spine - TMJ

TMD signs/sxs

- jaw/ear pain

- jaw clicking/locking

- pain with chewing

- facial pain

- headaches

- dizziness

- tinnitus/hearing loss/ear fullness

microtrauma to the jaw

- nail biting

- pencil chewing

- chewing gum

- teeth clenching

- bruxism (grinding)

what systemic disease may contribute to TMD

Marfans syndrome

temporalis action

- elevation

- ant fibers: protrude

- post fibers: retrude

- ipsilateral lateral deviation

masseter action

- elevation

- protrusion

- ipsilateral lateral deviation

medial pterygoid action

- elevation

- protrusion

- contralateral lateral deviation

lateral pterygoid action

- protrusion

- contralateral lateral deviation

- superior head: eccentrically controls disc with closing

- inferior head: assists with opening

suprahyoids assist with

depression and retrusion

suprahyoids can only work is

infrahyoidd are stabilizing the hyoid bone

hyoid is at the same level of what vertebrae

C3

superior vs inferior articulation of TMJ

- superior: superior disc/articular eminence

- inferior: condyle and inferior aspect of disc

articular disc attachments anterior vs posterior

- anterior: superior head of lateral pterygoid and joint capsule

- posterior: bilaminar retrodiscal tissue

during phase 1 of opening the condyle ______. during phase 2 the condyle ______

- rotates

- translates

kinematics of mandibular retrusion/protrusion

translates posterior/anterior

R lateral deviation kinematics

- R condyle rotation

- L condyle anterior translation

(ipsilateral rotation, contralateral translation)

what muscles are working during opening

- lateral pterygoid (inferior head)

- digastric

- suprahyoids

what muscles are working during closing

- temporalis

- masseter

- medial pterygoid

*lateral pterygoid superior head eccentrically controls disc with closing

muscles working during lateral deviation

- ipsilateral: temporalis & masseter

- contralateral: lateral & medial pterygoid

muscles during protrusion

- bilateral medial & lateral pterygoids

- anterior fibers of temporalis

muscles during retrusion

- posterior fibers of temporalis

- digastric

- hyoid muscles

what branch of trigeminal innervates muscles of mastication?

mandibular

what questions should you ask during hx for TMD?

- does moving the jaw alter sxs

- jaw locking or catching?

- clicking, popping?

- crepitus?

reciprocal click suggests

anterior disc dislocation that is relocating

if someone has reciprocal click the opening click occurs because of _____. the closing click occurs because of ______

- open: disc back on condyle

- close: disc dislocates anteriorly

what is "closed lock"

severe limited opening due to abnormal position of disc being in front of the condyle (anterior disc displacement without reduction)

- progression of anterior disc dislocation w/ relocation

retrodiscal tissue can remodel to become

a pseudodisc

what is "open lock"

- extreme mouth opening

- disc is POSTERIOR

observation for TMJ pt

- facial asymmetry (distance from eye to mouth = distance from nose to chin)

- malocclusions (crossbite, overbite, overjet)

- posture (resting position, FHP)

what is the resting position of TMJ

- tongue on roof of mouth

- opening btwn teeth (freeway space: 2-4 mm)

FHP causes a ____ force on the jaw

retrusive

what causes C-curve

joint hypomobile on side of deviation

what causes S-curve

muscular imbalance or displacement of condyle around disc, or pain

normal mandibular lateral deviation

8-11mm (up to 15mm)

mandibular distraction

- head stabilized against PT

- thumb placed intra-orally on bottom molars

- hand under chin serving as pivot point

- gently apply downward force

mandibular anterior glide

- head stabilized against PT

- thumb placed intra-orally on bottom molars

- gently distract then pull anteriorly

(opening, protrusion)

mandibular medial glide

- mouth is open

- stabilizing hand on limited side

- mobilizing hand on normal side

bite test/dynamic loading

- patient bites down on tongue depressor or cotton roll unilaterally

- pain on ipsilateral side = muscle

- pain on contralateral side = jointq

disc displacement without reduction is characterized by opening of --mm or less

40

arthritis in TMJ

- joint pain and crepitus

- bite test positive contralaterally

- pain/stiffness

- capsular pattern [limited opening]

what will you find if someone has a 1 sided capsular adhesion

- opening less than 40 mm (C-curve)

- limited contralateral lateral excursion/translation

- protrusion with with deflection toward affected side

what will you find if someone has a masseter or temporalis problem

- palpation reproduces sxs

- bite test is positive same side

- mouth opening painful because of stretch

- pain with resisted iso of closing

*confirm lateral excursion and protrusion not limited

if lateral pterygoid is the problem then pain is reproduced with resisted

protrusion

does someone have an upper or lower cervical problem if they have cervicogenic headaches

upper

with cervicogenic headaches, there may cervical trigger point referral from

- suboccipitals

- scalenes

- SCM

what motion do you lose if you have a TMJ replacement

lateral deviation

rocobado's 6x6 progrsm

1. tongue resting position

2. controlled TMJ rotation on opening

3. mandibular rhythmic stabilization

4. upper cervical distraction

5. cervical axial extension

6. shoulder girdle retraction

1. tongue resting position

2. controlled TMJ rotation on opening

3. mandibular rhythmic stabilization

4. upper cervical distraction

5. cervical axial extension

education for TMD

- "rest" the TMJ

- soft foods, chew on affected side

- protected yawn

- habit awareness and modification

- avoid prone (compresses TMJ & cervical stress)

education - RTTPB

- relax

- tongue up

- teeth apart

- posture

- breath

occlusal appliances change the contact of

the posterior teeth

if someone is having neurological sxs in jaw then consider...

trigeminal neuralgia

jaw jerk reflex tests what

masseter & temporalis - closing