio relationship should there be between opening: lateral excursion: protrusion?
4:1:1
37
As the __________ tightens rotation ends and translation begins.
temporomandibular ligament
38
What are S and S for muscular TMD that need to be investigated?
1. Jaw clicking 2. Headaches 3. Facial pain 4. Jaw locking 5. Ear pressure 6. Ear pain 7. Ear ringing 8. Tooth sensitivity 9. Muscle tension 10. Malocclusion = not coming together naturally and normally 11. Jaw deviation 12. Neck pain 13. Suboccipital tenderness
39
What indicates a shorter upper lip?
upper should cover ¾ upper teeth when smiling | - short upper lip – may work hard to keep upper lip down
40
What should you palpate during your examination?
1. Masseter 2. Lateral Pterogoid – just below the zygomatic arch w/middle finger and pointer finger; myofascial release 3. Temporalis Tendon – just superior to zygomatic arch 4. Intraoral Palapation – he doesn’t do because they HURT 5. Anterior versus posterior TMJ 6. Laterally Deviate, then feel condyle of contralateral side – anterior and posterior, assess for pain
41
What are PT treatments for TMD?
1. Education - parafxn'l habits 2. Proprioceptive training 3. Postural correction 4. Manual therapy 5. Relaxation training 6. Stabilization exercises 7. Flexibility and ROM 8. Modality management
42
What are the proprioceptive training used in treating TMD?
1. Rest positioning – The tip of the tongue resting gently against the roof of the mouth at rest. - habit 2. Controlled opening – Proprioceptive feedback from the tongue to stabilize for pure rotation in the joint. #1 exercise
43
What are the manual therapy options for treating TMD?
1. Soft tissue mobilization 2. Joint glides 3. Long axis distraction 4. Manual stabilization training - isometrics 5. Cervical spine mobilization and postural correction
44
What are the modality options for treating TMD?
1. Ultrasound - Want small sound head; Frequency of 3 MHz 2. Phonophoresis 3. Iontophoresis - If inflammatory process is still present 4. Electrical Stimulation (TENS) 5. Low-Level Laser (he doesn't think this makes a difference of low level vs laser alone) 5. Biofeedback - Visual, auditory, etc to relax masseter for ex 6. Hot and Cold Therapy - Pain at the end of the day, talk a lot = Ice massage – 5 mins on, 5 mins off, etc - Contrast, heat/ice - Wake up in the morning and have pain = Heat – could have some clenching etc
45
What % of pt's seen by PTs are hyper vs hypo mobile?
hypermobile = 50% | - hypomobile pts are the result of hyper that led to ADD w/o reduction

Ortho (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions