TMJ, teeth and c-spine are intimately related cervical posture affects mandibular path of closure - FHP=posterior occlusion - retracted c-spine= anterior occlusion

TMJ Flashcards by Lauren Bradshaw

mandible

condyle
coronoid process
mandibular notch
ramus
angle
body

How well did you know this?

Not at all

Perfectly

dental alveolar joints

teeth

How well did you know this?

Not at all

Perfectly

movements of the mandible

elevation
depression
protraction
retraction
lateral gliding
combinations

How well did you know this?

Not at all

Perfectly

muscles

temporalis
masseter
medial pterygoid
lateral pterygoid
digastric
mylohyoid
genohyoid
omohyoid

How well did you know this?

Not at all

Perfectly

ligaments

medial collateral (spenomandibular and stylomandibular)
lateral collateral (temporomandibular)
retrodiscal lamina
fibrocartilagenous disc

How well did you know this?

Not at all

Perfectly

TMJ joints

superior joint cavity

inferior joint cavity

How well did you know this?

Not at all

Perfectly

muscles of mandible elevation

masseter
temporalis
medial pterygoid

How well did you know this?

Not at all

Perfectly

muscles of mandible depression

geniohyoid
mylohyoid
stylohyoid
digastric

How well did you know this?

Not at all

Perfectly

muscles of mandible protrusion

lateral and medial pterygoid (bilaterally)

masseter

How well did you know this?

Not at all

Perfectly

muscles of mandible retraction

temporalis

digastric

How well did you know this?

Not at all

Perfectly

muscles of lateral excursion

ipsil: temporalis and masseter
contra: pterygoids

How well did you know this?

Not at all

Perfectly

kinetics

TMJ, teeth and c-spine are intimately related

cervical posture affects mandibular path of closure

FHP=posterior occlusion
retracted c-spine= anterior occlusion

How well did you know this?

Not at all

Perfectly

forward head posture link

increases passive tension of

suprahyoid
infrahyoid

pulls mandible:
-inferiorly and posteriorly

How well did you know this?

Not at all

Perfectly

early phase kinematics

first 50% of ROM
20-25 mm opening
rotation in inferior joint space

increase tension in oblique portion of lateral ligament
-transition to late phase

How well did you know this?

Not at all

Perfectly

late phase kinematics

last 50% of ROM
last 20-25 mm of opening
anterior translation in superior joint space

increase tension in superior retrodiscal lamina

How well did you know this?

Not at all

Perfectly

closing

reverse of opening
*also 2 phases

posterior translation in superior joint space
-disc pulled back by tension in superior retrodiscal lamina, posterior fibers of temporal is; controlled by eccentric lateral pterygoid

rotation in inferior joint space
-muscles of mastication

How well did you know this?

Not at all

Perfectly

exam and eval subjective

onset of symptoms

incidence of joint locking-open or close

presence of joint noise

joint click hallmark of disc derangement
click on opening
click on closing

history of surgery

pain (intensity, frequency, location)

outcome measure
-TMD disability index

pain examination (palpation)

mandible, hyoid, TMJ
-palpate posterior TMJ and capsule (through ear)-tender w/ swelling

relevant joints of upper quadrant, cervical and upper thoracic spine

muscles

relevant trigger points and tender points

mobility impairment exam

active and passive physiologic ROM of cervical and thoracic spine

TMJ: A/PROM- vertical opening, lateral excursion, protrusion

TMJ translation and rotation SYMMETRY!!

joint play assessment (distraction, medial and lateral glide, compression)

muscle tests (length, test, control)

mobility of nervous system (if indicated)

classification of TMDs

capsulitis/synovitis
capsular fibrosis
disorders of the muscles of mastication
hypermobility
anterior disc displacement w/ reduction
anterior disc displacement w/out reduction

capsulitis/synovitis S/S

=micro/macro trauma

tender to palpate lateral condyle or post compartment
pain w/ contralat biting
pain w/ retraction OP
pain w/ end range accessory motion testing

capsulitis/synovitis Rx

ionto (dex or xylocane)
manual therapy (STM, non-thrust mobs)
postural and TMJ proprioception ex

capsular fibrosis

=chronic inflammation, trauma, immobilization, entrapped disc

capsular fibrosis S&S

typically <25mm opening
limited accessory motion
no joint sounds
ipsilateral deviation of mandible when opening

capsular fibrosis Rx

- heat - TMJ mob/manip, prolonged stretching - AROM, proprioception exercise

disorders of muscles of mastication

* commonly tendonitis of temporalis muscle | * overuse

mastication muscle disorder S/S

- painful to palpate muscles (TrP may be present - possible alteration in mandibular active control - parafunctional oral behaviors - pain w/ ipsilateral biting

mastication muscle disorder rx

- heat - controlled opening/closing muscle re-ed - intraoral and extraoral STM - pt ed., activity mod (gum chewing, grinding)

hypermobility

- opening >40 mm w/ click at end range opening - can be asymptomatic - collaterals loosen - hypothesized pre-cursor to disc displacements

hypermobility S/S

- excessive opening ROM | - hypermobility noted on accessory motion exam

hypermobility rx

avoid end range positions - tongue on roof of mouth-yawning - avoid taking large bites exercise - proprioception - stabilization

articular disc displacement w/ reduction S/S

=laxity in collaterals and retrodiscal lamina - pain if recent dysfunction - abnormal mandibular motion maybe - on closing, disc does not come back and condyle slides posteriorly-click - on opening, the condyle re-captures the disk-click

articular disc displacement w/ reduction rx:

- TMJ mob - STM - posture ROM, isometric stabilization exercises - splints

articular disc displacement w/out reduction

=history of disc displacement w/ reduction (joint clicks) - disc remains displaced anterior to condyle - opening <25mm, ipsilateral deviation

articular disc displacement w/out reduction rx

- TMJ mobs - c-spine mob/manip - posture, c-spine exercises - pt ed (soft foods, parafunctional habits, tongue resting position, relaxation, activity mod)

TMJ OA

often accompanied by disc perforation | =joint pain and crepitus

TMJ OA rx

- TMJ mobs - A/PROM - STM - postural exercises

proprioceptive exercises

rubber rube phase 1: active lateral deviation away from painful side phase 2: lateral deviation, bite for 5 sec, release, return phase 3: lat dev, bite and maintain to return phase 4: protrusion phase 5: protrusion, bite, relax, return phase 6: protrusion, bite and maintain to return final: gently pull tube (resist protrusion and lat dev)

rocabodo's 6x6

6 exercises 6 reps 6x/day 1: tongue rest and nasal breathing 2: controlled opening 3: rhythmic stabilization (isometric) 4: craniocervical flexion (nod) 5: cervical retraction 6: shoulder retraction (retract and depress)

hypermobility

head and/or ice if condition is painful muscle performance: - TMJ rotation and translation control - proprioception, strengthening and stabilization exercises - isometric or static exercises initially - progress to dynamic and functional exercises