552: Exam 2: Tmj: Cheryl

Front 1

what cervical muscles must be considered with TMJ

Back 1

- upper, middle, lower traps
- levator scap
- suboccipital
- multifidus (the intersegmental stabilizer)
- SCM
- scalenes

Front 2

what are the masticatory muscles that must be considered with TMJ

Back 2

- masseter
- temporalis
- lateral pterygoid
- medial pterygoid

Front 3

which head of the lateral pterygoid helps close the mouth

Back 3

superior head

Front 4

which muslces are the "mandibular elevators"

Back 4

medial pterygoid

Front 5

what are the roles of the suprahyoid and infrahyoid muscles

Back 5

suprahyoid depress the mandible when the hoid is being fixed by the infrahyoid (which can also depress the hyoid)

Front 6

what muscles that do not fit into either cervical, masticatory, or hyoid bones, must also be considered when looking at TMJ

Back 6

diaphragm and pec major/minor

Front 7

what are the posterior attachments for the disc

Back 7

superior and inferior stratum (collagen
retrodiscal pad

Front 8

what direction does the disc usually dislocate

Back 8

anterior/medial

Front 9

what are the capsular structures

Back 9

- fibrous capsule
- synovial membrane
- tempromandibular ligament

Front 10

what are the intracapsular structures

Back 10

- fibrocartilaginous disc
- posterior attachments (sup/inf stratum, retrodiscal pad)

Front 11

what is the primary innervation to the TMJ

Back 11

auriculotemporal branch of the third division of the trigeminal nerve- CNV

Front 12

what type of joint is the TMJ

Back 12

ginglymoarthrodial

Front 13

the TMJ being a ginglymoarthrodial joint combines what two types of joints

Back 13

hinge and gliding

Front 14

what is functional ROM for depression of the mandible

Back 14

32-40 mm
(3 knuckles is normal, 2 is functional)

Front 15

what is deflection

Back 15

the "c-shaped" movement when someone opens their mouth where it begins and finishes at midline but deviates in the middle

Front 16

what is deviation

Back 16

the "s-shaped" movement when someone opens their mouth

Front 17

which movement during depression of the mandible represents arthrogenous and which represents a myogenous issue

Back 17

deflection is arthrogenous
deviation is myogenous

Front 18

what is protrusion

Back 18

when the mandibular incisors move anterior to maxillary

Front 19

what occurs during lateral excursion

Back 19

mandibular canine moves laterally past maxillary

Front 20

what is normal lateral excursion

Back 20

~5-10 mm

Front 21

what is the normal range of opening for phase 1

Back 21

first 10-15 mm, but could attain 20-25 mm

Front 22

what occurs during phase 1 of opening

Back 22

- rotation of condyle in lower jt space (under the disc)

Front 23

what occurs in phase two of depression

Back 23

anterior translation of mandibular condyle in upper joint space

Front 24

phase 1 occurs in ____ joint space vs. phase 2 that occurs in ____ joint space

Back 24

- phase 1 is in lower joint space
- phase 2 in the upper joint space

Front 25

what occurs during elevation

Back 25

upper head of lateral pterygoid eccentricall positions the disc as the spuerior stratum relaxes

Front 26

what occurs during lateral excursion

Back 26

anterior translation at the contralateral side, with spin of the ipsilateral side

Front 27

what occurs during protrusion

Back 27

bilateral anterior glide

Front 28

what are the accessory movements of the TMJ

Back 28

distraction/compression, lateral glide

Front 29

what is the classical restriction pattern for depression

Back 29

- decrease in functional opening
- deflection to side of involved side

Front 30

what is hte classical restriction pattern for protrusion

Back 30

- less than functional opening
- deflection to side of involved joint

Front 31

what is the classical restriction pattern for lateral excursion

Back 31

- normal movement to involved side
- less than functional excursion to contralateral side

Front 32

what is the quick screen to differentiate arthrogenous from myogenous

Back 32

reduced depression could be either.... if protrusion and lateral excursion are functional bilaterally- restruction is myogenous

Front 33

common complaint for capsulitis/synovitis

Back 33

hx of pain with activity, localized to preaurical area

Front 34

physical findings for capsulitis/synovitis

Back 34

- pain with palpation over lateral capsular structures
- pain with TMJ loading

Front 35

common complaint for capsular fibrosis

Back 35

hx of chronic capsulitis, trauma, or arthritides, often has been immobilized

Front 36

physical findings for capsular fibrosis

Back 36

restricted mandibular mechanics indicating a decrease in translation on the involved side

Front 37

common complaint for TMJ hypermobility

Back 37

"jaw feels out of place" with max depression, or joint noise

Front 38

physical findings include

Back 38

- palpable hollow behind lateral pole of condyle at maximal opening
- deflection of mandible toward contralateral side at end of full mandibular opening as condyle moves anterior to articular tubercle
- if palpable irregularities are present, they will bre present at the end of opening or beginning of closing
- mandibular opening in excess of 40 mm

Front 39

what is the common complaint for a disc displacement with reduction

Back 39

history of joint noise with opening and closing of mouth--- reciprocal click

Front 40

what physical findings indicate a decrease in translation on the involved side

Back 40

- deflects to ipsilateral side with depression
- deflects to ipsilateral side with protrusion
- limited lateral excursion to CL side, relatively normal laterral excursion to ipsilateral side

Front 41

what are the physical findings for DDWR (disc displacement wirh reduction)

Back 41

1) palpable irregularities or "pop" during opening and closing
2) reciprocal click enhanced by joint loading
3) anteriorly repositioning the mandible eliminates reciprocal click

Front 42

common complaints for acute disc displacement without reduction (DDwoR)

Back 42

- hx of previous reciprocal clicking
- previous hx of intermittent locking
- patient currently unable to open mouth fully

Front 43

what are the physical findings for acute disc displacement without reduction

Back 43

restricted mandibular mechanics indicating decrease in translation on involved side

Front 44

what are the pathomechanics for DDwoR

Back 44

disc is displaced anteriorly of condyle and does not reduce during opening and closing

Front 45

why does the disc block anterior translation of the condyle during ROM with DDwoR

Back 45

because the posterior attachments are still intact

Front 46

what are common complaints for chronic DDwor

Back 46

hx of reciprocal clicking with report of joint noise during mandibular opening and closing (crepitus)

Front 47

what are the physical findings for DDwoR

Back 47

palpable grinding felt throughtout the full range of mandibular opening and closing
- can hear crepitus with stethoscope throughout the full range

Front 48

what are the pathomechanics of chronic DDwoR

Back 48

posterior attachments worn through, therefore bone-on-bone movement results in crepitus

Front 49

why is ROM often near normal for chronic DDwoR

Back 49

because the disc is no longer attached posteriorly

Front 50

what are the physical findings for a dislocation

Back 50

- patient presents with mouth fully open
- jaw is deflected to CL side

Front 51

common complaints of osteoarthritis/polyarthritides

Back 51

hx similar to synovitis, often with crepitus noted throughout ROM

Front 52

physical findings for osteoarthritis/polyarthritides

Back 52

often fairly good, may have palpable crepitus with ROM
- main finding is radiological change/radiographs

Front 53

what is the goal for osteoarthritis/polyarthritides

Back 53

preserve the condyle

Front 54

complaints for fibrous or bony ankylosis

Back 54

hx of significant trauma (includes surgery) or infection

Front 55

physcial findings for fibrous or bony ankylosis

Back 55

severe restrictions in ROM, which can be bilateral

Front 56

complaints for deviation in shape of articular condyle

Back 56

hx of joint noise with opening and closing

Front 57

physical findings for deviation in shape of articular condyle

Back 57

repetitive, nonvariable joint noise occuring at th eexact same mandibular position during opening and closing ---- noise is not modifiable

Front 58

Evaluation of the TMJ is based on

Back 58

Kraus

Front 59

what questions should be included in the subjective exam

Back 59

- questions regarding functional and parafunctional activities (eating, nail biting)
- tinnitis
- dizziness
- ear and respiratory symptoms
- sleeping posture and disturbances
- splint or appliance use
- childhood asthma

Front 60

during protrusion the mandible should do what

Back 60

lower teeth move forward in reference to the maxilla

Front 61

what should you feel when palpating the TMJ during opening

Back 61

1st phase should feel like straight rotation

2nd phase should feel translation

Front 62

how can you enhance clicking during opening and closing

Back 62

pressure on mandibular ramus in anteriosuperior direction while patient opens and closes mouth

Front 63

how can you eliminate clicking during opening and closing

Back 63

by protruding the chin forward while patient opens and closes

Front 64

what would you be able to palpate for a hypermobile TMJ

Back 64

excessive hollow just anterior to external auditory meatus

Front 65

what are the two main causes for a "click"

Back 65

1) disc popping anterior and displacing back in
2) hypermobility where clunk over crest of tubercle

Front 66

biting onto cotton/gauze casues what to occur at the TMJ

Back 66

distraction of ipsilateral joint and compression of contralateral joint

Front 67

what does the biting test assess

Back 67

for inflammation or synovium or capsule

Front 68

if you bite on the R and have pain on the R what does that indicate

Back 68

masticatory muscle involvement

Front 69

if you bite on the R and have pain on the L what does that indicate

Back 69

capsule involvement

Front 70

explain the retrusive overpressure test

Back 70

passive load in posterosuperior direction with back teeth apart--- tests for inflammation of synovium or capsule

Front 71

what should happen to the hyoid during swallowing

Back 71

should elevate

Front 72

how do you assess distraction

Back 72

straight caudal movement

Front 73

how do you assess anterior translation

Back 73

distraction with a j movement forward

Front 74

how do you assess lateral glide

Back 74

lateral movement from lingual surface of teeth

Front 75

how do you assess medial glide

Back 75

medial movement external force on condyle with gentle bite at incisors

Front 76

when is treatment initiated for TMJ

Back 76

if >2 of following are (+)
- complaints of TMJ or masseter area pain with functional or parafunctional activities
- TMJ noise with movement
- pain with joint loading
- limitation of mandibular movement, or difficulty with movement
- pain with joint palpation
- radiological changes

Front 77

what is condylar remodeling

Back 77

place tube/device between middle incisors
1) roll away from affected side
2) after roll, gently bite down
3) after bite, maintain force and return to midline
4) do 6 reps 3x/day

Front 78

what is the treatment for synovitis/capsulitis

Back 78

control inflammation and pain
1) control habits - nothing by mouth except liquids, food
2) soft foods only
3) control excessive opening- tongue on roof of mouth
4) modaliites for inflammation

Front 79

what is the treatment for masticatory muscles

Back 79

1) control parafunctional activities (gum chewing, nail biting)
2) soft tissue work to the involved side
3) modalities applied to elevator muscles of mandible

Front 80

how does a non-repositioning appliance work

Back 80

decreases hyperactivity of mandibular muscles by
1) reminding patient to decrease activity of clenching
2) decrease adverse effects of parafunctional activity to TMJ, muscles of mastication, occlusion, and cervical muscles

Front 81

what is the treatment for capsular fibrosis

Back 81

joint mobs:
- distraction
- anterior translation
- lateral glide
- medial glide

Front 82

what is the treatment for hypermobility

Back 82

neuromuscular re-ed
- PNF
- home exercises

Front 83

what is the tx for DDWR

Back 83

- condylar remodeling
- anterior repositioning appliance
- may be followed by permanent moving of teeth

Front 84

what is the treatment for DDWoR

Back 84

manipulations intra-orally

Front 85

what are the three possible outcomes for intra-oral manipulations

Back 85

1) disc returns to normal position and stays put
2) becomes DDWR
3) progresses to chronic displacement without reduction

Front 86

what are the Rocabado exercises

Back 86

1) tongue in rest position
2) control of TMJ rotation (stop before translation)
3) PNF- isometrics
4) cervical joint liberation- OA joint forward bending
5) axial extension of cervical spine
6) scapular retraction

Front 87

how many times should you do the rocabado exercises

Back 87

6 exercise 6 times