TMJ & Disorders

Question 1

What are the 5 components of a synovial joint:

Answer 1

-synovial membrane
-fibrous capsule
-synovial fluid
-articular cartilage
-space

Question 2

Temporal and mandible are _______ bones

Answer 2

condyle

Question 3

TMJ disc is avascular except at ______ like other fibrocartilage

Answer 3

periphery

Question 4

Functions of TMJ disc?

Answer 4

resists tension (primary)
resists compression (secondary)

Question 5

TMJ has multiplanar movements. T or F

Answer 5

True

Question 6

2 main muscles of the TMJ and where do they attach?

Answer 6

masseter and lateral pterygoid
attach to disc

Question 7

The function of the masseter, lateral pterygoid, capsule condyle, and post. elastic ligament?

Answer 7

guides motion resists compression and provides stability

Question 8

TMJ structures are MOSTLY innervated by what nerve?

Answer 8

Trigeminal N. branches

Question 9

TMJ capsule is attached to:

Answer 9

mm. and disc

Question 10

Ligaments that blends w/capsule prevent:

Answer 10

excessive motion

Question 11

Resting or OPP of TMJ:

Answer 11

lips closed, teeth not touched, and tongue resting on roof of mouth
2mm overbite
2+mm overjet or overjet beyond overbite

Question 12

CPP is _____________

Answer 12

unknown

Question 13

Mandibular condyles may move ____________ OR ___________ directions

Answer 13

together in the same OR different directions

Question 14

The condyle is convex-concave or concave-convex

Answer 14

convex-concave fossa -allows multiple functions

Question 15

Motions of the TMJ:

Answer 15

depression, elevation, lat. deviation, protrusion, retrusion

Question 16

Opening norms :

Answer 16

3 knuckles width

Question 17

If only ≤ 1 knuckle, then:

Answer 17

urgent referral to dentist/oral surgeon

Question 18

Opening: mandibular condyles glides_______ as mandible goes ________

Answer 18

anterior ; posterior

Question 19

grinding and bilateral clicking on opening is abnormal. T or F

Answer 19

False; normal

Question 20

Opening mm for TMJ:

Answer 20

digastric -main opener
lateral pterygoid
hyoids

Question 21

Swallowing mm. for TMJ

Answer 21

hyoids - main movers
digatric- stabilize

Question 22

Closing mm. for TMJ

Answer 22

temporalis
masseter
medial pterygoid
lateral pterygoid - pulls disc

Question 23

closing: mandibular condyle glide _________ as mandible goes __________

Answer 23

posterior ; anterior

Question 24

The Function of Lateral Deviation
mm.?

Answer 24

masseter
pterygoid -same side medial and lateral (primarily act to move mandible medial for grinding food)
temporalis

Question 25

S&S of TMJ Disorder:

Answer 25

Oral habit hx Thumb sucking -overbite, change teeth position Nail/ice biter - excessive compression force Excessive teeth grinder -AM HA that goes away; if HA from neck it would get worse with ADL Gum/smokeless tobacco chewer

Question 26

S&S of TMJ Disorder: -Observation: -_________ P! and/or __________ -Trigeminal S&S?

Answer 26

FHP localized P!; crepitus tinnitus, HA, toothache

Question 27

# EARLIER deviation WITH loss of functional opening: of capsular patterns? acute w/recent trauma:

Answer 27

(2) -deviation toward P!ful TMJ due to inflammation and willingness to move (ACUTE)

Question 28

# EARLIER deviation WITH loss of functional opening -chronic with fibrotic TMJ:

Answer 28

due to past trauma -deviation away from hypermobile TMJ (click may happen @end range) -accessory motion limited on side of deviation

Question 29

# EARLIER deviation WITHOUT loss of functional opening -hx of _______ resulting in ______ -minimal to no ______ unless ______ -deviation _________from ________ hypermobile side -______ at end range hypermobile side indicates ____________

Answer 29

past trauma ; greater laxity P! unless irritated away from UNILATERAL Click; larger displacement

Question 30

# END RANGE deviation WITHOUT loss of functional opening no ____ of trauma minimal to no _____ unless irritated gradual and less _______ developed BILATERALLY due _______

Answer 30

hx P! hypermobility ; FHP

Question 31

Click @ end range indicates ______________

Answer 31

larger displacement -condyle + displacement has too much motion

Question 32

FHP influence -increased tension and lengthening of:

Answer 32

digastric/hyoid mm. mouth opens posterior elastic ligament

Question 33

FHP influence -anterior mandibular condyle displacement to disc

Answer 33

excessive glide forward

Question 34

FHP influence: - impaired ___________ of mm.

Answer 34

length tension

Question 35

FHP assessment:

Answer 35

opening in neutral and FHP should be the same swallow in neutral and FHP; no excessive neck motion

Question 36

anterior displacement =

Answer 36

condyle ant. to the disc

Question 37

Hx of ant. displacement:

Answer 37

prolonged opening (FHP, mouth breather) trauma w/sudden opening excessive opening(yawning/dentistry)

Question 38

Ant. Displacement S&S:

Answer 38

full opening/nodeviation likely P! and limitation on closing

Question 39

Ant. Displacement Rx:

Answer 39

distx w/ post. glide to reposition mandibular condyle post.

Question 40

Ant. displacement Rx: in hopes of reversing creep of capsule and ligament pt. should:

Answer 40

avoid wide opening with diet/yawning correct posture sleep with neck flexed and chin tucked

Question 41

TMJ MET focus:

Answer 41

stabilization of TMJ and neck

Question 42

Other clicks and signs of hypermobility: (3)

Answer 42

early clicking upon opening indicates - a small displacement inconsistent clicking reciprocal clicking (consistent) condyle moves ahead of the disc on opening and behind on closing

Question 43

crepitus =

Answer 43

TMJ and/or disc damage

Question 44

posterior displacement =

Answer 44

condyle posterior to the disc

Question 45

hx of post. displacement:

Answer 45

trauma w/ sudden closing

Question 46

S&S of post. displacement:

Answer 46

-likely P! and limitation on opening -full closing **opposite of what creates the problem**

Question 47

Posterior displacement Rx:

Answer 47

-distx with ant. glide to reposition mandibular condyle ant. -sleep w/small neck roll for slight neck ext. and opening -avoid excessive or hard chewing/grinding

Question 48

Possible cervical dysfunction relating to TMJ disorder is greater in the upper or lower cervical?

Answer 48

Upper

Question 49

General PT Rx for TMJ Disorder:

Answer 49

POLICED Postural edu. Oral habit modification Diaphragmatic breathing training Activity modifications -diet, motion, sleep)

Question 50

MT for TMJ:

Answer 50

JMs and neck hypomobility and displacement reduction

Question 51

MET for TMJ:

Answer 51

-typically isometrics, plus neck exercises -practice resting and talking with cork in btw teeth

Question 52

Dentist and/or MD Rx for TMJ:

Answer 52

-Splints -Orthodontics -Sx

Question 53

The prognosis for TMJ:

Answer 53

very good if proper mechanics posture and breathing patterns restored