Anatomy
Which muscles assist in opening the jaw and which ones close it?
Open: Lateral pterygoid
Close: masseter, temporalis, medial pterygoid
What are the 5 cardinal signs of TMD?
1. limited or restricted jaw opening or excursion movements
2. pain with jaw movements
3. TMJ sounds, such as clicking and crepitus
4. TMJ tenderness with palpation
5. Jaw muscle tenderness with palpation
What are the treatment options for Internal derangement?
Joint mobilization to assist with reducing anterior disc displacement, stretching, controlled opening exercises
What would a person present with if they had TMJ subluxation? What is the PTs role?
Anterior positioning of the condyle, muscle pain with palpation, excessive opening, lateral and anterior glides, pain with mastication and speaking
PT: eliminate deforming forces, treat pain, US and heat, exercise to address muscle imbalance, postural correction
What are some Capsulolabral procedures?
Adhesive capsulitis: Manipulation under anesthesia (MUA)- start PT right away after surgery
SLAP or Bankart lesion: Arthroscopic labral repair
How is cervical spine involved in TMJ dysfunction?
If you have a forward head position--> it increases tension in the supramandibular muscles which pulls on the mandible--> may cause altered TMJ positioning
What are the 3 types of TMD?
Internal derangement (articular disorders)
Myofascial pain (masticatory muscle disorder)
Degenerative and inflammatory conditions (arthritides)
What are the treatment options for Myofascial pain disorder of TMJ?
Soft tissue mobilization, stretching, postural improvements, rest, modalities, night splints
What would a person present with if they had TMJ closed or locked jaw? How can a PT help?
Maximum mouth opening: <25-35mm, Maximal protrusion <5mm, clicking or crepitation with mouth opening/closing, tenderness with palpation of lateral TMJ and muscles
PT: STM, modalities, active and passive exercises to promote TMJ motion, isometric exercises, improve mobility
What is the main goal for weeks 0-6 in an RTC repair?
maintain integrity of the repair- often in a sling for 4-6 weeks
What are the normal measurements for depression, protrusion/retrusion, laterotrusion and overbite/overjet?
Depression: 40 mm
Protrusion: 6-8 mm
Retrusion: 1 mm
Laterotrusion: 8 mm
Overbite/overjet: 40 mm
What is internal derangement of the TMJ? What are the main traits?
Mechanical joint fault that interferes with joints smooth action
Causes: Anterior disk displacement with reduction, Anterior disk displacement without reduction, posterior disc displacement, condylar fracture, dislocation of condyle, subluxation of condyle
Traits: clicking is prevalent, intermittent bouts of locking, decreased ability to open the mouth
What are the treatment options for Degenerative/Inflammatory conditions of the TMJ?
Passive movement during mobilization and repetitive stretching
What is the most common procedure done for neck pain with radiating pain?
Anterior cervical decompression with fusion
What are some indicators of a total shoulder arthroplasty? What are some things to know about this procedure?
Pain, OA, unsuccessful nonoperative management, intact RTC muscles
Avoid aggressive ER/IR PROM in scapular plane, no WB through involved UE, Full "normal" AROM is not usually attained
What is Temporomandibular Dysfunction (TMD)? How does it happen? What are some common characteristics?
TMD is a group of related disorders associated with the TMJ joint
May be caused by trauma, stress, repetitive loading, posture or bruxism
Most common in women 20-40 years old
Traits: pain and possible locking (opening and closing), possible clicking or popping (opening or closing), aggravated by chewing or other jaw movements, jaw may be deviated to one side or limited opening of mouth
What is Myofascial pain disorder of the TMJ? What are the main traits?
Symptoms originate from the muscles with potential tenderness and referred pain
Usually found during palpation of muscles and assessment of passive movement
How is the bite stick test done?
- if contralateral pain: it is a joint problem (compresses the opposite side you bite down on)
- if ipsilateral pain: the problem is primarily muscle (there is a distraction force at the joint on the side you bite down)
What is a common procedure done for persistent non-radiating neck pain the degenerative disc disease?
Spinal fusion or cervical disc replacement
When would someone have a reverse total shoulder arthroplasty done? How is it done? What are things we should know about this procedure?
Insufficient RTC muscles, failed Total shoulder arthroplasty
Reversed placement of humeral head and glenoid- to overcome absence of RTC muscles
Higher risk of dislocation (Avoid IR, Adduction and Extension), avoid sleeping on surgical side, passive elevation goal: 140, Active elevation goal: 105
If someone has anterior disc displacement without reduction what will they NOT have as a trait?
There will be NO clicking during opening/closing
the patient may still have limited opening
What are degenerative/inflammatory conditions of the TMJ? What are the main traits?
Inflammation of the joint
Pain/stiffness with joint assessment and palpation, pain with function, pain with passive opening
What is the main difference between posterior cervical decompression and anterior cervical decompression and fusion procedure? What is the main disadvantage to posterior cervical decompression?
For posterior cervical decompression there is no fusion so this causes more motion with increases degenerative changes which may require revision
How are Zone V/VI extensor tendon repairs protected during the first weeks after the procedure?
Splinting: dorsal part- wrist extended 40-45 degrees, MPs and IPs 0 degrees of extension, volar part- MPs have active flexion of 30 degrees