TMJ and Cervical Muscle actions, and other points

Question 1

What are the actions of the Medial Pterygoid

Answer 1

CHEWING
-Bilateral Protrusion (Due to attatchement to mandible, shortening would pull forward = protrude
- Elevation of the mandible (due to distal attachment on the mandible)
- Lateral movement toward opposite side (due to diagonal orientation that pulls from inside, one side to another (unilateral)

Question 2

What are the actions of the lateral pterygoid

Answer 2

RELATED TO DISC MOVEMENT
- Bilateral protrusion because it inserts on ramus of mandible so pulls it forward
- Lateral movement because frontal plane/diagonal orientation
- Superior head does forced closure b/c connected to condyle
- Does initiate depression/open
-Muscle most associated with disc

Question 3

What are the actions of the temporalis muscle

Answer 3

GUIDES BITING
- Retrusion because of orientation muscle fibers behind mandible to pull backwards
- Elevation bc superior to inferior fibers that connect on mandible
- Some lateral movement

Question 4

What are the actions of the Masseter

Answer 4

BIG CLENCH AND GRIND, BITING
- Strong Elevation b/c of main attachment to the lower mandible
- Retrusion b/c of deep attachment
- Protrusion BL because of Inserts posteriorly so when shortened, it will move forward

Question 5

Suprahyoids

Answer 5

SWALLOW
Mandibular depression because of attachment beneath the mandible

Question 6

Infrahyoid

Answer 6

Also depression but more so swallowing
Consider digastric also below chin to help with retrusion and swallowing.

Question 7

What TMJ muscles cause protrusion

Answer 7

Masseter, Lateral pterygoid, medial pterygoid

Question 8

What muscle is most related to the TMJ disc/joint itself

Answer 8

Lateral pterygoid (superior head)

Question 9

What muscles cause elevation/closing of the mouth

Answer 9

Temporalis, Medial pterygoid, lateral pterygoid Masseter

Question 10

What muscles causes depression/opening of the mouth

Answer 10

Suprahyoid, infrahyoid, lateral pterygoid because it moves the condyle

Question 11

What muscles cause retrusion

Answer 11

Temporalis, Masseter

Question 12

What muscles cause lateral excursion

Answer 12

Medial, lateral pterygoids, masseter, and temporalis

Question 13

What is the main clencher/biter muscle

Answer 13

Masseter

Question 14

What muscle guides the biting motion

Answer 14

Temporalis

Question 15

What muscles assist with swallowing

Answer 15

The suprahyoid and infrahyoid and, digastric

Question 16

Sternocleidomastoid

Answer 16

Flexion
Side bend to the ipsilateral side (shorten and pull towards side its on)
Rotate opposite (twist to shorten)

Tightens with forward head

Question 17

Scalene muscles

Answer 17

Accessory breathing muscle by elevating 1st and 2nd rib

same muscle actions as SCM (anterior mainly)

Question 18

Longus colli (dont confuse with the colli/cervicis brothers)

Answer 18

Deep neck flexor, also include longus capitis, longus cervicis, rectus, capitis (THE LONGUS BROTHERS and one rectus)

Question 19

Cervical extensors

Answer 19

The 4 (colli/cervicis/capitis) brothers, multifidi, and trapezius,

Question 20

Which TMJ glide for restriction

Answer 20

Inferior glide (causes distraction) to improve sx

Question 21

Which TMJ glide compresses

Answer 21

Superior glide (more diagnostic)

Question 22

Resting position

Answer 22

Slightly open

Question 23

Norms

Answer 23

Open 30- 55mm
Protrusion more than 7 mm
Retrusion 3-4 mm
Lateral excursion 10-15 mm

Question 24

Bite down test

Answer 24

Pain on same side as bite down = muscle
Opposite sided pain = joint

BITE DOWN STRESSES OPPOSITE SIDE SO IF BITE DOWN IS ON R SIDE AND YOU HAVE L SIDE PAIN > JOINT ON LEFT SIDE

Question 25

Pterygoids individually vs together

Answer 25

Individual they do unilaterl exrcusion to other side cause slanted orientation pulls in Together does protrusion

Question 26

Must differentiate

Answer 26

Trigeminal nerve/nuclesus issues vs cervical

Question 27

Bruxism

Answer 27

Clenching or grinding teet

Question 28

Muscles of mastication

Answer 28

1. Masseter 2. Temporal 3. Medial pterygoid

Question 29

Biomechanics with opening (depression)

Answer 29

Anterior roll and translation of mandibular condyle Disc goes opposite direction*

Question 30

Biomechanics of closing (elevation)

Answer 30

Posterior roll and glide Makes sense directionally when you do it Disc does opposite*

Question 31

Pain referalls

Answer 31

Make sense based on location Masseter is exception with pain referral to many locations including eyebrow

Question 32

Pain in ear or in front of ear

Answer 32

think TMJ, retrodiscal tissue, disc

Question 33

Pain in jaw, temple

Answer 33

Referred

Question 34

Lateral pterygoid can only be reached

Answer 34

Intra orally

Question 35

Painful resisted testing

Answer 35

Think myalgia, muscle, myofascial pain

Question 36

Arthralgia

Answer 36

Joint related pain vs DJD same but with imaging and prior history

Question 37

Muscle interventions

Answer 37

Always soft tissue work

Question 38

Joint interventions

Answer 38

Mobs, stretching, modalities, controlled opening, lifestyle changes

Question 39

Disc replacement with reduction

Answer 39

Includes ipsilateral deviation that returns to midline (reduction) Wobbly painful clicking 2 Clicks* one for when it displaces second for when it gets back in place

Question 40

Without reduction

Answer 40

Clicks went away Ipsilateral deviation that remains (does not return to midline upon opening) So ipsilateral deviation on the R side would have a positive bite stick test on the L side because the L side stressed R sided joint and muscles on the L side